American Surgeon最新文献

{"title":"Small Bowel Obstruction Following Congenital Diaphragmatic Hernia Repair-Incidence and Risk Factors.","authors":"Nicholas Schmoke, Francesca Cali, Terri Wilken, Devin Midura, Christopher Nemeh, Weijia Fan, Julie Khlevner, Vincent Duron","doi":"10.1177/00031348241266633","DOIUrl":"10.1177/00031348241266633","url":null,"abstract":"<p><strong>Background: </strong>Small bowel obstruction (SBO) is a known complication following congenital diaphragmatic hernia (CDH) repair, resulting in significant morbidity and potential mortality. Our study aims to evaluate the incidence and risk factors for SBO following CDH repair.</p><p><strong>Methods: </strong>A single-institution retrospective review evaluated all CDH births between January 2010 and September 2022 (n = 120). Risk factors for SBO were analyzed, including operative approach, type of repair, need for extracorporeal membrane oxygenation (ECMO), and additional abdominal surgeries (gastrostomy tube and fundoplication).</p><p><strong>Results: </strong>120 patients were included. 16 (13%) patients developed an SBO, of which 94% were due to adhesive bands. The median time to SBO was 7.5 months. 15/16 (94%) patients required operative intervention. Need for ECMO (<i>P</i> < 0.01), prior gastrostomy tube (<i>P</i> < 0.01), and prior fundoplication (<i>P</i> < 0.01) were associated with an increased risk of SBO, as were longer time to initial CDH repair (6 days vs 3 days; <i>P</i> < 0.01) and longer length of initial hospitalization (63 days vs 29 days; <i>P</i> = 0.01).</p><p><strong>Discussion: </strong>Neonates with increased acuity of illness (ie, those requiring ECMO, additional abdominal operations, longer time to repair, and longer initial hospitalizations) appear to have an increased risk of developing adhesive SBO after CDH repair. More than 90% of patients who developed SBO required surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3223-3228"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730979","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":"Influence of Trauma Patients Aged ≥55 With PEC in Long Stay in the Hospital and Intensive Care Unit.","authors":"Zulmari Resto, Ilko Luque, Nicole López, Hector Mendez, Mariel Javier, Marcela Ramirez, Orlando Morejón, Mark McKenney","doi":"10.1177/00031348241304041","DOIUrl":"https://doi.org/10.1177/00031348241304041","url":null,"abstract":"<p><strong>Background: </strong>Trauma and pre-existing conditions (PECs) can independently impact patient hospital length of stay (H-LOS) or intensive care unit (ICU) ICU-LOS. Pre-existing conditions impact on LOS has rarely been studied in older trauma patients aged ≥55. Our purpose is to examine the relationship between PEC status and ICU-LOS and H-LOS in this population.</p><p><strong>Methods: </strong>This is a 3-year retrospective study, for calendar years 2020 through 2022. Multiple linear regression was used for analysis. Confounding factors were controlled for. Statistical significance was defined as <i>P</i> < 0.05.</p><p><strong>Results: </strong>There were 5168 patients (54.9% female) reviewed. The age breakdown was 51.6% were 70-80 years old. The injury breakdown showed 49.1% mild injury. The mean H-LOS was 6.00 and mean ICU-LOS was 2.55. Having certain PECs increases H-LOS, including congestive heart failure (CHF) by 2.29 days (<i>P</i> < 0.001), chronic obstructive pulmonary disease (COPD) by 1.10 days (<i>P</i> < 0.001), and chronic renal failure (CRF) by 0.96 days (<i>P</i> = 0.02). Increases in ICU-LOS were associated with having certain PECs, specially CRF by 1.03 days (<i>P</i> < 0.001) and CHF by 1.47 days (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Older trauma patients aged ≥55 with certain PECs had an associated increase in ICU and hospital length of stay. Identifying PEC is essential for the care and management of any patient. Identification of PECs on injured patients is essential since this can prolong the LOS. Early involvement of specialists in patient care directed to each PEC may improve these outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241304041"},"PeriodicalIF":1.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754579","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":"Long-Term Reoperation Rates Following Pancreatoduodenectomy for Pancreatic Adenocarcinoma.","authors":"Chi Zhang, Lauren Lu, Kristine Hanson, Ahmer Sultan, Patrick Starlinger, Rory Smoot, Michael L Kendrick, Mark Truty, Susanne G Warner, Cornelius Thiels","doi":"10.1177/00031348241304021","DOIUrl":"https://doi.org/10.1177/00031348241304021","url":null,"abstract":"<p><strong>Background: </strong>Short-term outcomes after pancreatoduodenectomy (PD) are well-studied, but long-term reoperation rates and their indications remain poorly characterized.</p><p><strong>Methods: </strong>A single-center retrospective chart review was performed on patients who underwent PD for pancreatic adenocarcinoma between 1/2011 and 12/2021. Reoperations occurring >90 days after PD were dichotomized to being related or unrelated to the index PD or pancreatic adenocarcinoma. The Kaplan-Meier analysis estimated the incidence of long-term reoperation at 1 and 5 years postoperatively.</p><p><strong>Results: </strong>Six-hundred twenty-eight patients were included. The 5-year incidence of any additional operation >90 days after PD was 30.0% (95% CI 23.2-36.2%), and the 5-year incidence of any long-term related reoperation was 21.2% (95% CI 15.0-26.8%). The most common indications for reoperations by 5-year incidence were cancer recurrence (12.8%, 95% CI 7.6-17.7%), incisional hernia (6.2%, 95% CI 2.6-9.7%), small bowel obstruction (1.3%, 95% CI 0.2-2.4%), and leak, fistula, or infection (1.0%, 95% CI 0.1-2.0%). Of the examined risk factors, only 90-day reoperation was found to be predictive of long-term related reoperations (<i>P</i> = 0.02). Additionally, the 5-year incidence of endoscopic or interventional radiology procedures was 20.2% (95% CI 14.5-25.4%). However, 40.9% (95% CI 33.6-47.3%) of patients required additional surgery or procedures of any kind between 90 days and 5 years after PD.</p><p><strong>Discussion: </strong>Within 5 years of PD, one in three patients required additional surgery, and one in five had operations for related indications. Related reoperative indications included recurrence, hernia, PD-specific complications, and small bowel obstruction. However, the rates of each of these reoperations were relatively low.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241304021"},"PeriodicalIF":1.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754582","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 Association Between Body Mass Index and 28-day Mortality in Patients With Sepsis: A Retrospective Cohort Study.","authors":"Xu Zhang, Weiwei Yuan, Tingting Li, Haiwang Sha, Zhiyan Hui","doi":"10.1177/00031348241304040","DOIUrl":"https://doi.org/10.1177/00031348241304040","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a severe clinical syndrome with high morbidity and mortality in intensive care units (ICUs). Body Mass Index (BMI) shows a rising trend of obese patients being admitted to ICUs. The relationship between BMI and the clinical outcome of sepsis remains highly debated.</p><p><strong>Methods: </strong>The data used in this study were sourced from the Intensive Care Information Center IV (MIMIC-IV) database. Baseline information extracted within 24 hours of ICU admission was categorized according to World Health Organization (WHO)'s BMI classifications. A multivariate Cox regression model and curve fitting assessed the independent correlation between BMI and the primary outcome.</p><p><strong>Results: </strong>A total of 7836 patients were included in the study and categorized into five groups based on BMI. The overall 28-day mortality rate was 21.94% (1719/7836). Class I obesity (17.14%) and class II/III obesity (13.49%) individuals tended to be younger and male. Compared to patients with normal BMI (32.55%), those with low BMI (5.79%) had a 47% increased risk of 28-day mortality (HR 1.47, 95% CI 1.16-1.85, <i>P</i> = 0.0013), while class II/III obesity patients had a 17% lower 28-day mortality rate (HR 0.83, 95% CI 0.71-0.97, <i>P</i> = 0.0218). Curve fitting revealed a nonlinear relationship between BMI and 28-day mortality. The Kaplan-Meier survival analysis highlighted variations in survival rates across the five groups (<i>P</i> = 0.0123), with underweight patients exhibiting poorer survival outcomes.</p><p><strong>Conclusion: </strong>In sepsis patients, a low BMI is related to higher 28-day mortality compared to those with a normal BMI. Conversely, patients with a BMI≥35 kg/m² have significantly reduced mortality risks.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241304040"},"PeriodicalIF":1.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738130","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":"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":"https://doi.org/10.1177/00031348241304008","url":null,"abstract":"<p><strong>Background: </strong>For difficult cholecystectomies, bail out procedures (BOP) are performed to mitigate risk of patient harm.</p><p><strong>Objective: </strong>This 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.</p><p><strong>Results: </strong>Of 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).</p><p><strong>Conclusion: </strong>The 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":"31348241304008"},"PeriodicalIF":1.0,"publicationDate":"2024-11-28","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":"Efficacy and Validity of Percutaneous Transhepatic Gallbladder Drainage as a Bridge to Surgery for Octogenarian and Older Patients With Acute Cholecystitis: A Single-Center Retrospective Observational Study in Japan.","authors":"Satoshi Nishiwada, Tetsuya Tanaka, Teruyuki Hidaka, Yuki Kirihataya, Takeshi Takei, Tomomi Sadamitsu, Takuma Morimoto, Kengo Hata, Masaru Enoki, Yui Osaki, Kazusuke Matsumoto, Hazuki Horiuchi, Yasushi Okura, Masayoshi Sawai, Atsushi Yoshimura","doi":"10.1177/00031348241304047","DOIUrl":"https://doi.org/10.1177/00031348241304047","url":null,"abstract":"<p><strong>Background: </strong>Japan currently has a super-aged society, with a rapid increase in elderly patients in need of medical care. Determining treatment strategies for acute cholecystitis (AC) in very elderly patients with various comorbidities is often difficult. Although percutaneous cholecystostomy (PC) is a less-invasive treatment option, its impact on subsequent surgery remains debatable. This study investigated the validity of PC as a bridge to surgery in very elderly patients with AC.</p><p><strong>Methods: </strong>Of 215 patients who underwent cholecystectomy for AC at our hospital, we retrospectively investigated 83 patients aged ≥80 years-53 and 30 who underwent upfront surgery (US) and PC before surgery, respectively-to assess the treatment strategies and clinical course.</p><p><strong>Results: </strong>The PC group had a significantly worse systemic status at diagnosis than the US group, including age, severity grading, comorbidities, performance status, systemic inflammatory status, and blood coagulation abnormalities, which improved after PC. The elective surgery rate was significantly higher in the PC group than in the US group. Despite the high number of severe cases in the PC group, surgical quality indicators, including the conversion rate to open surgery, operative time, blood loss, and critical view of safety achievement rate, tended to be better in the PC group, without severe perioperative complications.</p><p><strong>Discussion: </strong>PC followed by cholecystectomy improves preoperative conditions, including systemic inflammation status and blood coagulation abnormalities, in very elderly patients, allowing safe elective surgical treatment while securing the quality of surgery and clinical outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241304047"},"PeriodicalIF":1.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709030","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":"Letter re: \"Open Versus Minimally Invasive Emergent Colectomy for Diverticulitis\".","authors":"Uday Singh Dadhwal, Mohamed Arsath Shamsudeen","doi":"10.1177/00031348241304003","DOIUrl":"https://doi.org/10.1177/00031348241304003","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241304003"},"PeriodicalIF":1.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715217","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":"Outcomes After Duodenoduodenostomy for Superior Mesenteric Artery Syndrome.","authors":"Darwin Ang, Alana Hofmann, Abdelrahman Attili, Whiyie Sang, Tandis Soltani, Winston Richards, Laurence Ferber, Dana Taylor","doi":"10.1177/00031348241300361","DOIUrl":"10.1177/00031348241300361","url":null,"abstract":"<p><strong>Background: </strong>Superior Mesenteric Artery Syndrome (SMAS) is a very rare disease that causes starvation and malnutrition secondary to a mechanical obstruction of the 3^rd portion of the duodenum between the superior mesenteric artery and aorta. Long-term outcomes following surgery for SMAS by current methods have a high failure rate of 21%-67%. We report the 3-year outcomes of a novel operation for SMAS described as the duodenoduodenostomy (DD).</p><p><strong>Methods: </strong>This is a longitudinal case series of 12 patients who underwent the DD operation for SMAS, comparing pre-surgery to post-surgery 3-year outcomes. Weight, Body Metabolic Index (BMI), iron levels, and subjective data were collected to assess restoration of nutrition, correction of malabsorption, and lifestyle. The Wilcoxon signed-rank test was applied to nonparametric matched or dependent samples, with statistical significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>At the end of 3 years, there was a significant increase in median weight and BMI, at 108 lbs vs 123.1 lbs (<i>P</i>-value 0.0156) and a BMI of 18.57 vs 20.59 (<i>P</i>-value 0.0161). At 3 months, iron levels normalized after surgery and stayed normal at 45 mcg/dL vs 130 mcg/dL (<i>P</i>-value = 0.046). After 3 years, 75% of patients gained weight and BMI while 83% were able to maintain their BMI to a normal range.</p><p><strong>Conclusion: </strong>Our study demonstrates that DD surgery leads to significant increases in weight and BMI, accompanied by improved iron levels. The DD procedure emerges as a promising surgical option in the definitive treatment for SMAS.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300361"},"PeriodicalIF":1.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680566","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":"Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis.","authors":"İlyas Kudaş, Fatih Başak, Yahya K Çalışkan, Aylin Acar, Hüsna Tosun","doi":"10.1177/00031348241300362","DOIUrl":"10.1177/00031348241300362","url":null,"abstract":"<p><strong>Background: </strong>Malignancy in pilonidal sinus disease (PSD) is rare, with squamous cell carcinoma (SCC) being the most common type. This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023. Patients with incomplete or missing histopathological data were excluded, and no imputation methods were used for missing data. All specimens underwent histopathological examination to detect malignancies.</p><p><strong>Results: </strong>Two cases (0.13%) of SCC were identified, both in males aged 50 and 58 years without a history of Crohn's disease, HIV, prior radiation, or other cancers. Significant risk factors for malignancy included age over 40 years (OR 3.2, 95% CI 1.1-9.5) and disease duration over 3 years (OR 2.8, 95% CI 1.0-7.6). Both cases were treated surgically and received adjuvant radiotherapy, with both patients being disease-free at the 2-year follow-up.</p><p><strong>Conclusion: </strong>While malignancy in PSD is rare (0.13%), older age and prolonged disease duration are associated with increased risk. Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300362"},"PeriodicalIF":1.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612377","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":"Letter re: Acute Appendicitis in the Epicenter of the COVID-19 Pandemic: A New York City Single-Center Experience.","authors":"Camilla Mattiuzzi, Giuseppe Lippi","doi":"10.1177/00031348241300359","DOIUrl":"https://doi.org/10.1177/00031348241300359","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300359"},"PeriodicalIF":1.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638563","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}