American Surgeon最新文献_第6页

Timely Follow-Up After Positive Stool-Based Testing: Evaluating Diagnostic Colonoscopy Delays in Rural and Non-Rural Populations. 粪便检测阳性后的及时随访：评估农村和非农村人群的诊断性结肠镜检查延迟。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-05 DOI: 10.1177/00031348251385107

Anthony J Duncan, Grayson H Baden, Sandi Zukanovic, Hilla I Sang, Joclyn Seiler Hall

{"title":"Timely Follow-Up After Positive Stool-Based Testing: Evaluating Diagnostic Colonoscopy Delays in Rural and Non-Rural Populations.","authors":"Anthony J Duncan, Grayson H Baden, Sandi Zukanovic, Hilla I Sang, Joclyn Seiler Hall","doi":"10.1177/00031348251385107","DOIUrl":"https://doi.org/10.1177/00031348251385107","url":null,"abstract":"BackgroundColorectal cancer is a leading cause of cancer-related deaths in the United States Hesitancy toward colonoscopy and long wait times have led to increased interest in DNA stool-based testing. Access to timely colonoscopy after positive stool-based tests may be challenging, particularly for rural populations. This study aimed to evaluate the timeliness of diagnostic colonoscopies following positive stool-based tests in rural and non-rural patients.MethodsThis was an observational case-control study of patients aged ≥18 years who had a positive DNA-based stool test and underwent diagnostic colonoscopy between January 2018 and December 2023. Participants were classified as rural or non-rural based on Rural-Urban Commuting Area (RUCA) codes. The primary outcome was the number of days from a positive stool test to diagnostic colonoscopy. Statistical analyses were performed using Wilcoxon rank-sum and Pearson's Chi-squared tests.ResultsOf 1316 patients, 668 (50.8%) were from rural areas. The median time to colonoscopy was 35 days for rural patients and 37 days for non-rural patients (P = .6). There was no significant difference in follow-up times. Rural patients were more likely to undergo colonoscopy at an external facility (25% vs 3.1%, P < .001).ConclusionBoth rural and non-rural patients received timely follow-up colonoscopies after positive stool-based tests, indicating that stool-based testing is an effective and accessible method for CRC screening. This supports the continued use of stool-based DNA testing in reducing the burden on health care systems and enhancing screening accessibility for all patients.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385107"},"PeriodicalIF":0.9,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231418","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

Impact of Operative Volume on Outcomes of Component Separation in Abdominal Wall Reconstruction. 腹壁重建术中手术体积对构件分离效果的影响。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-04 DOI: 10.1177/00031348251387151

Arjun Chaturvedi, Oh Jin Kwon, Nam Yong Cho, Nguyen Le, Dariush Yalzadeh, Daniel Tabibian, Barzin Badiee, Ashkan Moazzez, Peyman Benharash

{"title":"Impact of Operative Volume on Outcomes of Component Separation in Abdominal Wall Reconstruction.","authors":"Arjun Chaturvedi, Oh Jin Kwon, Nam Yong Cho, Nguyen Le, Dariush Yalzadeh, Daniel Tabibian, Barzin Badiee, Ashkan Moazzez, Peyman Benharash","doi":"10.1177/00031348251387151","DOIUrl":"https://doi.org/10.1177/00031348251387151","url":null,"abstract":"BackgroundComponent separation technique (CST) has emerged as a novel surgical strategy in the management of large and complex hernia defects. Although prior work has associated CST with decreased hernia recurrence and improved clinical outcomes, the impact of hospital-level variation in component separation utilization remains understudied.MethodsThis retrospective cohort study investigated the impact of operative volume on outcomes in patients undergoing CST. All adult (≥18 years) records for elective CST procedures were tabulated using the 2016-2021 Nationwide Readmissions Database. Hospitals ranked in the top quartile of annual CST volume were defined as high-volume hospitals (HVH; others LVH, MVH, and MHVH). Multivariable regression models were developed to characterize the association between HVH status and outcomes of interest.ResultsOf an estimated 12 720 patients undergoing component separation, 3359 (26.3%) underwent treatment at HVH. Although CST utilization increased significantly over the study period, the total number of high-volume centers remained relatively stable. Additionally, Medicaid recipient status, lowest income quartile, and treatment at rural hospitals were all associated with lower odds of component separation use. Following comprehensive risk adjustment, HVH status was associated with decreased odds of major adverse events (AOR [adjusted odds ratio] 0.75, 95% CI [0.61, 0.91], P = 0.003). However, the HVH cohort had similar resource utilization compared to their LVH, MVH, and MHVH counterparts.DiscussionHigher CST hospital volume was linked with improved clinical outcomes without increased resource utilization. Persistent disparities in component separation utilization highlight the need for protocol standardization and expanded access to specialized surgical care nationally.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251387151"},"PeriodicalIF":0.9,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224852","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

Evaluation of Resident Participation on Specimen Margin Status in Patients Undergoing Lumpectomy. 评价住院医师对乳房肿瘤切除术患者标本边缘状态的参与。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-03 DOI: 10.1177/00031348251385106

Daniel Schmidt, Kristina Fraser, Jared Reyes, Stephen D Helmer, Mohamad Halloum, Patty L Tenofsky

{"title":"Evaluation of Resident Participation on Specimen Margin Status in Patients Undergoing Lumpectomy.","authors":"Daniel Schmidt, Kristina Fraser, Jared Reyes, Stephen D Helmer, Mohamad Halloum, Patty L Tenofsky","doi":"10.1177/00031348251385106","DOIUrl":"https://doi.org/10.1177/00031348251385106","url":null,"abstract":"In the practice of breast surgery, positive margins are a troublesome pathologic finding associated with an increased risk of local recurrence and the recommendation of re-excision. For this reason, there is an emphasis placed on negative margins for breast surgeries. In this study, we analyze surgical resident involvement in breast cancer operations and associations with margin status.MethodsA retrospective study was completed of adult female patients who underwent a lumpectomy by a single surgeon. The surgeries were categorized by resident involvement in the surgical procedure. Other variables assessed were cancer type, grade, size, neoadjuvant chemotherapy use, and oncoplastic surgery. Variables were evaluated to determine what associated with a positive margin.ResultsWhen comparing cases with and without resident involvement, no statistically significant differences were noted in patient age (65.46 ± 1.76 years vs. 66.14 ± 9.31 years, P = .560), neoadjuvant therapy (11.8% vs. 8.0%, P =.273), and tumor size (12 mm vs. 13 mm, P =.871). The number of positive margins did not differ statistically whether a resident was involved or not (20.3% vs. 16.7%, P =.420). The only variable associated with increased positive margins was adenocarcinoma mixed with ductal carcinoma in situ (DCIS) and pure DCIS, which was associated with the greatest proportions of positive margins.DiscussionUnlike some previous studies, our data reinforces it is safe to involve residents in breast conservation surgery. Specifically, program year did not significantly impact margin status. Thus, surgical training should continue to involve residents in breast surgery without fear of providing suboptimal care.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251385106"},"PeriodicalIF":0.9,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224787","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

Examination of Resource Utilization and Adverse Outcomes Among Isolated Traumatic Brain Injury Patients Using Modified Brain Injury Guidelines. 使用改进的脑损伤指南检查孤立性创伤性脑损伤患者的资源利用和不良结局。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-03 DOI: 10.1177/00031348251381621

Erica Dobbs, Gaige Wilder, Damayanti Samanta, Chisom Maduakonam, Brandon Radow

{"title":"Examination of Resource Utilization and Adverse Outcomes Among Isolated Traumatic Brain Injury Patients Using Modified Brain Injury Guidelines.","authors":"Erica Dobbs, Gaige Wilder, Damayanti Samanta, Chisom Maduakonam, Brandon Radow","doi":"10.1177/00031348251381621","DOIUrl":"https://doi.org/10.1177/00031348251381621","url":null,"abstract":"BackgroundMild traumatic brain injuries (TBI) are often overmanaged, resulting in an inefficient use of time and resources. The Brain Injury Guidelines was developed and subsequently improved as the modified Brain Injury Guidelines (mBIG) to help standardize TBI management. This study evaluates how adopting the mBIG criteria could improve TBI management at our institution.Materials and MethodsThis retrospective observational study included patients aged 18 to 89 admitted for isolated TBI to our Level 1 trauma center ICU between January 2021 and December 2023. Patients were categorized into 3 groups using the mBIG guidelines-mBIG 1, 2, and 3; mBIG 3 were excluded. Data were collected through the institutional trauma registry and chart review.ResultsThe study included 46 mBIG 1 and 44 mBIG 2 patients, who were comparable in terms of characteristics, clinical presentation, and procedures. Both groups had similar clinical outcomes, including in-hospital complications, mortality, discharge disposition, and 30-day readmission, and utilized hospital resources. All patients had a neurosurgery consult, with 49 repeat head CTs in the mBIG 1 group and 50 in the mBIG 2 group. The total combined cost for repeat head computer tomography (RHCTs) scans, magnetic resonance imaging (MRIs), computed tomography angiography (CTAs), neurosurgical consultations, and ICU stay in both groups was $337,637.4.DiscussionThe overutilization of imaging, ICU admissions, and neurosurgeon consultations can strain institutional resources and may not benefit patients with mild TBI. By adopting the mBIG criteria, institutions can implement a more efficient and safe management strategy, allowing these valuable resources to be better allocated to more severely injured patients who require them.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251381621"},"PeriodicalIF":0.9,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224799","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

Ten Years of Pediatric Velopharyngeal Insufficiency Surgery: National Operative Trends, 30-day Complication Rates, and Implications. 儿童腭咽功能不全手术十年：全国手术趋势，30天并发症发生率及其意义。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-01 Epub Date: 2025-05-13 DOI: 10.1177/00031348251341942

Melanie Bakovic, Valeria Mejia, Asli Pekcan, Raina K Patel, Laura Herrera-Gomez, Alyssa Valenti, Mark M Urata, Jeffrey A Hammoudeh

{"title":"Ten Years of Pediatric Velopharyngeal Insufficiency Surgery: National Operative Trends, 30-day Complication Rates, and Implications.","authors":"Melanie Bakovic, Valeria Mejia, Asli Pekcan, Raina K Patel, Laura Herrera-Gomez, Alyssa Valenti, Mark M Urata, Jeffrey A Hammoudeh","doi":"10.1177/00031348251341942","DOIUrl":"10.1177/00031348251341942","url":null,"abstract":"BackgroundVelopharyngeal insufficiency (VPI) can be effectively treated surgically with palatal lengthening or pharyngeal procedures. There is limited data on long-term national trends in their use and associated outcomes. This study evaluates 10 years of trends and outcomes in VPI-correcting procedures.MethodsWe conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database, identifying cases with CPT codes corresponding to VPI-correction procedures. Patients 6 to 18 years old were included. Outcomes included operative characteristics and postoperative complications.ResultsOf 5957 cases, 45% were palatal lengthening, and 55% were pharyngeal procedures (63% pharyngeal flap and 37% sphincter pharyngoplasties). Palatal procedures had longer operative (P < 0.001) and anesthesia (P < 0.001) durations compared to pharyngeal procedures. Pharyngeal flaps had longer operative (P < 0.001) and anesthesia (P < 0.001) durations compared to sphincter pharyngoplasties. Palatal-lengthening surgeries had higher rates of wound dehiscence (P = 0.001) but no significant difference in major complications compared to pharyngoplasties. No differences in complication rates between pharyngeal flaps and sphincter pharyngoplasties were observed.DiscussionLow complication rates across palatal lengthening and pharyngeal procedures suggest that VPI surgical planning should prioritize factors such as patient anatomy, existing comorbidities, and the potential risks associated with prolonged operative and anesthesia times.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1643-1649"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960237","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

Great Debates: The Wave of the Future vs Tried and True: Integrated Training in Surgery vs General Surgery Training Followed by Fellowship. 伟大的辩论：未来的浪潮vs尝试和真实：外科综合培训vs普通外科培训之后的奖学金。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-01 Epub Date: 2025-04-21 DOI: 10.1177/00031348251337168

Esteban Aguayo, Jacob Dixon, Jukes Namm, Peyman Benharash

引用次数: 0

Increasing Utilization of Palliative Care is Associated With Reduced Health Care Costs in Operative Trauma: A National Analysis. 增加姑息治疗的使用与手术创伤中医疗保健费用的降低有关：一项国家分析。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-01 Epub Date: 2025-07-07 DOI: 10.1177/00031348251359119

Syed Shaheer Ali, Amulya Vadlakonda, Konmal Ali, Troy Coaston, Saad Mallick, Nam Yong Cho, Esteban Aguayo, Peyman Benharash, On Behalf Of The Academic Trauma Research Consortium Atrium

{"title":"Increasing Utilization of Palliative Care is Associated With Reduced Health Care Costs in Operative Trauma: A National Analysis.","authors":"Syed Shaheer Ali, Amulya Vadlakonda, Konmal Ali, Troy Coaston, Saad Mallick, Nam Yong Cho, Esteban Aguayo, Peyman Benharash, On Behalf Of The Academic Trauma Research Consortium Atrium","doi":"10.1177/00031348251359119","DOIUrl":"10.1177/00031348251359119","url":null,"abstract":"IntroductionPalliative care (PC) has been shown to improve comfort for surgical patients nearing the end of life. Although single-institution studies suggest PC to be a cost-effective strategy, the contemporary national trends in costs and utilization of this modality remain unknown.MethodsAdult patients (≥18 years) who did not survive following hospitalization for surgical management of traumatic injury were tabulated in the 2016 to 2020 Nationwide Readmissions Database. Patients were stratified by receipt of PC. Entropy balancing on key covariates was used to ensure an equivalent comparison of groups. A multivariable linear regression model was constructed to assess the association between PC and hospitalization costs per day across quintiles of injury severity.ResultsOf an estimated 56 431 patients who did not survive hospitalization for traumatic injury, 43.7% received PC. Compared to others, those receiving PC were older (77 [64-87] vs 73 years [55-85], P < 0.001), insured by Medicare (65.3 vs 58.6%, P < 0.001), and had a higher Elixhauser Comorbidity Index (4 [3-6] vs 4 [2-6], P < 0.001). Following multivariable adjustment and entropy balancing, PC was associated with a decrement in daily costs (β, $1,300, 95% confidence interval -1500 to -1,000, P < 0.001). Such difference was greatest among those in the highest quintile of injury severity.ConclusionWe demonstrate a potential cost benefit to the utilization of PC for trauma patients nearing end of life. In the context of known benefits of PC to quality of life for acutely ill patients, our findings highlight the economic feasibility of integrating PC into trauma services.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1770-1777"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574668","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

Great Debates-Two Hands Versus Four: Open Abdominal Wall Reconstruction (AWR) Versus Robotic-Assisted AWR. 大辩论-两只手与四只手：开放式腹壁重建（AWR）与机器人辅助的AWR。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-01 Epub Date: 2025-07-03 DOI: 10.1177/00031348251355932

Kyuseok Im, Nicole Hanson, Anthony Carden, Louise Yeung

{"title":"Great Debates-Two Hands Versus Four: Open Abdominal Wall Reconstruction (AWR) Versus Robotic-Assisted AWR.","authors":"Kyuseok Im, Nicole Hanson, Anthony Carden, Louise Yeung","doi":"10.1177/00031348251355932","DOIUrl":"10.1177/00031348251355932","url":null,"abstract":"Abdominal wall reconstruction (AWR) represents a heterogeneous spectrum of operations, ranging from simple ventral hernia repairs to more complex hernia with loss of abdominal wall domain. Historically, AWR has been performed via the open approach, and eventually it was also performed via minimally invasive approaches with advancements in laparoscopic surgery. Compared to open AWR, laparoscopic AWR provided advantages of being less invasive, shorter hospital stays, and improved patient outcomes. With the emergence of robotic surgery, AWR has been increasingly performed via robotic approach, given that it provides all the advantages of laparoscopic AWR as well as better precision and superior surgeon ergonomics. However, robotic AWR can often be expensive, especially with high acquisition costs and longer operative times. Furthermore, data on long-term outcomes after robotic AWR do not yet clearly demonstrate its benefits. While open AWR remains the classic and widely available approach, robotic AWR is a promising approach with significant potential benefits. Ultimately, the best approach to AWR depends on thoughtful patient selection, access, and surgeons' technical capabilities and familiarity.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1754-1757"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551702","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

Contemporary Operative Trends and Outcomes of Laparoscopic and Robotic Heller Myotomy Using a Large National Database. 当代腹腔镜和机器人海勒肌切开术的手术趋势和结果：使用大型国家数据库。

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-01 Epub Date: 2025-08-04 DOI: 10.1177/00031348251365412

Paul Brosnihan, Esteban Aguayo, Christian Perez, Peyman Benharash, Amy Yetasook

{"title":"Contemporary Operative Trends and Outcomes of Laparoscopic and Robotic Heller Myotomy Using a Large National Database.","authors":"Paul Brosnihan, Esteban Aguayo, Christian Perez, Peyman Benharash, Amy Yetasook","doi":"10.1177/00031348251365412","DOIUrl":"10.1177/00031348251365412","url":null,"abstract":"BackgroundRobotic-assisted Heller myotomy (RAHM) is increasingly utilized for the surgical treatment of achalasia. While prior studies have suggested potential technical advantages of RAHM over laparoscopic Heller myotomy (LHM), the economic implications remain less well-defined. This study aimed to compare hospitalization costs and clinical outcomes between RAHM and LHM using a nationally representative cohort.MethodsThe 2016-2021 Nationwide Readmission Database was utilized to identify adult patients ((≥18 years) undergoing either LHM or RAHM for achalasia. Entropy balancing on key variables followed by multivariable linear regression analysis was used to elucidate the association between LHM and RHM on outcomes, including mortality, 30-day readmission, hospitalization costs, and length of stay (LOS).ResultsAmong 14 662 patients, 30.5% underwent RAHM. While use of RAHM increased over the study period, LHM remained the most frequently performed approach. There were no significant differences in mortality (0.25% vs 0.19%, P = 0.64), LOS (3.1 vs 3.0 days, P = 0.09), or 30-day readmissions (4.86% vs 4.88%, P = 0.98) between RAHM and LHM. However, index hospitalization costs were higher for RAHM ($19,387 vs $16,317, P < 0.001), and this cost difference persisted after adjustment (β +$3,345, 95% CI $2473-$4,217, P < 0.001).ConclusionRobotic-assisted Heller myotomy and LHM demonstrate equivalent short-term clinical outcomes for achalasia. However, RAHM is consistently associated with higher hospitalization costs, warranting further evaluation of its economic impact.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1802-1807"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774530","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

Association of Preoperative Hematocrit and Intraoperative/Postoperative Transfusion Volume With Outcomes of Major Abdominal Surgery. 术前红细胞压积、术中/术后输血量与腹部大手术预后的关系

IF 0.9 4区医学

American Surgeon Pub Date : 2025-10-01 Epub Date: 2025-04-30 DOI: 10.1177/00031348251339533

Dariush Yalzadeh, Oh Jin Kwon, Nam Yong Cho, Kevin Tabibian, Daniel Tabibian, Barzin Badiee, Arjun Chaturvedi, Peyman Benharash

{"title":"Association of Preoperative Hematocrit and Intraoperative/Postoperative Transfusion Volume With Outcomes of Major Abdominal Surgery.","authors":"Dariush Yalzadeh, Oh Jin Kwon, Nam Yong Cho, Kevin Tabibian, Daniel Tabibian, Barzin Badiee, Arjun Chaturvedi, Peyman Benharash","doi":"10.1177/00031348251339533","DOIUrl":"10.1177/00031348251339533","url":null,"abstract":"BackgroundDespite the independent effect of lower preoperative hematocrit levels and higher transfusion volumes with increased postoperative morbidity and mortality, the impact of the interplay between these variables on outcomes remains poorly understood. We hypothesized that after adjusting for preoperative hematocrit, red cell transfusions exhibit a stepwise association with increased mortality and complications after major abdominal surgery (MAS).MethodsAll adults (≥18 years) undergoing elective MAS (colectomy, enterectomy, proctectomy, laparotomy, splenectomy, gastrectomy, enterorrhaphy/colorrhaphy, and peritoneal drainage) were identified in the 2020-2022 American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome of interest was in-hospital mortality within 30 days of discharge. Secondary outcomes included postoperative complications, as well as length of stay (LOS) and unplanned readmission.ResultsAmong 15,646 patients undergoing MAS, 88.0% were not transfused, while 5.3% received 1 unit and 6.7% received ≥2 units of blood. After multivariable adjustment, lower preoperative hematocrit levels (AOR 0.9, 95% Cl 0.9-1.0) and higher transfusion volumes (1 Unit: AOR 1.6, 95% Cl 1.1-2.4; ≥2 Unit: AOR 2.4, 95% Cl 1.6-3.4) were independently associated with an increased risk of mortality (all P < 0.05). Notably, higher transfusion volumes demonstrated a stronger association with increased rates of individual complications, prolonged LOS, and unplanned readmission compared to preoperative hematocrit levels (all P < 0.05).DiscussionGiven the independent impact of transfusion volume on acute outcomes, efforts should focus on early, multimodal anemia management to reduce transfusion requirements in the preoperative phase, rather than relying on intraoperative transfusions, when feasible.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1620-1628"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966035","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