American Surgeon最新文献

{"title":"The Implementation of Incisional Negative Pressure Therapy in Trauma Laparotomies Leads to Fewer Open Wounds at Discharge.","authors":"Miles W Reese, Raymond L Hogge, Brendan J Roess, John M Hepner, Robert D Luke, Ricardo E Rendel, Ishraq K Kabir, Tuan M Nguyen, Kristen N Snyder, Julia A Heaton, Michael T Martyak","doi":"10.1177/00031348251339700","DOIUrl":"10.1177/00031348251339700","url":null,"abstract":"<p><p><b>Background:</b> Surgical site infections (SSIs) tend to be higher in emergent trauma cases. To combat this increased risk, the skin is often left open and allowed to heal by secondary intention. We sought to investigate the effect of the implementation of incisional negative pressure wound therapy (iNPWT) in trauma laparotomies. <b>Methods:</b> A single-institution retrospective chart review was performed of trauma patients receiving an emergent exploratory laparotomy between 2015 and 2022. Patients with class II and III wounds were included. The primary outcome was open wound at discharge between the pre-iNPWT and post-iNPWT implementation. The secondary outcome was development of superficial SSI in closed wounds. <b>Results:</b> 260 patients, 111 pre-iNPWT and 149 post-iNPWT implementation, were included. The proportion of patients who were discharged with an open wound in the pre-iNPWT group was 52.3% vs 18.8% in the post-iNPWT group, <i>P</i> = <.001. The proportion of patients with closed wounds who developed a superficial SSI in the pre-iNPWT group was 12.1%, 8 of 66, vs 5.9%, 8 of 135, in the post-iNPWT group, <i>P</i> = .13. The proportion of patients with closed class III wounds who developed a superficial SSI was 14.0%, 7 of 50, vs 5.0%, 6 of 119, in the post-iNPWT group, <i>P</i> = .046. <b>Conclusion:</b> Our study identified a decrease in the number of patients who were discharged with an open wound after the implementation of iNPWT without an increase in SSIs. A decrease in SSIs in class III wounds closed with iNPWT was also observed.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1123-1128"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118555","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":"Social Vulnerability Index in Emergency General Surgery Outcomes: A Systematic Review.","authors":"Anthony J Duncan, Samuel J Bloomsburg, Mentor Ahmeti","doi":"10.1177/00031348251337152","DOIUrl":"10.1177/00031348251337152","url":null,"abstract":"<p><p>BackgroundThe Social Vulnerability Index (SVI) has also been used as a measure of social determinants of health (SDOH), with several studies showing worse health outcomes in patients with higher burdens of SDOH. This systematic review focuses on the application of SVI in Emergency General Surgery (EGS), exploring the impact of patient vulnerability on individual health outcomes.MethodsA systematic literature search was conducted using PubMed, EMBASE and Web of Science. Inclusion criteria consisted of studies that were peer reviewed, obtainable in English, used SVI as a measurement applied to EGS. Of the initial 1216 papers 11 studies met inclusion criteria.ResultsHigh SVI is associated with increased mortality, respiratory, cardiac and bleeding complications, and readmissions. Acute cholecystitis showed higher SVI linked to an increased likelihood of requiring emergent cholecystectomy. Investigations into bowel-related surgeries show connections between high SVI and increased stoma creation and likelihood of emergent operations.ConclusionThere is evidence of correlation between SVI and a variety of poor outcomes in emergency general surgery patient. This suggests that SVI can serve as an indicator of high risk patients as well as allow there to be inventions in specific communities to improve health care outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1193-1202"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958889","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":"Patterns of Failure in Cutaneous Head and Neck Melanoma Following Negative Sentinel Lymph Node Biopsy: A Retrospective Cohort Study.","authors":"Phillip Staibano, Michael Xie, Zahra Abdallah, Sofia Nguyen, Michael Au, Kelvin Zhou, Hailey Bensky, Michael K Gupta, David L Choi, Trevor A Lewis, J E M Ted Young, Han Zhang","doi":"10.1177/00031348251323707","DOIUrl":"10.1177/00031348251323707","url":null,"abstract":"<p><p>BackgroundCutaneous head and neck melanoma (cHNM) has a high rate of false-negative sentinel lymph node biopsy (SLNB) and up to a 25% risk of recurrence despite negative SLNB. The aim of this study was to investigate the pattern of melanoma recurrence in patients with cHNM with negative SLNB.MethodsA retrospective cohort study of consecutive cHNM patients at a tertiary care centre from 2014-2022. We included all cHNM patients with negative SLNB. All patients were categorized into Breslow thickness >2 mm and ≤2 mm and extracted information pertaining to histopathological characteristics and the presence and type of disease recurrences. We performed multivariable analysis using logistic and cox regression. We used an alpha of 0.05 and all statistical analyses were performed using R software.ResultsOverall, 167 patients met eligibility criteria and of these, 53.5% patients had cHNM ≤2 mm thick and 46.7% had lesions >2 mm thick. The overall recurrence rate was 29.3%. Multivariable analysis demonstrated that Breslow thickness [aOR: 5.89 (95% CI: 1.37, 32.3), <i>P</i> = 0.02] was associated with distant recurrence. Multivariable cox regression also identified that pathological ulceration [aHR: 3.17 (95% CI: 1.61, 7.66), <i>P</i> = 0.01] predicted time to distant recurrence. The SLNB false omission rate was 3.6% (95% CI: 1.3%, 7.7%).ConclusionSLNB-negative cHNM patients with high-risk pathological features may benefit from adjuvant immunotherapy.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1156-1162"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771083","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 Challenging Case of Thyrotoxicosis and Thyroid Abscess due to Acute Suppurative Thyroiditis.","authors":"R Martin, S Yakoubovitch, L Christopher, D Bavishi, J Parreco, M A Lopez-Viego, M Lopez, J L Buicko","doi":"10.1177/00031348251341958","DOIUrl":"10.1177/00031348251341958","url":null,"abstract":"<p><p>Acute suppurative thyroiditis is a rare but serious condition that can progress to a thyroid abscess, requiring emergency surgical intervention. It is typically caused by Gram-positive bacteria like <i>Staphylococcus</i> or <i>Streptococcus</i>, with mycobacteria or fungi seen in immunocompromised patients.We report a case of a 46-year-old female who presented with neck pain, swelling, palpitations, and malaise. Initial diagnosis was a viral infection, but imaging at our facility revealed a 6 × 5.5 cm abscess in the right thyroid lobe, causing tracheal compression. Labs showed thyrotoxicosis, leukocytosis, and anemia. She was started on β-blockers, PTU, IV steroids, antibiotics, and given a blood transfusion on admission. Her condition worsened, and she underwent neck exploration with drainage of the abscess, revealing <i>E</i>. <i>coli</i>. After treatment, she recovered and was discharged with antibiotics and antithyroid medications. This case emphasizes the importance of early detection and timely surgical intervention of acute suppurative thyroiditis.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1120-1122"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952619","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":"Bundling Procedures in Critically Ill Trauma Patients: Should It Be Done?","authors":"Hannah Shin, Amy Young, Madison E Morgan, Hanna Kim, Catherine T Brown, Katherine Moore, James J Lamberg, Lindsey L Perea","doi":"10.1177/00031348251314154","DOIUrl":"10.1177/00031348251314154","url":null,"abstract":"<p><p>BackgroundThe precautions brought on by the COVID-19 pandemic led to the growing practice of bundling lines in patients requiring intubation. Our study aims to examine the effect of immediate bundled lines (IBL) on traumatic injuries. We hypothesized that severely injured patients may benefit from IBL.MethodsA retrospective review of all intubated trauma patients (1/2015-12/2020) at a Level I Trauma Center was conducted. Patients ≤18 years and those who died or were transferred prior to intensive care unit (ICU) admission were excluded. IBL was defined as placement of central venous catheter (CVC) and arterial line (AL) ≤4 hours after intubation. Delayed lines were any lines placed >4 hours after intubation. Primary outcome was time from intubation to CVC and AL.Results728 patients were included. The majority received CVC and/or AL with 17.7% in a delayed fashion. Severe head injury (AIS ≥3) most often had immediate AL or delayed bundled lines (<i>P</i> < 0.001). IBL were more common with gunshot wounds (GSW) (<i>P</i> < 0.001) and blood transfusions (<i>P</i> < 0.001). IBL were associated with significantly lower GCS (<i>P</i> = 0.018) and higher median ISS. Multivariate logistic regression revealed severe/profound ISS, GSW, and pedestrian struck were predictive of IBL.DiscussionIntubated trauma patients who presented with certain mechanisms (GSW, pedestrian struck), received blood transfusions, or exhibited severe/profound ISS may be more likely to receive IBL. IBL is not superior to either immediate AL or to no lines in terms of mortality. No lines had a significant effect on ICU LOS or hospital LOS, except in the setting of severe head injury.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1113-1119"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063199","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 the Affordable Care Act on Lung Cancer Stage at Presentation.","authors":"Sumaiyya Arshad, Oluwasegun A Akinyemi, Mojisola Fasokun, Edward E Cornwell, Gal Levy","doi":"10.1177/00031348251339526","DOIUrl":"10.1177/00031348251339526","url":null,"abstract":"<p><p>IntroductionThis study assesses the impact of the Affordable Care Act (ACA) on lung cancer stage at diagnosis and cancer-specific survival, focusing on whether increased access to care for minorities and low-income individuals improves detection and outcomes.MethodologyA retrospective analysis of SEER database data (2007-2020) compared lung cancer cases in pre-ACA (2007-2013) and post-ACA (2014-2020) periods. California, a Medicaid expansion state, and Texas, a non-expansion state, were analyzed. Patients aged 18-64 years were followed for up to 6 years. Difference-in-differences and multinomial logistic regression were used to evaluate the ACA Medicaid expansion impact on disease stage and cancer-specific mortality.ResultsAmong 104,415 lung cancer patients, 59,825 (57.3%) were diagnosed pre-ACA, and 44,590 (42.7%) post-ACA. The cohort was predominantly White (63.7%) and male (52.9%), with an average age of 56.8 years. In California, ACA implementation led to a 1.2 percentage point increase in localized disease (95% CI: 0.2%-2.2%, <i>P</i> < 0.001) and a 2.8 percentage point reduction in metastatic disease (95% CI: -4.1% to -1.4%, <i>P</i> < 0.001) compared to Texas. Cancer-specific mortality in California decreased by 15.9% (95% CI: -23.9% to -7.8%, <i>P</i> < 0.001) vs Texas.ConclusionACA Medicaid expansion in California resulted in earlier lung cancer detection, reduced metastatic disease, and lower cancer-specific mortality compared to Texas. These improvements spanned all racial and ethnic groups, underscoring the benefits of Medicaid expansion in improving cancer outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1086-1092"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962606","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 Effect of Prior Nondefinitive Surgery on Perioperative Outcomes and Survival in Mucinous Appendix Cancer Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.","authors":"Sergei Iugai, Vadim Gushchin, Mary C King, Vladislav Kovalik, Kseniia Uzhegova, Luis F Falla-Zuniga, Carol Nieroda, Armando Sardi","doi":"10.1177/00031348251353806","DOIUrl":"https://doi.org/10.1177/00031348251353806","url":null,"abstract":"<p><p><b>Introduction:</b> Peritoneal metastases (PM) from mucinous appendix cancer (MAC) are common and often mismanaged. While cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is standard, many patients undergo nondefinitive surgery. We compared outcomes in MAC patients undergoing CRS/HIPEC after limited vs excessive prior surgeries. <b>Methods:</b> We conducted a retrospective analysis of MAC patients (1998-2023) from a single-center prospective database who underwent CRS/HIPEC. Surgical history was evaluated using the prior surgical score (PSS). Perioperative characteristics were compared between PSS-0/1 and PSS-2/3 groups. Logistic regression identified factors associated with extensive prior surgery. Overall survival (OS) was analyzed with Kaplan-Meier and Cox regression. <b>Results:</b> Of 351 eligible cases, 221 (63%) had PSS-0/1 and 130 (37%) had PSS-2/3. Most individuals with PSS-2/3 were women (89.2%, n = 116). Only female sex was significantly associated with the higher likelihood of PSS-2/3 (odds ratio: 9.02, <i>P</i> < .001). PSS-2/3 patients had longer time from diagnosis to CRS/HIPEC (<i>P</i> < .001), longer CRS/HIPEC procedure (<i>P</i> = .007), and greater blood loss (<i>P</i> = .038). Complete cytoreduction (CC) rates were similar (<i>P</i> = .227). Despite comparable major complication rates, PSS-2/3 patients had more transfusions (<i>P</i> = .016), infections (<i>P</i> = .048), and pulmonary complications (<i>P</i> = .028). Five-year OS was 76% and 66% for PSS-0/1 and PSS-2/3 groups, respectively (<i>P</i> = .049). After adjusting for age, tumor burden, CC-score, and histology, PSS-2/3 was not significantly associated with shorter OS (hazard ratio: 1.32; <i>P</i> = .139). <b>Conclusion:</b> Females with MAC are more likely to have extensive surgeries, delaying CRS/HIPEC and compromising safety. This highlights the importance of general surgeons and gynecologists limiting the surgical extent and referring patients to an HIPEC center.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251353806"},"PeriodicalIF":1.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526103","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":"Evaluating Resource Utilization After Implementation of a Minimal Traumatic Brain Injury Guideline at a Rural Appalachian Level 1 Trauma Center.","authors":"Verina M Sawiers, Lauren E Phemister, Samuel D Cartwright, Matthew A Leonard, Hannah W Collins, Keelin F Roche, Bracken Burns","doi":"10.1177/00031348251356740","DOIUrl":"https://doi.org/10.1177/00031348251356740","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251356740"},"PeriodicalIF":1.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526101","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 the Shift in Clinical Management From Reactive to Preventative on the Rate of Bowel Resection in Inflammatory Bowel Disease Within a Large Health Care Organization.","authors":"May Let Wah, SeungYong Han, Marco J Tomassi, Elisabeth C McLemore","doi":"10.1177/00031348251355934","DOIUrl":"https://doi.org/10.1177/00031348251355934","url":null,"abstract":"<p><p>BackgroundThe advent of biologic therapy has been used as a surrogate marker for the shift from reactive to preventative management and surveillance for inflammatory bowel disease (IBD). This shift has resulted in earlier detection, earlier medical therapy, and increased bowel preservation in many published series.MethodsA retrospective population-based study was conducted in adult patients (age ≥18) with an IBD diagnosis using SCPMG Clinical & Administrative Database containing diagnostic, prescribing, and billing codes for IBD and IBD-related gastrointestinal surgery. An Interrupted Time Series design with a segmented regression analysis was used to estimate the rate of change in bowel resection and/or strictureplasty before and after the introduction of biologic therapy (1993-1999 and 1999-2009).ResultsBowel resection and/or strictureplasty rate of change was higher between 1993 and 1999, with a rate of -0.26 (<i>P</i> < 0.0001, 95% CI: -0.34 to -0.18), compared to -0.10 between 1999 and 2009. The difference in the rates of change between 2 time periods (0.16) was significant (α = 0.05, <i>P</i> = 0.0003, 95% CI: 0.07 to 0.24).DiscussionA declining trend in bowel resection rates was evident before the introduction of biologic therapy in IBD patients. This finding suggests that the transition from reactive to preventative management and surveillance began well before the biologic era within our health care system.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251355934"},"PeriodicalIF":1.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526104","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":"Caudal Block With Intravenous Sedation and Natural Airway Provides Adequate Anesthesia and Analgesia for Circumcision in Young Patients.","authors":"Cory Nonnemacher, Seth Saylors, Meredith Elman, Christian Taylor, Todd Glenski, Tolulope A Oyetunji","doi":"10.1177/00031348251356741","DOIUrl":"https://doi.org/10.1177/00031348251356741","url":null,"abstract":"<p><p>IntroductionDuring the newborn period, circumcision is performed under local anesthesia, but for older infants it is typically performed by general surgeons or urologists under general anesthesia. Recent literature debates over a concern for neurotoxicity associated with general anesthesia in the developing brain, and it is important to create techniques to decrease exposure to neurotoxic agents while still allowing safe performance of procedures. We performed a prospective feasibility study performing circumcision with use of caudal block as the primary anesthetic with a natural airway under dexmedetomidine sedation.MethodsThis is a single-institution, prospective comparative study of male patients undergoing outpatient circumcision ages 2 to 24 months. A 1:3 case-control match was utilized. Patients underwent circumcision with natural airway, caudal block, and dexmedetomidine sedation compared to patients performed under general anesthesia. The primary endpoint was successful performance of the operation and secondarily assessed operative times, total-OR times, and intra- and postoperative medication use.Results27 patients were enrolled in the study. Of the 27 patients, 23 (85%) successfully tolerated the procedure after caudal block was performed. Four patients required conversion to placement of an LMA for deeper sedation. Patients had similar OR and operative times, with significantly less Sevoflurane exposure time and less postoperative fentanyl use compared to control.ConclusionCaudal block with intravenous sedation is a feasible alternative to maintaining general anesthesia during circumcision in young patients. It avoids prolonged airway instrumentation and provides adequate intra- and postoperative analgesia without increased postoperative pain or change in expected recovery time.Level of EvidenceLevel 2; prospective comparative study.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251356741"},"PeriodicalIF":1.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526099","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}