American Surgeon最新文献

{"title":"Modified Frailty Index for Patients Undergoing Surgery for Colorectal Cancer: Analysis of the National Inpatient Sample From 2015 to 2019.","authors":"Rehab Alsayari, Tyler McKechnie, Tania Kazi, Luke Heimann, Anjali Sachdeva, Yung Lee, Bright Huo, Niv Sne, Dennis Hong, Cagla Eskicioglu","doi":"10.1177/00031348241269398","DOIUrl":"https://doi.org/10.1177/00031348241269398","url":null,"abstract":"<p><strong>Background: </strong>Frailty is increasingly recognized as a perioperative risk for numerous surgical diseases. We applied the modified frailty index (mFI-11) to the National Inpatient Sample (NIS) for patients undergoing surgery for colorectal cancer (CRC).</p><p><strong>Methods: </strong>We performed a retrospective analysis of the NIS (2015-2019) including CRC patients undergoing surgery. We classified patients into frail (ie, mFI ≥0.27) and robust (ie, mFI <0.27) categories. Primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes included system-specific postoperative morbidity and length of stay (LOS). Multivariable regression models were fit.</p><p><strong>Results: </strong>Within the 53,652 identified patients undergoing surgery for CRC, 19.1% were frail. Frail patients were at higher risk of postoperative mortality (3.1% vs 1.0%, odds ratio [OR] 1.96, 95% confidence intervals [CIs] 1.68-2.30, <i>P</i> < 0.001), morbidity (41.3 % vs 23.1%, OR 1.75, 95% CI 1.66-1.83, <i>P</i> < 0.001), and LOS (mean difference [MD] 1.46, 95% CI 0.29-1.62, <i>P</i> < 0.001). Significant differences existed between groups in system-specific postoperative morbidity, with the largest effect estimates seen in cardiovascular morbidities (OR 4.07, 95% CI 3.36-4.93, <i>P</i> = 0.001), followed by respiratory (OR 1.75, 95% CI 1.66-1.83, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>Frail patients undergoing CRC surgery are at risk of increased postoperative complications. Preoperative frailty screening may allow for individualized preoperative counseling.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":"91 1","pages":"76-85"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811931","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":"Failure to Rescue a Virtuoso: The Death of Emanuel Feuermann.","authors":"Don K Nakayama","doi":"10.1177/00031348241272339","DOIUrl":"10.1177/00031348241272339","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"153-157"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873975","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":"Antibiotics Within One Hour for Pediatric Open Lower Extremity Fractures May Not be Warranted as a Quality Metric.","authors":"Marlene Jacobo, Areg Grigorian, Lourdes Swentek, Laura F Goodman, Yigit Guner, Patrick T Delaplain, Jeffry Nahmias","doi":"10.1177/00031348241269392","DOIUrl":"10.1177/00031348241269392","url":null,"abstract":"<p><strong>Background: </strong>Open fractures have been associated with a higher risk of infection if antibiotics are not administered within 1 h of presentation in adult trauma patients. Time to antibiotic administration for open fractures is frequently used as a quality metric for trauma centers, but there have been no large studies evaluating this topic for pediatric patients.</p><p><strong>Methods: </strong>The 2019 Trauma Quality Improvement Program dataset was queried for patients ≤ 16 years old with isolated open femur or tibia fractures undergoing operative intervention after blunt trauma. Patients transferred from another hospital were excluded. Pediatric patients receiving early antibiotics (EA) within 1 h were compared to patients receiving delayed antibiotics (DA) greater than or equal to 1 h from arrival. Multivariate logistic regression was used to evaluate risk of surgical site infection (SSI).</p><p><strong>Results: </strong>There were 150 patients with open lower extremity fractures: 98 (64.9%) EA vs 52 (34.4%) DA. There was no difference in the rate of SSI between the 2 groups (EA: 1.0% vs DA: 1.9%, <i>P</i> = 0.65). There remained similar associated risk of infection after adjusting for lower extremity abbreviated injury scale >3, blood transfusion requirement, and vital signs on arrival (OR 0.62, 95% CI 0.04-10.24, <i>P</i> = 0.74).</p><p><strong>Conclusions: </strong>Most pediatric trauma patients with open lower extremity fracture received antibiotics within 1 h of presentation. However, SSI was rare and the risk of SSI was not associated with antibiotic administration within 1 h. Therefore, timing of antibiotic administration for pediatric open lower extremity fractures should be re-evaluated as a quality metric.<b>Level of Evidence:</b> Level III.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"59-64"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888274","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":"Optimal Self-Care for Surgeons: Sleep, Diet, and Exercise.","authors":"Justin Park, Kimberly McElveen","doi":"10.1177/00031348241269422","DOIUrl":"10.1177/00031348241269422","url":null,"abstract":"<p><strong>Background: </strong>Surgeons face intense stress, causing hormonal imbalances that harm their health, leading to burnout, chronic illness, and shorter lifespans due to their demanding careers.</p><p><strong>Purpose: </strong>This study explores self-care strategies focusing on sleep, nutrition, and exercise to help surgeons reduce stress and improve their overall well-being and quality of life.</p><p><strong>Research design: </strong>A thorough literature review of physiological, metabolic, and psychological principles informed the development of a structured self-care approach.</p><p><strong>Data collection and/or analysis: </strong>We reviewed existing research on brain-body interactions, highlighting hormonal balance, nutrition, and exercise to mitigate chronic stress.</p><p><strong>Results: </strong>The review underscores the importance of quality sleep for hormonal balance and overall health. Proper nutrition, emphasizing balanced macronutrients and meal timing, supports health. Exercise should be 80% low-intensity aerobic activities, with 20% high-intensity. Combining these elements strengthens resistance to chronic stress and enhances health.</p><p><strong>Conclusions: </strong>A structured self-care approach, prioritizing sleep, followed by nutrition and exercise, effectively reduces stress among surgeons. This sequence improves well-being and quality of life. Surgeons should focus on consistent sleep, balanced nutrition, and regular low-intensity exercise to enhance resilience and achieve a fulfilling professional life.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"161-164"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905668","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":"Mark Ravitch and How Surgical Stapling Devices Came to America.","authors":"Don K Nakayama","doi":"10.1177/00031348241272325","DOIUrl":"10.1177/00031348241272325","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"158-160"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896556","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: Prophylactic Enoxaparin Dosing Using Anti-Factor Xa Levels in Hepatic Surgery Patients: A Pilot Study.","authors":"Stephanie S Hyon, Jana K Elsawwah, Maia A Harris, Zoltan H Nemeth","doi":"10.1177/00031348241275721","DOIUrl":"10.1177/00031348241275721","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"151-152"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003425","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":"Medical and Surgical Weight Loss as a Pathway to Renal Transplant Listing.","authors":"Jason M Samuels, Wayne English, Kelly A Birdwell, Irene D Feurer, David Shaffer, Sunil K Geevarghese, Seth J Karp","doi":"10.1177/00031348241275714","DOIUrl":"10.1177/00031348241275714","url":null,"abstract":"<p><strong>Purpose: </strong>Severe obesity is a barrier to listing for kidney transplantation due to concern for poor outcomes. This study aims to compare bariatric surgery with medical weight loss as a means of achieving weight loss and subsequent listing for renal transplant. We hypothesize that bariatric surgery will induce greater frequency of listing for transplant within 18 months of study initiation.</p><p><strong>Materials and methods: </strong>We performed a randomized study of metabolic bariatric surgery (MBS) vs medical weight loss (MM) in patients on dialysis with a body mass index (BMI) of 40-55 kg/m². The primary outcome was suitability for renal transplant within 18 months of initiating treatment. Secondary outcomes included weight loss, mortality, and complications.</p><p><strong>Results: </strong>Twenty patients enrolled, only 9 (5 MBS, 4 MM) received treatment. Treated groups did not differ in age, gender, or race (<i>P</i> ≥ .44). There was no statistically significant difference in the primary endpoint: 2 MBS (40%) and 1 MM (25%) listed for transplant ≤18 months (<i>P</i> = 1.00). With additional time, 100% MBS and 25% MM patients achieved listing status (<i>P</i> = .048); 100% of MBS and 0 MM received kidney transplants to date (<i>P</i> = .008). Weight, weight loss, and BMI trajectories differed between the groups (<i>P</i> ≤ .002). One death from COVID-19 occurred in the MM group, and 1 MBS patient had a myocardial infarction 3.75 years after baseline evaluation.</p><p><strong>Conclusion: </strong>These results suggest MBS is superior to MM in achieving weight loss prior to listing for kidney transplantation. Larger studies are needed to ensure the safety profile is acceptable in patients with ESRD undergoing bariatric surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"99-106"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995055","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":"Determining if Admission Thromboelastography can Predict the Development of Late Resolving Multiple Organ Failure in Trauma Patients.","authors":"Ross P Smith, Lauren K Dwyer, Jacob C O'Dell, Christopher C McCoy, Christopher A Guidry, Robert A Winfield","doi":"10.1177/00031348241275718","DOIUrl":"10.1177/00031348241275718","url":null,"abstract":"<p><strong>Background: </strong>Normal coagulation TEG values on admission negatively correlate with overall risk of multiple organ failure, but less is known about association between coagulation and late-resolving multiple organ failure (LRMOF) risk. Here, the relationship between TEG parameters and development of LRMOF was investigated.</p><p><strong>Methods: </strong>We conducted a retrospective assessment of patients at high postinjury multiple organ failure risk at our center. The primary outcome was LRMOF.</p><p><strong>Results: </strong>Analysis included 742 patients. Demographics were 76% male, mean age of 41, mean ISS of 23, 34% hypercoagulability, and 16% developed LRMOF. Patients with normal admission TEG developed LRMOF at significantly lower unadjusted rates than patients with coagulation disturbances (9 vs 16%-19%, <i>P</i> = 0.029); however, multivariable logistic regression demonstrated that neither coagulation profile nor individual admission TEG parameters showed association with LRMOF.</p><p><strong>Conclusions: </strong>In this series, we found no significant relationship between coagulation status and LRMOF development.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"38-41"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003424","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":"Prognostic Impact of a Decrease in Serum Carbohydrate Antigen 19-9 Levels After Preoperative Therapy for 4 Months or More for Borderline Resectable Pancreatic Cancer Abutting Major Arteries.","authors":"Michinori Matsumoto, Masashi Tsunematsu, Kyohei Abe, Ryoga Hamura, Shinji Onda, Kenei Furukawa, Koichiro Haruki, Tomoyoshi Okamoto, Tadashi Uwagawa, Toru Ikegami","doi":"10.1177/00031348241278016","DOIUrl":"10.1177/00031348241278016","url":null,"abstract":"<p><p><b>Background:</b> This study aimed to identify the prognostic factors after pancreatectomy for borderline resectable pancreatic cancer abutting major arteries (BR-A).<b>Methods:</b> We retrospectively investigated relationship between preoperative and intraoperative variables and overall survival (OS) through univariate and multivariate analyses. The cut-off points of preoperative therapy duration and response rates of serum carbohydrate antigen 19-9 (CA19-9) levels after preoperative therapy were determined through a minimum <i>P</i>-value approach using the log-rank test for OS. Overall survival was compared among patients stratified according to the independent prognostic factors and the presence or absence of pancreatectomy.<b>Results:</b> After pretreatment, 17 patients underwent pancreatectomy and four patients continued chemotherapy without surgery. Multivariate analysis in 17 resected BR-A patients demonstrated decreased serum CA19-9 levels and preoperative therapy duration of ≥4 months were the independent prognostic factors [hazard ratio (HR) 0.01; <i>P</i> = 0.002, HR 0.13; <i>P</i> = 0.02]. Patients who underwent surgery with decreased serum CA19-9 levels after preoperative therapy of ≥4 months had a significantly better prognosis than those without one or both of independent prognostic factors and those who did not undergo surgery (median survival time: not estimated, 23.3 months, 10.5 months, and 10.8 months; <i>P</i> = 0.02, <i>P</i> = 0.004, and <i>P</i> = 0.001, respectively). Furthermore, the prognosis did not significantly differ between the patients who underwent surgery without meeting either one or both criteria and those without surgery.<b>Conclusions:</b> Preoperative therapy duration of ≥4 months and decreased serum CA19-9 levels are independent prognostic factors among BR-A patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"42-50"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035027","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":"Early Vasopressor Requirement Among Hypotensive Trauma Patients: Does It Cause More Harm Than Good?","authors":"Tanya Anand, Omar Hejazi, Adam Nelson, Ben Litmanovich, Audrey L Spencer, Muhammad Haris Khurshid, Arshin Ghaedi, Hamidreza Hosseinpour, Louis J Magnotti, Bellal Joseph","doi":"10.1177/00031348241269425","DOIUrl":"10.1177/00031348241269425","url":null,"abstract":"<p><strong>Background: </strong>Optimal utilization of vasopressors during early post-injury resuscitation remains unclear. Our study aims to describe the relationship between the timing of vasopressor administration and outcomes among hypotensive trauma patients.</p><p><strong>Methods: </strong>This was a retrospective analysis of the 2017-2018 ACS-TQIP database. We included adult (≥18 years) trauma patients presenting with hypotension (lowest SBP <90 mmHg) who received vasopressors within 6 hours of admission. We excluded patients who had a severe head injury (Head-AIS >3) and those with spinal cord injury (Spine-AIS >3). Patients were stratified based on the time to receive vasopressors. Multivariable regression analyses were performed to identify the independent association between timing of vasopressor initiation and outcomes.</p><p><strong>Results: </strong>1049 patients were identified. Mean age was 55 ± 20 years, and 70% of patients were male. The median ISS was 16 [9-24], 80% had a blunt injury, and the mean SBP was 61 ± 24 mmHg. The median time to first vasopressor administration was 319 [68-352] minutes. Overall, 24-hour and in-hospital mortality rates were 19% and 33%, respectively. Every one-hour delay in vasopressor administration beyond the first hour was independently associated with decreased odds of 24-hour mortality (aOR: 0.65, <i>P</i> < 0.001), in-hospital mortality (aOR: 0.65, <i>P</i> < 0.001), major complications (aOR: 0.77, <i>P</i> = 0.003), and increased odds of longer ICU LOS (β + 2.53, <i>P</i> = 0.012). There were no associations between the timing of early vasopressor administration and 24-hour PRBC transfusion requirements (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Earlier vasopressor requirement among hypotensive trauma patients was independently associated with increased mortality and major complications. Further research on the utility and optimal timing of vasopressors during the post-injury resuscitative period is warranted.</p><p><strong>Level of evidence: </strong>III therapeutic/care management.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"22-30"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854462","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}