American Surgeon最新文献_第6页

Impact of Limited Access to Surgical Care in Medically Underserved Communities.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-27 DOI: 10.1177/00031348251324265

Shebiki Beaton, Theodora Abah, Kimberly Miller-Hammond

{"title":"Impact of Limited Access to Surgical Care in Medically Underserved Communities.","authors":"Shebiki Beaton, Theodora Abah, Kimberly Miller-Hammond","doi":"10.1177/00031348251324265","DOIUrl":"https://doi.org/10.1177/00031348251324265","url":null,"abstract":"Summary/BackgroundMedically underserved communities and ethnic minorities constitute a significant portion of the vulnerable population within the United States. Recent changes in the health care structure, rising inflation with a decline in median household income, and the SARS-CoV-2 pandemic have disproportionately impacted communities of low socioeconomic status. Healthcare providers and federal organizations must be aware of how these factors influence access to surgical care to tailor treatment, interventions, and policies better to meet the needs of these populations.MethodWe systematically reviewed 19 articles to identify key factors influencing barriers to health care for minority populations and how the dynamic changes in healthcare structures can further exacerbate this divide.DiscussionMedically underserved populations face significant barriers to health care due to socioeconomic factors like income, housing instability, and lack of insurance. These areas often have shortages of primary care providers, access to healthy foods, and high-value health care that may lead to unfavorable outcomes. Poor access and utilization of health services can also affect hospital systems, leading to decreased funding and increased hospital closures. Despite federal intervention and policy changes, the need for further support for rural healthcare institutions and underserved populations remains, requiring financial assistance, resource allocation improvements, and incentives for healthcare providers and investors.ConclusionHealthcare systems can work towards bridging the gap in access to surgical services by implementing targeted outreach programs and ensuring equitable resource distribution. Additionally, fostering partnerships with community organizations can enhance awareness and address specific barriers these populations face.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251324265"},"PeriodicalIF":1.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727557","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

Optimizing Pediatric Resuscitation: Evidence-Based Approaches and Emerging Trends.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-26 DOI: 10.1177/00031348251329503

Micaela K Gomez, Lucas P Neff

引用次数: 0

Quality Verification in Surgical Subspecialty Programs.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-25 DOI: 10.1177/00031348241298073

Anton N Sidawy

{"title":"Quality Verification in Surgical Subspecialty Programs.","authors":"Anton N Sidawy","doi":"10.1177/00031348241298073","DOIUrl":"https://doi.org/10.1177/00031348241298073","url":null,"abstract":"In 2001, the Institute of Medicine defined 6 domains in quality health care: safe, effective, patient-centered, timely, efficient, and equitable. In 2010, the Affordable Care Act (ACA) or Obamacare, was passed into law. In addition to the well-known health insurance reform, it introduced delivery system redesign based on quality performance. Basically, it heralded a transition of reimbursement from payment for service and volume to payment for quality and value. Defining value is rather elusive; but if one considers that value equals quality divided by cost, payers aim to increase the value of a service either by improving quality, decreasing cost, or, preferably for them, both. The question is who defines value and quality of surgical services. Surgical specialists and their professional organizations should. Such organizations have the knowledge in their specialty but usually lack the infrastructure necessary to do so; but quality verification programs can be established in collaboration with the American College of Surgeons (ACS). ACS has had a long history of establishing quality verification programs; it has the infrastructure and the experienced personnel to do so. All ACS verification programs are based on four guiding principles: Setting standards based on evidence based guidelines, building the right infrastructure based on the standards, collecting the appropriate outcome data, and verifying compliance with the standards by site visit by outside experts. In this article, I outline the reasons for establishing verification programs, the process used to establish and maintain such programs, and their implications using the ACS/SVS (Society for Vascular Surgery) Vascular Verification Program as an example.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241298073"},"PeriodicalIF":1.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699421","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

Use of the National Cancer Database in Identifying Disparities in Cancer Treatment.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329497

Fatima Mubarak, Emmanuel M Gabriel, Jade C Bowers

引用次数: 0

The Impact of Sarcopenia on Postoperative Outcomes in Colorectal Cancer Surgery: An Updated Systematic Review and Meta-Analysis.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329748

Sara Keshavjee, Tyler Mckechnie, Victoria Shi, Muhammad Abbas, Elena Huang, Nalin Amin, Dennis Hong, Cagla Eskicioglu

{"title":"The Impact of Sarcopenia on Postoperative Outcomes in Colorectal Cancer Surgery: An Updated Systematic Review and Meta-Analysis.","authors":"Sara Keshavjee, Tyler Mckechnie, Victoria Shi, Muhammad Abbas, Elena Huang, Nalin Amin, Dennis Hong, Cagla Eskicioglu","doi":"10.1177/00031348251329748","DOIUrl":"https://doi.org/10.1177/00031348251329748","url":null,"abstract":"Sarcopenia is thought to be a marker for underlying frailty and malnutrition, contributing to poor functional status and suboptimal healing postoperatively. We aimed to complete an updated systematic review and meta-analysis evaluating the impact of sarcopenia on short- and long-term outcomes following colorectal cancer surgery. We searched MEDLINE, Embase, and CENTRAL up to September 2023. Studies that compared sarcopenic and non-sarcopenic patients' short- and long-term outcomes following curative intent elective surgery for colorectal cancer were included. The main outcomes included postoperative morbidity, postoperative mortality, and length of stay (LOS), among others. Inverse variance random effects meta-analyses was performed. Risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE. After screening 215 studies, we included 40 non-randomized studies, totalling 13,422 patients, of which 5,432 (40.4%) were classified as sarcopenic. Across 27 studies, patients with sarcopenia were more likely to experience 30-day postoperative morbidity (40% vs 33%, RR 1.30, 95% CI 1.12-1.50, P < 0.01, I2 79%). The mean LOS was 1.46 days longer for sarcopenic patients (26 studies, 95% CI 0.85-2.07, P < 0.01, I2 82%). Upon pooling data from 13 studies, sarcopenic patients had increased risk of 30-day postoperative mortality (2.8% vs 1.0%, RR 2.74, 95% CI 1.63-4.62, P < 0.01, I2 0%). The findings from this systematic review suggest with low to very-low certainty evidence that in patients who are undergoing curative intent surgery for colorectal cancer, preoperative sarcopenia is associated with poor postoperative outcomes.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329748"},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699427","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

Outcomes After Damage Control Laparotomy Among White, American Indian, and Alaska Native Populations.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329501

Conor S Roche, Anthony J Duncan, Mark R Williamson, Mentor Ahmeti

{"title":"Outcomes After Damage Control Laparotomy Among White, American Indian, and Alaska Native Populations.","authors":"Conor S Roche, Anthony J Duncan, Mark R Williamson, Mentor Ahmeti","doi":"10.1177/00031348251329501","DOIUrl":"https://doi.org/10.1177/00031348251329501","url":null,"abstract":"BackgroundAmerican Indian and Alaska Native (AIAN) populations have been shown to have severe health disparities, with increased 30-day mortality rates and surgical complications. They continue to represent a population that has the worst outcomes, however, still underrepresented within the medical literature. Further research into AIAN is critical to start to determine why these differences exist.MethodsA retrospective review of patients undergoing damage control laparotomies (DCLs) between 2015 and 2024 was conducted. Logistic regression was used to compare variables (age, race, gender, ASA, APACHE II, ICU admission, ventilation, number of operations, and time until abdominal closure).ResultsA total of 502 patients were included in the analysis. 10% of these were AIAN. The AIANs undergoing DCL had a mean age of 47.5 years, whereas White patients had a mean age of 62.1 years (P < 0.0001). There were no statistically significant differences in mortality rates. Non-mortality complications were equally distributed between the 2 groups. Logistic regression analysis identified age, APACHE II score, and procedure count as significant predictors of mortality.ConclusionsAmerican Indians are presenting at notably younger ages compared to their White counterparts (62 vs 48 years old). Despite comparable outcomes between the groups, this highlights a distinct age-related gap within our AIAN population, underscoring the necessity for heightened care in this specific patient demographic.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329501"},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690836","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

"Policy and Funding Impact on Access to Care".

IF 1 4区医学

American Surgeon Pub Date : 2025-03-24 DOI: 10.1177/00031348251329467

Ross F Goldberg

引用次数: 0

Access to Care for Patients With Disabilities.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-23 DOI: 10.1177/00031348251329476

Christine Castater, Erica Roth, Christine Ward, Jenaye Burrows, Tatyana Young, Zhuri Nisseau-Bey, Diallo Dieynabou, Jamesa Fabien, Randi N Smith

引用次数: 0

Mesenteric Ischemia: Predicting Problems.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-23 DOI: 10.1177/00031348251329475

Bonnie E Holley, Laura A Peterson, Barbara A Bennie, Isaiah I Fitzmaurice, Benjamin T Jarman

{"title":"Mesenteric Ischemia: Predicting Problems.","authors":"Bonnie E Holley, Laura A Peterson, Barbara A Bennie, Isaiah I Fitzmaurice, Benjamin T Jarman","doi":"10.1177/00031348251329475","DOIUrl":"https://doi.org/10.1177/00031348251329475","url":null,"abstract":"BackgroundMesenteric ischemia is an uncommon diagnosis that is often overlooked until patients present with non-salvageable bowel. Our objective was to identify risk factors for mesenteric ischemia, clinical warning signs, and imaging findings that could suggest earlier diagnosis and intervention.MethodsWe queried our health system's electronic health record (EHR) to identify patients with ischemic bowel and/or a diagnosis of mesenteric ischemia between November 2013 and December 2020. Using stringent exclusion criteria, we included patients whose event was likely caused by atherosclerotic disease. From the EHR, we abstracted these patients' comorbidities and symptoms from the previous 6 months. We evaluated relevant computed tomography scans (CTs) obtained up to 2 years prior to admission and graded stenosis of the celiac artery and the superior mesenteric artery (SMA).ResultsForty-five patients met inclusion criteria. The most prevalent comorbidities were hypertension, hyperlipidemia, and heart disease. Over half of the patients in the cohort had mentioned suspicious abdominal symptoms during the 6 months preceding admission. Of the patients who had a CT within the 2 years prior to admission, there was discordance between the formal interpretations and independent reviews with significant stenosis being noted more commonly on independent review. Furthermore, in-hospital mortality was significantly higher when pre-presentation imaging noted SMA stenosis >70%.DiscussionThese data suggest that patients who were at risk of developing mesenteric ischemia had underlying vascular disease, a history of concerning symptoms, and prior CT imaging consistent with mesenteric atherosclerotic disease which could potentially be acted upon before the manifestation of an acute event.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329475"},"PeriodicalIF":1.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690657","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

The Use of Holistic Review in Colon and Rectal Surgery Residency Applications.

IF 1 4区医学

American Surgeon Pub Date : 2025-03-23 DOI: 10.1177/00031348251329478

Saher-Zahra Khan, Sharon L Stein, Emily Steinhagen

{"title":"The Use of Holistic Review in Colon and Rectal Surgery Residency Applications.","authors":"Saher-Zahra Khan, Sharon L Stein, Emily Steinhagen","doi":"10.1177/00031348251329478","DOIUrl":"https://doi.org/10.1177/00031348251329478","url":null,"abstract":"Background: Advice regarding application preparation is often anecdotal; there is limited information about how programs evaluate applicants. It is unclear if holistic review is being properly used in an increasingly competitive field. This study aims to describe desirable applicant characteristics and the application review process of CRS programs. Methods: A survey was distributed to all United States CRS Program Directors (PD) during the 2022 application cycle. The survey had questions regarding number of applicants received and the review process including which screening parameters were used and which criteria were valued when evaluating applications. Descriptive statistics are reported. Results: Thirty-six responses from the 67 CRS residency PD (54%) were received. Most (72%) characterized their review process as \"holistic.\" The majority (58%) of PD classified their hospital setting as academic. The median number of applications reviewed per program was 100, with a median of 26% (IQR 20-31%) of applicants invited to interview. When deciding who to interview, in-training examination (ABSITE) score (92%), letter of recommendation (LOR) content (89%), LOR writer (83%), and research productivity (83%) were the most commonly considered criteria. The \"Top 3 Criteria\" cited by PD in choosing applicants to interview were LOR, ABSITE and Publications/Research. Discussion: CRS residencies continue to value traditional metrics such as ABSITE scores, publications, and LOR with both the content and identity writer appearing to be important. Despite many PDs claiming they use a holistic review process, our results indicate otherwise. Increased education providing the rationale behind holistic review should be provided.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251329478"},"PeriodicalIF":1.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690775","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