American Surgeon最新文献

{"title":"Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities.","authors":"Jacob M Tupa, Hunter T Row, Greta C Schwartz, Ashley L Matter, Elena J Danielson, Abe E Sahmoun, Thomas A Haldis, Cornelius M Dyke","doi":"10.1177/00031348241300364","DOIUrl":"https://doi.org/10.1177/00031348241300364","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe aortic stenosis (AS). It remains unclear whether disparities exist in rural or socially vulnerable populations undergoing TAVR. This study assessed whether outcomes differ based on geographic location or vulnerability of patients undergoing TAVR.</p><p><strong>Methods: </strong>Patients undergoing TAVR at a single institution from August 2012 to June 2023 were studied (n = 1565). Zip codes determined Social Vulnerability Index (SVI) and measured distance to our facility. Outcomes defined by the Valve Academic Research Consortium 3 (VARC-3) included stroke, transient ischemic attack (TIA)/delirium, pacemaker implantation, new atrial fibrillation/atrial flutter, and myocardial infarction (MI). Average time between preoperative coronary angiogram (CATH)/computed tomography angiography (CTA) and TAVR was calculated. Kaplan-Meier curves estimated survival probability.</p><p><strong>Results: </strong>The average time between CATH and TAVR in patients living furthest away was ∼9 days more than patients living closest to the implant site. The average number of days between CATH and TAVR for low and high SVI were 71 and 78 days, respectively. The average number of days between CTA and TAVR for low and high SVI were 40 and 39 days, respectively.</p><p><strong>Discussion: </strong>Further distances traveled were associated with longer wait times between preoperative workup and TAVR. Patients with longer waits between CATH and TAVR had no differences in medium-term survival probability but had decreased long-term survival probability compared to patients with rapid pre-procedural evaluation. Although geographic and socioeconomic vulnerability can disadvantage patients, our study demonstrates that patients undergoing TAVR can have timely care and similar outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300364"},"PeriodicalIF":1.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612385","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 Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review.","authors":"Mariel Javier, Ilko Luque, Jaclyn Kliewer, Nicole Yordan Lopez, David Ritchie, Beatriz Cobo Dominguez, Orlando Morejon","doi":"10.1177/00031348241300368","DOIUrl":"https://doi.org/10.1177/00031348241300368","url":null,"abstract":"<p><strong>Background: </strong>The death of trauma patients with low injury severity scores (ISS) may not be fully explained by the severity of their injuries. Our objective was to evaluate preexisting conditions (PECs) that may contribute to the mortality rate of and hospital resources consumed by patients with low ISS.</p><p><strong>Methods: </strong>Trauma patients with ISS <9 were selected from the National Trauma Database Bank [NTDB] [2019-21]. Bivariate and multivariate analysis identified the risk factors associated with mortality, adjusting for secondary PECs, mechanism of injury, AIS body region, vital signs, and blood transfusion. A <i>t</i> test was used to compare PEC status with intensive care unit (ICU) and hospital length of stay (LOS) for significant differences (<i>P</i> < .05).</p><p><strong>Results: </strong>1,689,392 patients suffered mild injuries [59.1% male, mean age 45.2, 8579 expired (0.5%)]. Mortality was associated with the presence of several risk factors, especially advanced directive [OR = 9.13, <i>P</i> < .001], cirrhosis [OR = 8.55, <i>P</i> < .001], disseminated cancer [OR = 8.53, <i>P</i> < .001], congestive heart failure (CHF) [OR = 6.62, <i>P</i> < .001], chronic renal failure (CRF) [OR = 6.16, <i>P</i> < .001], chemotherapy for cancer [OR = 5.64, <i>P</i> < .001], peripheral arterial disease (PAD) [OR = 5.32, <i>P</i> < .001], myocardial infarction (MI) [OR = 4.96, <i>P</i> < .001], dementia [OR = 4.62, <i>P</i> < .001], and functionally dependent health [OR = 4.57, <i>P</i> < .001]. In addition, there was a relationship between the presence of several PECs and increased ICU and hospital LOS, especially cirrhosis, CRF, CHF, and PAD.</p><p><strong>Discussion: </strong>Nontraumatic factors and preexisting conditions are associated with increased mortality and hospital resource consumption in trauma patients with a low ISS. They should be considered during clinical decision-making for these patients, who may otherwise masquerade as part of a low-risk population.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300368"},"PeriodicalIF":1.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612381","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":"Evaluation of New Mental Health Diagnoses After Pediatric Traumatic Injuries at a Level 1 Pediatric Trauma Center.","authors":"Marshall W Wallace, Stephanie E Iantorno, Zachary J Moore, Bryan Tate Colton, Brooks Keeshin, Robert A Swendiman, Katie W Russell","doi":"10.1177/00031348241300358","DOIUrl":"https://doi.org/10.1177/00031348241300358","url":null,"abstract":"<p><strong>Background: </strong>Traumatic injury is associated with significant mental health morbidity. To evaluate the need for implementation of active-post injury mental health screening at a Level 1 Pediatric Trauma center, we aimed to characterize all new mental health diagnoses after injury and evaluated for patient or injury factors that may aid in targeting of future screening.</p><p><strong>Methods: </strong>A single-center retrospective analysis of trauma patients aged 6-18 years presenting in 2022 was performed. Our primary outcome was a new DSM-5 mental health diagnosis documented after traumatic injury. Patients with and without a new mental health diagnosis were compared by age, sex, race, ethnicity, injury type/mechanism, injury severity score (ISS), intensive care unit (ICU) admission, and length of stay (LOS).</p><p><strong>Results: </strong>492 patients were included. Their median (IQR) age was 13.5 (10.4, 15.4) years. The median (IQR) follow-up interval was 157 (9, 429) days. There were 24 (4.9%) children with a new mental health diagnosis: 12 (50%) with trauma-related stress disorders, with the remaining having diagnoses such as depressive or anxiety disorders. Patients with a new mental health diagnosis had longer LOS (3.0 [1.8, 7.5] vs 2.0 [1.0, 3.3] days, <i>P</i> = 0.02) and were more likely to have sustained penetrating injury (<i>P</i> = 0.01). There were no differences in demographics, rates of preexisting mental health diagnosis or area deprivation index (<i>P</i> > 0.05).</p><p><strong>Discussion: </strong>There were fewer new mental health diagnoses in our cohort than expected, likely underestimating the acute need. Comprehensive post-injury screening is imperative to sufficiently identify and intervene upon mental health morbidity after pediatric trauma.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300358"},"PeriodicalIF":1.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612337","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":"Linaclotide as a Single Agent Bowel Preparation Regimen Before Colonoscopy.","authors":"Pavel Mazirka, Ahmed Rashid, Jeremy Balch, Lindsey Goldstein, Krista Terracina, Thomas E Read, Johan Nordenstam","doi":"10.1177/00031348241300360","DOIUrl":"https://doi.org/10.1177/00031348241300360","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300360"},"PeriodicalIF":1.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612375","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":"Establishment of a Predictive Model for Seroma Formation After TAPP Repair for Unilateral Indirect Inguinal Hernia in Males.","authors":"Xue-Feng Peng, Miao Yu, Deng-Chao Wang","doi":"10.1177/00031348241300369","DOIUrl":"https://doi.org/10.1177/00031348241300369","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair, particularly using TAPP, is common in males, and acclaimed for minimal invasiveness but often complicated by seromas, significantly affecting recovery and health care costs.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 266 male patients with unilateral indirect inguinal hernia who underwent transabdominal preperitoneal (TAPP) repair. We divided the patients into a training set (n = 188) and a validation set (n = 78). We employed logistic regression to identify independent risk factors for post-TAPP seroma and developed a nomogram to predict the occurrence of seromas. The model's accuracy was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Postoperatively, 20.3% of patients developed a seroma. Multivariate logistic regression analysis highlighted several independent risk factors for seroma formation: the use of anticoagulants, an internal ring defect ≥5 cm, scrotal hernia, incarcerated hernia, and transected hernia sac (<i>P</i> < 0.05). The ROC curves for the training and validation sets demonstrated areas under the curve of 0.893 (95% CI: 0.845-0.942) and 0.864 (95% CI: 0.765-0.963), respectively, indicating good model fits (<i>P</i> > 0.05). DCA confirmed significant clinical applicability of the model.</p><p><strong>Conclusion: </strong>The findings suggest that the use of anticoagulants, an internal ring defect ≥5 cm, scrotal hernia, incarcerated hernia, and transected hernia sac are significant independent risk factors for seroma formation after TAPP repair. Clinical consideration of these factors and proactive preventive measures are essential. Although many of these factors are non-modifiable, understanding them is crucial for preoperative risk assessment and patient management.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300369"},"PeriodicalIF":1.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612333","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":"Resection of Mediastinal Lymph Node Metastasis From HCC Using ICG Fluorescence Imaging and Repeat Resection of Its Solitary Recurrence.","authors":"Takaomi Ozawa, Nobuyuki Takemura, Kyoji Ito, Fuminori Mihara, Fuyuki Inagaki, Satoshi Nagasaka, Kazuhiko Yamada, Norihiro Kokudo","doi":"10.1177/00031348241300366","DOIUrl":"https://doi.org/10.1177/00031348241300366","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300366"},"PeriodicalIF":1.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612379","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":"Can't Buy Me Love? The Use of Gifts in the Residency Application Process.","authors":"Brigitte Anderson, Nicole Ducich, Brady Campbell, Matthew Cahn, Stephen M Kavic","doi":"10.1177/00031348241300357","DOIUrl":"https://doi.org/10.1177/00031348241300357","url":null,"abstract":"<p><strong>Introduction: </strong>To set themselves apart, some programs use gifts or promotional items to highlight the residency program or unique local culture. The distinction between advertisement and persuasion may be blurry in this case. We sought to quantify the prevalence of gifts to applicants and how frequently the US federal threshold for \"nominal gifts\" was exceeded.</p><p><strong>Methods: </strong>We reviewed a publicly accessible, Internet resource called the \"ERAS Megathread.\" This is a Google spreadsheet found on Reddit where applicants participating in The Match can anonymously contribute information about their experience. The incidence of \"gifts\" was quantified for surgical residency programs, along with the nominal value if indicated. The spreadsheets were reviewed for 2021, 2022, and 2023.</p><p><strong>Results: </strong>Over the past 3 application cycles, 15.1% [11.1%-18.2%] of general surgery residency programs provided a gift to applicants. Of these programs, the majority (70.2%) are university-based programs. In 2023, 57.9% of these gifts exceeded US$20. Given the anonymous nature of the data set, and the lack of transparency in the match process, it was not possible to correlate gift giving with its effect on recruitment.</p><p><strong>Discussion/conclusion: </strong>Students are courted by residency programs, and a significant minority of programs provide a gift to applicants. The impact of a substantial gift on a financially vulnerable student is difficult to quantify. It behooves us as a specialty to determine what should be a universal standard and to consider outlining explicit guidelines for The Match.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300357"},"PeriodicalIF":1.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612301","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":"Improving Trauma Surgeons Prospective Estimation of the Injury Severity Score.","authors":"Eli Mlaver, Christopher J Dente, Gina Solomon, Morgan Krause, William Matthew Vassy, S Rob Todd, Patricia Ayoung-Chee","doi":"10.1177/00031348241300365","DOIUrl":"https://doi.org/10.1177/00031348241300365","url":null,"abstract":"<p><p>Injury Severity Score (ISS) as a prospective predictive variable is limited, as it is scored post-discharge by registrars. We followed a phase 1 pilot investigation of the feasibility of prospective ISS estimation (eISS) by trauma surgeons within 1 day of admission with an investigation of the impact of a simple educational aid on the accuracy of these estimations. Eleven surgeons evaluated 178 patients in phase 2. With the educational aid, ISS concordance improved from 74.6% to 85.1% for non-severe (abstracted ISS, aISS <16) injuries and from 78.8% to 83.1% for severe (aISS ≥16) injuries; weighted <i>k</i> improved from 0.53 to 0.72. Abbreviated Injury Scale (AIS) concordance similarly improved in five of seven body regions. The ability to prospectively document ISS has important clinical and research implications. There remains opportunity to refine educational aides and harness the EHR to further improve prediction accuracy and facilitate adoption in standard clinical workflows.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241300365"},"PeriodicalIF":1.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612338","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":"Neoadjuvant Chemotherapy and Radiation Improves Recurrence-free and Overall Survival in Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma.","authors":"Jesse K Kelley, Hordur Kolbeinsson, Sreenivasa Chandana, Benjamin Eastburg, Austin Frisch, Jessica Parker, G Paul Wright, M Mura Assifi, Mathew Chung","doi":"10.1177/00031348241250043","DOIUrl":"10.1177/00031348241250043","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to analyze the outcomes of patients with resectable/borderline resectable PDAC who receive total neoadjuvant therapy vs upfront surgery.</p><p><strong>Methods and analysis: </strong>Patients who were treated at a single institution from 2006 to 2021 were included. The primary outcome was overall survival (OS). Secondary outcomes included disease free survival (DFS), rates of lymph node positivity, and R0 resection. All survival analyses were performed with intention-to-treat.</p><p><strong>Results: </strong>26 patients received neoadjuvant chemotherapy and radiation (TNT), 28 received neoadjuvant chemotherapy only (NAC), and 168 received upfront surgery. Demographics were comparable across all three groups. Patients who received TNT or NAC had longer OS and DFS compared to the surgery first patients (<i>P</i> < .01). Patients who received TNT had a lymph node positivity rate of 0% at time of surgery compared to 5.3% and 13.3% in the NAC and surgery-first groups, respectively (<i>P</i> < .01). The rate of R0 resection did not differ between groups (<i>P</i> = .17).</p><p><strong>Conclusion: </strong>Patients with resectable/borderline resectable PDAC who receive neoadjuvant therapy have longer OS and RFS relative to those who receive upfront surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2762-2768"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850487","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 of Combined Opioids and Benzodiazepines Consumption in Elderly Trauma: A Retrospective Cohort Study.","authors":"Osaid Alser, Ander Dorken Gallastegi, Mohamad El Moheb, Toby Raybould, Christopher DePesa, Alice Gervasini, Michael Flaherty, Peter T Masiakos, George C Velmahos, Haytham Kaafarani, Jonathan Parks","doi":"10.1177/00031348241259036","DOIUrl":"10.1177/00031348241259036","url":null,"abstract":"<p><strong>Background: </strong>Acute substance intoxication is associated with traumatic injury and worse hospital outcomes. The objective of this study was to evaluate the association between simultaneous opioids and benzodiazepines (OB) use and hospital outcomes in elderly trauma patients.</p><p><strong>Methods: </strong>We performed a retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) 2017 database. We included trauma patients (age ≥ 65 years) examined by urine toxicology within 24 hours of presentation. The primary outcome was in-hospital mortality. Secondary outcomes included hospital and ICU lengths of stay (HLOS AND ICULOS), in-hospital complications (eg, ventilator-associated pneumonia), unplanned intubation, and duration of mechanical ventilation. Patients were stratified being both positive for opioids and benzodiazepines (OB+) or not (OB-) based on having positive or negative drug screen for both drugs, respectively. A 1:1 propensity score matching was performed controlling for demographics (eg, age and sex), comorbidities (eg, alcoholism), and injury characteristics.</p><p><strong>Results: </strong>Of 77,311 tested patients, 849 OB+ were matched to OB- patients. Compared to OB- group, OB+ patients were more likely to have unplanned intubation (26 [3.1%] vs 8 [0.9%], <i>P</i> = 0.002) and had prolonged HLOS (≥2 days: 683 [84.0%] vs 625 [77.8%], <i>P</i> = 0.002). There were no differences in all other outcomes (<i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>The OB intake is associated with higher incidence of unplanned intubation and longer HLOS in elderly trauma patients. Early identification of elderly trauma patient with OB+ can help provide necessary pharmacologic and behavioral interventions to treat their substance use and potentially improve outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"2951-2957"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247164","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}