American Surgeon最新文献

{"title":"Contemporary Nationwide Assessment of Resource Utilization and Perioperative Outcomes in Open and Minimally Invasive Pancreaticoduodenectomy.","authors":"Bibek Aryal, Yue Yin, Edward A Joseph, David L Bartlett, Sricharan Chalikonda, Casey J Allen","doi":"10.1177/00031348241307401","DOIUrl":"https://doi.org/10.1177/00031348241307401","url":null,"abstract":"<p><p><b>Background:</b> While minimally invasive pancreaticoduodenectomy (MIPD) has historically demonstrated benefits over open pancreaticoduodenectomy (OPD), recent advances in perioperative care and surgical techniques may have impacted the relative advantages of these two approaches. This contemporary analysis examines national trends to assess potential differences in resource utilization metrics along with perioperative outcomes between the two approaches. <b>Methods:</b> We analyzed the Nationwide Inpatient Sample database for cancer patients who underwent pancreaticoduodenectomies from 2016 through 2020. We compared socio-demographics, length of stay (LOS), total charges, and perioperative complications between MIPD and OPD. <b>Results:</b> In this observational study, MIPD was associated with lower total charges ($97,470 vs $126,586), shorter LOS (5.05 vs 7.37 days), and lower odds of perioperative complications (OR 1.40, 95% CI 1.18-1.65) compared to OPD. While total charges increased similarly in both groups over time, a declining trend in LOS was observed for OPD (11.49 to 10.36 days). Non-white race and private/other insurance correlated with longer stays, higher charges, and more complications regardless of surgical approach. <b>Conclusions:</b> Despite the gradual improvements in LOS observed with OPD, MIPD demonstrated advantages in resource utilization metrics, indicating potential for reduced healthcare utilization and costs compared to the open surgical approach during the study period. Continued prospective investigation is warranted to comprehensively evaluate MIPD's value proposition.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241307401"},"PeriodicalIF":1.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799035","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 Stomal Stent: A Novel Bridging Therapy for Patients Requiring Delayed Ostomy Revision.","authors":"Mason Henrich, Bianca Fischer, Jun Tashiro","doi":"10.1177/00031348241307398","DOIUrl":"https://doi.org/10.1177/00031348241307398","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241307398"},"PeriodicalIF":1.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799042","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":"Socioeconomic and Racial Disparities in the Use of Robotic-Assisted Proctectomy in Rectal Cancer.","authors":"Sameh Hany Emile, Zoe Garoufalia, Rachel Gefen, Giovanna Dasilva, Steven D Wexner","doi":"10.1177/00031348241304013","DOIUrl":"https://doi.org/10.1177/00031348241304013","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer surgery is technically demanding, especially in males. Robotic assistance may help overcome these challenges. This study aimed to identify factors associated with robotic-assisted proctectomy in rectal cancer.</p><p><strong>Methods: </strong>Retrospective case-control analysis of patients with clinical stage I-III rectal adenocarcinoma who underwent proctectomy from the National Cancer Database (2010-2019) was conducted. Univariable and multivariable binary logistic regression analyses were conducted to determine predictive factors of robotic-assisted proctectomy in rectal cancer.</p><p><strong>Results: </strong>67 145 patients (60.9% male; mean age: 61.15 ± 12.49 years) were included. 44.7% had stage III disease and 66.2% received neoadjuvant radiation. The surgical approach was laparotomy (n = 29 725), laparoscopy (n = 21 657), and robotic-assisted proctectomy (n = 15 763). Independent predictors for the use of robotic-assisted proctectomy were age <50 years (OR: 1.06; <i>P</i> = .032), male sex (OR: 1.07, <i>P</i> < .001), Asian race (OR: 1.25; <i>P</i> < .001), private insurance (OR: 1.25; <i>P</i> < .001), rectal cancer treatment between 2015 and 2019 (OR: 3.52; <i>P</i> < .001), stage III disease (OR: 1.06; <i>P</i> = .048), neoadjuvant radiation (OR: 1.26; <i>P</i> < .001), and pull-through coloanal anastomosis (OR: 1.15; <i>P</i> < .001). Robotic-assisted surgery was less often used in Black (OR: .857, <i>P</i> < .001) and American Indian patients (OR: .62, <i>P</i> = .002) and those with a Charlson score = 3 (OR: .818, <i>P</i> = .002), living in rural areas (OR: .865, <i>P</i> = .033), who were uninsured (OR: .611, <i>P</i> < .001), and undergoing pelvic exenteration (OR: .461, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Demographic and insurance disparities of robotic-assisted proctectomy are Black and American Indian patients and those with higher Charlson comorbidity index scores and uninsured patients were less likely to undergo robotic-assisted proctectomy. While patients with advanced disease and/or received neoadjuvant radiation were more likely to undergo robotic-assisted proctectomy, robotic-assisted surgery was less often performed in pelvic exenteration.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241304013"},"PeriodicalIF":1.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765398","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":"Juan Miguel Acosta: His Revolutionary Contribution to Our Understanding of the Pathophysiology of Gallstone Pancreatitis.","authors":"Luigi S Pianetti, Lauren N Smith, Christian M de Virgilio","doi":"10.1177/00031348241303996","DOIUrl":"10.1177/00031348241303996","url":null,"abstract":"<p><p>It is not every day that true scientific pioneers come along. Fortunately, the early 20^th century gifted us with immensely talented professionals like Dr Eugene Opie, who set the groundwork for Dr Juan Acosta and his associates to make revolutionary advancements on the pathophysiologic origin and proper management of acute biliary pancreatitis. Amidst a modest hospital in the city of Rosario, Argentina, Dr Acosta pioneered numerous studies to validate his hypothesis that transient gallstone obstruction of the lumen was the true source of acute biliary pancreatitis. His findings, along with his mentorship within his residency program, and his dedication to improving patient outcomes, have cemented his name into patient care as we know it today. The goal of this paper is to outline the relentless dedication of Dr Acosta to the improvement of patient care and pancreatitis management.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241303996"},"PeriodicalIF":1.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765395","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":"A Criteria to Reduce Interhospital Transfer of Traumatic Brain Injuries in Greater East Texas.","authors":"Jason Murry, Alan D Cook, Rebecca J Swindall, Hirofumi Kanazawa, Carly R Wadle, Musharaf Mohiuddin, Stephen V Nalbach, Tuan D Le, Brandi N Pero, Scott H Norwood","doi":"10.1177/00031348241266632","DOIUrl":"10.1177/00031348241266632","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) due to single-level falls (SLF) are frequent and often require interhospital transfer. This retrospective cohort study aimed to assess the safety of a criteria for non-transfer among a subset of TBI patients who could be observed at their local hospital, vs mandatory transfer to a level 1 trauma center (L1TC).</p><p><strong>Methods: </strong>We conducted a 7-year review of patients with TBI due to SLF at a rural L1TC. Patients were classified as transfer/non-transfer according to the Brain Injuries in Greater East Texas (BIGTEX) criteria. The primary outcome measure was the occurrence of a critical event defined as deteriorating repeat head computed tomography (CT) scan or neurological status, neurosurgical intervention, or death.</p><p><strong>Results: </strong>Of the 689 included patients, 63 (9.1%) were classified as non-transfer. Although there were 4 cases with a neurological change and one with a head CT change among the non-transfer group, there were no neurosurgical procedures or deaths. The Cox Proportional Hazard model showed a near 3-fold increased risk of experiencing a critical event if classified as a non-transfer. The multivariable regression model showed patients with an Abbreviated Injury Scale (AIS) of 3 was twice as likely to experience a critical event, with an AIS of 4, three times, and 3 times more likely to be classified to transfer.</p><p><strong>Discussion: </strong>The BIGTEX criteria identify a subset of patients who can safely be observed at their local hospital. To confirm the safety and efficacy of this transfer criteria recommendation, a prospective study is warranted.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3201-3208"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141722889","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":"Safety Study of Percutaneous Gastroscopic Gastrostomy in Patients After Ventriculoperitoneal Shunt.","authors":"Dexian Wang, Run Peng, Yebin Huang, Jun Zhou, Zhihua Long, Jianjun Wang, Dejian Zhang","doi":"10.1177/00031348241265147","DOIUrl":"10.1177/00031348241265147","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge.</p><p><strong>Results: </strong>In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications.</p><p><strong>Conclusion: </strong>Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3262-3266"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726794","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":"Superior Mesenteric Artery to Gastric Artery Bypass to Correct Diffuse Gastric Ischemia in a Patient With Diffuse Vasculopathy, Congenital Absence of the Celiac Axis, and Previous Splenectomy From Trauma.","authors":"Clarisse S Muenyi, Elizabeth Gaudio, Erica L Mitchell, Evan S Glazer, Leonard Baidoo, Denis Foretia, Nia Zalamea","doi":"10.1177/00031348241265148","DOIUrl":"10.1177/00031348241265148","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3297-3300"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730980","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":"Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis.","authors":"Rashid Murtaza, Olivia Clarke, Tharshan Sivakanthan, Hashim Al-Sarireh, Ahmad Al-Sarireh, Muhammad Musa Raza, Ahmad Zia Navid, Baqar Ali, Shahin Hajibandeh, Shahab Hajibandeh","doi":"10.1177/00031348241265149","DOIUrl":"10.1177/00031348241265149","url":null,"abstract":"<p><strong>Aims: </strong>The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection.</p><p><strong>Methods: </strong>The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection. Postoperative ileus and length of hospital stay were the primary outcomes, and time to first bowel motion was the secondary outcome. Random-effects modeling was applied for analyses.</p><p><strong>Results: </strong>Analysis of 94 833 patients from 26 studies showed that alvimopan was associated with lower risk of postoperative ileus (OR: .57, 95% CI .48 to .67, <i>P</i> <.00001; high GRADE certainty), shorter length of hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, <i>P</i> < .00001; moderate GRADE certainty), and shorter time to first bowel motion (MD: -.43 day, 95% CI -.58 to -.28, <i>P</i> < .00001; moderate GRADE certainty). Separate analyses of randomized controlled trials and observational studies showed similar findings. Subgroup analyses suggested consistent findings in patients undergoing elective bowel resection, emergency bowel resection, and open surgery; however, alvimopan did not improve the outcomes in patients undergoing minimally invasive surgery.</p><p><strong>Conclusion: </strong>Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3272-3283"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730975","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 Role of Adrenalectomy in the Management of Cryptococcal Infection.","authors":"Grace A Proffitt, Meghan E Hovell, John G Little, Mahmoud A Shorman, Laurentia M Nodit, Tanaz M Vaghaiwalla","doi":"10.1177/00031348241265138","DOIUrl":"10.1177/00031348241265138","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3294-3296"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730981","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":"Successful Liver Transplant From a Donor With Sickle Cell Disease.","authors":"Kaitlin Pardue, Molly Timmerman, Shaima Elgenaid, Lewis Hassell, Narendra R Battula, Maheswaran Pitchaimuthu","doi":"10.1177/00031348241268273","DOIUrl":"10.1177/00031348241268273","url":null,"abstract":"<p><p>Sickle cell disease patients have routinely been excluded from liver transplant donation due to patients historically manifesting liver disease themselves. Marginal donors have become increasingly more welcome given organ shortage. Our institution performed a liver transplant in a recipient with cholangiocarcinoma using a sickle cell disease donor liver. Postoperatively, patient progressed well and is now cancer free. Pathology indicated sickle cells, and hemosiderin present at time of transplant had largely resolved by repeat biopsy on postoperative day 5. We conclude that sickle cell disease patients should be considered as donors for liver transplant in the appropriate setting.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3301-3304"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756678","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}