American Surgeon最新文献_第7页

Subcutaneous Wound Management in Complex, Contaminated Abdominal Wall Reconstruction (AWR) - The "French Fry" Technique. 复杂污染腹壁重建（AWR）的皮下伤口处理-“炸薯条”技术。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-04-30 DOI: 10.1177/00031348261448885

Samantha W Kerr, Lucy R Hinton, Victoria L Walker, Alynna J Wiley, Gregory T Scarola, Sullivan A Ayuso, B Todd Heniford

{"title":"Subcutaneous Wound Management in Complex, Contaminated Abdominal Wall Reconstruction (AWR) - The \"French Fry\" Technique.","authors":"Samantha W Kerr, Lucy R Hinton, Victoria L Walker, Alynna J Wiley, Gregory T Scarola, Sullivan A Ayuso, B Todd Heniford","doi":"10.1177/00031348261448885","DOIUrl":"10.1177/00031348261448885","url":null,"abstract":"IntroductionPrimary closure of contaminated abdominal wall reconstruction (AWR) wounds carries significant wound complication risks. Vacuum-assisted, delayed primary closure (VADPC) improves outcomes but requires a second anesthetic. The \"French fry\" technique (FFT) utilizes VA benefits without reoperation. The aim of this study was to evaluate the outcomes of FFT in complex, contaminated AWR.MethodsA single center's open AWRs (CDC class 2-4) managed with FFT were reviewed. Technique: incision is closed except for small gaps to place subcutaneous 1 × 1 × 8cm NPWT foam \"French fries\" at 5-6 cm intervals under an incisional NPWT (-125 mmHg). FF are removed POD3 at the bedside and precise measurement is taken to assure all FFs are accounted for. Incisional NPWT is continued. Primary outcome included wound complications compared to Carolinas Equation for Determining Associated Risks (CeDAR) predictions.ResultsTwenty-seven AWR patients (BMI 31.6 ± 5.9 kg/m2; 40.7% diabetic; 66.7% recurrent hernias; 100% CDC wound class 2-4; massive defect size 384.2 ± 143.8 cm2) underwent FFT. Biologic mesh was placed in 74.1% of cases; 18.5% of defects were closed primarily. Fascial closure was achieved in 92.6%. CeDAR-predicted wound complication rate was 53.8%. Observed wound complication rate was 25.9%, including infection (14.8%) requiring intervention, with 7.4% requiring reopening of their wounds. There were no mesh infections and no hernia recurrences over average follow-up of 8.2 ± 19.8 months.ConclusionFFT is a practical, single-stage, strategy for contaminated AWR, reducing complications compared to predicted risk.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2531-2538"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809270","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 National Data on Chronic Diaphragmatic Hernia: Does Surgical Approach Matter? 慢性膈疝的十年国家数据：手术方法重要吗？

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-06-01 DOI: 10.1177/00031348261457633

Hamidreza Hosseinpour, H Edward Garrett, Darryl Weiman, Stephen W Behrman

{"title":"Ten Years of National Data on Chronic Diaphragmatic Hernia: Does Surgical Approach Matter?","authors":"Hamidreza Hosseinpour, H Edward Garrett, Darryl Weiman, Stephen W Behrman","doi":"10.1177/00031348261457633","DOIUrl":"10.1177/00031348261457633","url":null,"abstract":"BackgroundThe optimal surgical approach for chronic diaphragmatic hernia (CDH) remains unclear. This study aimed to compare outcomes of thoracotomy vs laparotomy vs laparoscopic repair of CDH.MethodsWe conducted a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2013-2022. Adult patients (≥18 years) with non-congenital non-hiatal CDH (with or without obstruction) who underwent thoracotomy, laparotomy, or laparoscopy were included. Outcomes assessed included postoperative complications, unplanned return to the operating room (OR), 30-day readmissions, and unfavorable discharge disposition.ResultsA total of 610 patients underwent CDH repair: 156 thoracotomies, 275 laparotomies, and 179 laparoscopies. Chronic diaphragmatic hernia complicated by obstruction was present in 35.2% of patients. On univariate analysis, rates of complications (P = 0.248), readmissions (P = 0.971), unplanned return to OR (P = 0.068), and discharge disposition (P = 0.937) did not differ significantly among groups. On multivariable regression analysis, among patients presenting with obstruction symptoms, laparoscopy was associated with higher odds of unplanned return to OR (aOR: 3.91, 95% CI: 1.91-5.57) and unfavorable discharge (aOR: 1.50, 95% CI: 1.13-4.71), whereas laparotomy was associated with lower odds of both unplanned return to OR (aOR: 0.17, 95% CI: 0.01-0.36) and unfavorable discharge disposition (aOR: 0.41, 95% CI: 0.15-0.84), compared with thoracotomy.ConclusionAcross a decade of national data, outcomes were similar among thoracotomy, laparotomy, and laparoscopy for uncomplicated CDH. In patients with obstruction, however, laparoscopy, used in nearly one in five cases, was associated with increased risks of reoperation and unfavorable discharge disposition. These findings emphasize the importance of careful patient selection and surgical expertise in tailoring operative approach to CDH.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2679-2687"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136573","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

Managing Pyogenic Soft-Tissue Infections in People Living With HIV in a Resource-Limited Setting: Field Lessons and a Pragmatic Algorithm From South Sudan. 在资源有限的环境下管理艾滋病毒感染者的化脓性软组织感染：来自南苏丹的实地经验教训和实用算法。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-06-16 DOI: 10.1177/00031348261461280

Miloslav Mišánik, Marek Smolár, Diana Musová, Miroslav Slezák, Kristína Cmarková, Barbora Vasiľová, Juraj Miklušica

{"title":"Managing Pyogenic Soft-Tissue Infections in People Living With HIV in a Resource-Limited Setting: Field Lessons and a Pragmatic Algorithm From South Sudan.","authors":"Miloslav Mišánik, Marek Smolár, Diana Musová, Miroslav Slezák, Kristína Cmarková, Barbora Vasiľová, Juraj Miklušica","doi":"10.1177/00031348261461280","DOIUrl":"10.1177/00031348261461280","url":null,"abstract":"Severe pyogenic soft-tissue infections (SSTI) are a frequent cause of morbidity among people living with HIV (PLHIV) in resource-limited hospitals. Drawing on five months of frontline work in a district surgical unit in South Sudan, this field report distills practical lessons into a simple, resource-adapted algorithm for triage, source control, antibiotics, and wound care. Core steps include bedside sepsis screening with qSOFA, prompt empiric antibiotics aligned with the WHO EML/AWaRe approach, and decisive operative debridement without waiting for advanced diagnostics when necrotizing infection is suspected, followed by planned re-look procedures. Low-cost wound-care options (eg, diluted hypochlorite/povidone-iodine transitioning to saline gauze) and loss-to-follow-up-aware discharge practices are emphasized. The aim is to standardize care and shorten time to debridement in district-level services rather than report outcomes. Keywords: pyogenic soft-tissue infection; HIV; resource-limited settings; necrotizing fasciitis.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2707-2712"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257028","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

Child Restraint System Use and Injury Severity in Pediatric Motor Vehicle Collisions: Insights From the NTDB. 儿童约束系统的使用和伤害严重程度在儿童机动车辆碰撞：从NTDB的见解。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-04-28 DOI: 10.1177/00031348261448884

Zoe Flyer, Andriena Giron, John Schomberg, Laura F Goodman, Emily Gray Robillard, Michael Valente, Shelby K Shelton, Rishi Bhargava, Theodore Heyming

{"title":"Child Restraint System Use and Injury Severity in Pediatric Motor Vehicle Collisions: Insights From the NTDB.","authors":"Zoe Flyer, Andriena Giron, John Schomberg, Laura F Goodman, Emily Gray Robillard, Michael Valente, Shelby K Shelton, Rishi Bhargava, Theodore Heyming","doi":"10.1177/00031348261448884","DOIUrl":"10.1177/00031348261448884","url":null,"abstract":"BackgroundMotor vehicle collisions (MVCs) are the second leading cause of childhood mortality in the US, and child restraint systems (CRS) remain underutilized. We examine differences in demographics and clinical characteristics in pediatric patients presenting to the emergency department (ED) after MVCs with or without CRS.MethodsWe identified MVC trauma patients reported within the National Trauma Data Bank (NTDB) < 8 years of age and height/weight CRS-eligible. Bivariate descriptive analyses, interquartile range for continuous variables and a chi-square test of proportions tested differences of categorical variables of CRS strata. Sensitivity analysis was used in patients that were age appropriate for car and booster seats.ResultsIn all patients, median age for those without CRS was older (6 years, IQR 4-7) than those with CRS (4 years, IQR 2-5, P < 0.0001). A lower proportion of Black patients had CRS compared to White (24.0% vs 32.6%, P < 0.0001). For those with CRS, the highest proportion were boosters (38.7%). Injury severity score (ISS) was higher in the non-CRS group (8, IQR 4-14) than CRS (5, IQR 2-11, P < 0.0001). A larger proportion of CRS patients were discharged home from ED (26.8% vs 18.5%). Racial disparities persisted in older patients, with fewer booster-eligible Black children in CRS (30.0% vs 17.9%, P < 0.001).ConclusionsThis study demonstrates that older and Black children were less likely to be in a CRS, and that those who were not in CRS were more severely injured. Our study serves as the foundation for research to mitigate disparities, and outreach related to CRS improvements.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2624-2634"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760032","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

A Hidden Hurdle: The Plastic Surgery Bottleneck in Breast Cancer Care. 隐藏的障碍：乳腺癌治疗中的整形手术瓶颈。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-05-06 DOI: 10.1177/00031348261448892

Emily Orosco, Bradley Jensen, Robert Spencer Giglio, Sarah Anderson, Farnaz Haji

{"title":"A Hidden Hurdle: The Plastic Surgery Bottleneck in Breast Cancer Care.","authors":"Emily Orosco, Bradley Jensen, Robert Spencer Giglio, Sarah Anderson, Farnaz Haji","doi":"10.1177/00031348261448892","DOIUrl":"10.1177/00031348261448892","url":null,"abstract":"Timely surgical intervention is critical in breast cancer, with consensus supporting surgery within eight weeks of diagnosis to optimize survival. Immediate breast reconstruction (IBR) has been associated with delays related to insurance status, socioeconomic factors, race, and reconstructive intent. While barriers to accessing IBR have been studied, few investigations have quantified their impact on surgical timing and outcomes. A literature review was conducted using PubMed to identify studies published between 2015 and 2025 that examined time to definitive breast cancer surgery in relation to reconstructive intent, access to IBR, or barriers to reconstruction. Eligible studies included randomized controlled trials, cohort studies, and meta-analyses involving human participants and published in English. Data extracted included study design, patient population, and reported outcomes. Twelve studies met inclusion criteria representing over 1.69 million patients. Across studies, IBR was associated with increased time to definitive surgery compared with mastectomy alone, with reported delays ranging from several days to a few weeks. These delays were statistically significant but generally clinically modest. Patient-, institutional-, and system-level barriers to IBR were identified, including reconstructive surgeon availability, geographic disparities, insurance status, and socioeconomic factors, though operative timing was infrequently evaluated as a primary outcome. IBR is associated with delays in definitive breast cancer surgery, yet the mechanisms remain poorly defined. Identifying and addressing these barriers could reduce surgical delays and potentially impact survival. Our review highlights current gaps in the literature and emphasizes the need for targeted research to optimize timely, equitable access to reconstruction without compromising oncologic outcomes.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2546-2551"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832421","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

Explant and Bypass for Polymicrobial Mycotic Pseudoaneurysm Following Renal Transplant. 肾移植后多微生物真菌性假性动脉瘤的移植与搭桥治疗。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-05-31 DOI: 10.1177/00031348261457568

Hanna D Sun, William J Lain, Erin Buchanan, Margaret C Tracci

{"title":"Explant and Bypass for Polymicrobial Mycotic Pseudoaneurysm Following Renal Transplant.","authors":"Hanna D Sun, William J Lain, Erin Buchanan, Margaret C Tracci","doi":"10.1177/00031348261457568","DOIUrl":"10.1177/00031348261457568","url":null,"abstract":"Mycotic pseudoaneurysms in renal transplant patients are rare but serious complications associated with significant morbidity, graft loss, and mortality. They present a critical management challenge between endovascular salvage and definitive surgical explant. While contemporary reports suggest endovascular techniques can successfully treat this condition, their role as definitive treatment in fungal fields is controversial. We report a case where repeated endovascular stent treatment of a polymicrobial fungal and bacterial pseudoaneurysm perpetuated biofilm formation and polymicrobial colonization, enabling ongoing infection and ultimately requiring explant and femoral-femoral bypass for definitive source control and revascularization. This case highlights an important decision threshold: in the setting of angioinvasive molds, endovascular salvage is often futile, with recent series showing a high failure rate for allograft preservation. Recognition of persistent pain and recurrent fluid collections following endovascular therapy should trigger early surgical source control with infection-resistant conduits, such as autologous or cryopreserved allografts, rather than endovascular temporization.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2688-2690"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101154","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

Photodynamic Therapy as an Adjunct During Stent-Bridged Neoadjuvant Management of Obstructive Colon Cancer: A Case-Based Narrative Review. 光动力疗法在梗阻性结肠癌支架搭桥新辅助治疗中的辅助作用：一项基于病例的叙述性回顾。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-04-09 DOI: 10.1177/00031348261441681

Ben Liu, Zhen Ma, Zhuanfang Wang, Lijuan He, Qinying Han, Hao Chen

{"title":"Photodynamic Therapy as an Adjunct During Stent-Bridged Neoadjuvant Management of Obstructive Colon Cancer: A Case-Based Narrative Review.","authors":"Ben Liu, Zhen Ma, Zhuanfang Wang, Lijuan He, Qinying Han, Hao Chen","doi":"10.1177/00031348261441681","DOIUrl":"10.1177/00031348261441681","url":null,"abstract":"Malignant left-sided large-bowel obstruction remains a high-risk presentation that often requires urgent decompression. Self-expanding metal stents (SEMS) can convert an emergency to an elective operation and may create a window for staging, multidisciplinary planning, and (in selected patients) neoadjuvant systemic therapy. Photodynamic therapy (PDT) is a light-activated, locally delivered ablative modality that has been used historically for palliation or local control of colorectal and pelvic recurrences, but its role in contemporary management of obstructing colon cancer remains investigational. We present an anchoring case of obstructive rectosigmoid adenocarcinoma managed with endoscopic SEMS placement, interval endoluminal PDT, followed by systemic neoadjuvant therapy and curative resection with a pathologic complete response. Using this case as a framework, we review established management pathways for obstructing left-sided colon cancer (emergency surgery, diversion, and SEMS as a bridge to surgery), summarize evidence and guideline positions on SEMS and neoadjuvant therapy for resectable colon cancer, and synthesize the limited clinical literature describing PDT in colorectal malignancy. We emphasize that, given the multimodal sequence and existing evidence base, PDT should be viewed as a potential adjunct to-rather than a replacement for-SEMS, systemic therapy, or standard oncologic surgery. This case illustrates technical feasibility and conceptual integration, but does not establish efficacy; prospective study is needed to define patient selection, timing, and safety.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2601-2605"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643780","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

Right-Sided Versus Left-Sided Pneumonectomy in Trauma: A Nationwide Analysis. 创伤右侧与左侧全肺切除术：一项全国性的分析。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-04-15 DOI: 10.1177/00031348261443335

Negar Nekooei, Delbrynth P Mitchao, C Isabella Bent, Matthew J Ashbrook, Kemp Anderson, Cameron A Ghafil, Alberto Aiolfi, Takashi Harano, Kenji Inaba, Kazuhide Matsushima

{"title":"Right-Sided Versus Left-Sided Pneumonectomy in Trauma: A Nationwide Analysis.","authors":"Negar Nekooei, Delbrynth P Mitchao, C Isabella Bent, Matthew J Ashbrook, Kemp Anderson, Cameron A Ghafil, Alberto Aiolfi, Takashi Harano, Kenji Inaba, Kazuhide Matsushima","doi":"10.1177/00031348261443335","DOIUrl":"10.1177/00031348261443335","url":null,"abstract":"BackgroundPneumonectomy remains a rare trauma procedure due to its high morbidity and mortality. While previous studies suggest that right-sided pneumonectomy is associated with a higher mortality in patients with lung cancer, there are scarce data in trauma. We aimed to compare patient outcomes following right-sided and left-sided pneumonectomy after trauma.MethodsThis is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016-2022). Trauma patients (age ≥16 years) who underwent pneumonectomy were included and stratified by the laterality of pneumonectomy. Patient baseline characteristics, injury profile, and clinical outcomes were compared between the right- and left-sided pneumonectomy groups. Multivariable analysis was performed to evaluate the association between the laterality of pneumonectomy and in-hospital mortality.ResultsA total of 301 patients were included. The median age was 30 years, and 85.3% were male. Of those, 137 patients (45.5%) underwent right-sided pneumonectomy. Admission vital signs and Injury Severity Score were comparable between the right- and left-sided groups. Extracorporeal membrane oxygenation (ECMO) was used more frequently in right-sided pneumonectomy patients (8.8% vs 2.4%, P = 0.015). In-hospital mortality following right- and left-sided pneumonectomy was 54.0% and 48.2%, respectively (P = 0.313). In the multivariable logistic regression, right-sided pneumonectomy was not associated with increased odds of in-hospital mortality (adjusted odds ratio: 1.137, confidence interval: 0.641-2.015, P = 0.662).ConclusionThis study suggests that the laterality of pneumonectomy was not associated with an increased risk of in-hospital mortality. Future research should evaluate the utility of ECMO in trauma patients requiring pneumonectomy.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2736-2743"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687391","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

Corrigendum to "Local Anesthesia Is Associated With Lower Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysm". “局部麻醉与腹主动脉瘤破裂血管内修复术后较低死亡率相关”的更正。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-06-03 DOI: 10.1177/00031348261457116

引用次数: 0

Bedside Exploratory Laparotomy: Factors Associated With Mortality and Clinical Implications in Critically - Ill Patients. 床边剖腹探查术：危重病人死亡率及临床意义的相关因素。

IF 1 4区医学

American Surgeon Pub Date : 2026-10-01 Epub Date: 2026-04-15 DOI: 10.1177/00031348261443341

Jason M Aubrey, Apoorva Ojha, Matthew J Morris, Hannah R Liefeld, Aryana M Sharrak-Sitto, Lindsay E Burdett, Cathryn L Chadwick, Mathew Chung, G Paul Wright

{"title":"Bedside Exploratory Laparotomy: Factors Associated With Mortality and Clinical Implications in Critically - Ill Patients.","authors":"Jason M Aubrey, Apoorva Ojha, Matthew J Morris, Hannah R Liefeld, Aryana M Sharrak-Sitto, Lindsay E Burdett, Cathryn L Chadwick, Mathew Chung, G Paul Wright","doi":"10.1177/00031348261443341","DOIUrl":"10.1177/00031348261443341","url":null,"abstract":"Background: Bedside exploratory laparotomy is a heroic intervention for unstable patients who cannot be transported to the operating room. Given a previously documented high mortality rate, some argue against the procedure on assumption of non-beneficence. This study aims to evaluate procedural mortality rate and identify physiologic factors associated with death after bedside exploration.Methods: A single-center, retrospective review of consecutive patients who underwent bedside exploratory laparotomy between 2019 and 2024 was conducted. Patients were stratified into cohorts based on a composite outcome of in-hospital or 30-day survival, and an analysis was conducted to identify factors associated with mortality.Results: A total of 51 patients underwent bedside exploratory laparotomy, with a mortality rate of 82.4% (42/51) within 30 days or during index hospitalization. The median postoperative time to death was 18.1 hours. Mortality rates were 73.9% in SICU, 90.0% in MICU, and 88.2% in CTICU. Survivors were younger than non-survivors (46.5 vs. 60.8 years; p = 0.025) and had lower Charlson Comorbidity Index scores (2 vs. 4; p = 0.0011). Preoperative lactate was lower (4.12 vs. 10.16 mmol/L; p = 0.0012) and pH higher (7.30 vs. 7.20; p = 0.042) in survivors. Significant intraoperative findings were more frequent in non-survivors (95% vs. 33%; p < 0.001).Conclusion: Bedside exploratory laparotomy is a last-resort intervention with exceedingly high mortality. We observed older patients with significant acidosis or identifiable intraoperative findings have worse prognoses. Preoperative goals-of-care discussions should be prioritized in elderly patients before proceeding with bedside exploration to ensure ethical delivery of surgical care.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2700-2706"},"PeriodicalIF":1.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687898","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