Pub Date : 2024-05-31DOI: 10.1016/j.sopen.2024.05.016
Marianne Becnel , Ikaikaolahui Danner , Maria De Los Santos , Lindsay J. Escobedo , Marie Mohrbacher , Jacob Young , Robert Patterson
Background
A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention.
Methods
Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded.
Results
The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The p value is <0.00001. The three most common intraoperative findings were SBO obstruction from adhesions alone (48 % of cases), followed by incarcerated hernias (12 %) and ischemic bowel (9 %). Only 8 cases out of 133 operations (6 % of total) had no findings at time of surgery other than dilated bowel.
Conclusions
The CT grading scale for SBO developed at our institution shows excellent correlation between grade and going for surgery, with few negative results, and can be a useful tool among other factors for general surgeons when deciding whether or not to operate on a patient with suspected SBO.
{"title":"The utility of a CT grading scale in deciding on surgical intervention for patients with suspected small bowel obstruction","authors":"Marianne Becnel , Ikaikaolahui Danner , Maria De Los Santos , Lindsay J. Escobedo , Marie Mohrbacher , Jacob Young , Robert Patterson","doi":"10.1016/j.sopen.2024.05.016","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.016","url":null,"abstract":"<div><h3>Background</h3><p>A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention.</p></div><div><h3>Methods</h3><p>Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded.</p></div><div><h3>Results</h3><p>The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The <em>p</em> value is <0.00001. The three most common intraoperative findings were SBO obstruction from adhesions alone (48 % of cases), followed by incarcerated hernias (12 %) and ischemic bowel (9 %). Only 8 cases out of 133 operations (6 % of total) had no findings at time of surgery other than dilated bowel.</p></div><div><h3>Conclusions</h3><p>The CT grading scale for SBO developed at our institution shows excellent correlation between grade and going for surgery, with few negative results, and can be a useful tool among other factors for general surgeons when deciding whether or not to operate on a patient with suspected SBO.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000769/pdfft?md5=1633487f23c6f32ff097afc48332c39c&pid=1-s2.0-S2589845024000769-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141291466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-31DOI: 10.1016/j.sopen.2024.05.015
Peng Zhang , Xi Dang , Xiaojie Li , Bo Liu , Qingliang Wang
Background
Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) provides an effective alternative procedure for the management of complex hepatolithiasis and choledocholithiasis. Enhanced recovery after surgery (ERAS) program is an evidence-based approach that was developed to reduce surgical stress and accelerate postoperative recovery. However, little is known regarding PTCSL in the context of ERAS. The aim of this study was to evaluate the efficacy and safety of PTCSL within ERAS programs.
Patient and methods
The clinical data of patients who underwent PTCSL within ERAS programs consulted at our hospital between November 2017 and November 2022 was retrospectively reviewed. Individualized perioperative ERAS items were evaluated for all patients. The demographics, intraoperative variables, and postoperative outcomes were analyzed.
Results
A total of 43 patients who underwent PTCSL were included in the study. There were 13 men and 30 women aged between 39 and 89 years with an average age of 60 years (60.49 ± 12.37). The stone clearance rate was 77 % after the first operation, and the final clearance rate was 95 %. The incidence of complications in this study is 18.6 % (8/43), including 6 patients with Clavien-Dindo I-II, and 2 patients with Clavien-Dindo III. Pleural effusion, abdominal effusion, infection, bile leakage, and biliary bleeding are the most common complications, however, all patients recovered after aggressive treatment.
Conclusion
PTCSL is a relatively safe, feasible, and efficient method for treating complex hepatolithiasis and choledocholithiasis within ERAS programs. Individualized ERAS entries and precise disease management are required to minimize the occurrence of complications and to provide effective treatment.
{"title":"Enhanced recovery after surgery in percutaneous transhepatic cholangioscopic lithotripsy for patients with hepatolithiasis and choledocholithiasis","authors":"Peng Zhang , Xi Dang , Xiaojie Li , Bo Liu , Qingliang Wang","doi":"10.1016/j.sopen.2024.05.015","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><p>Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) provides an effective alternative procedure for the management of complex hepatolithiasis and choledocholithiasis. Enhanced recovery after surgery (ERAS) program is an evidence-based approach that was developed to reduce surgical stress and accelerate postoperative recovery. However, little is known regarding PTCSL in the context of ERAS. The aim of this study was to evaluate the efficacy and safety of PTCSL within ERAS programs.</p></div><div><h3>Patient and methods</h3><p>The clinical data of patients who underwent PTCSL within ERAS programs consulted at our hospital between November 2017 and November 2022 was retrospectively reviewed. Individualized perioperative ERAS items were evaluated for all patients. The demographics, intraoperative variables, and postoperative outcomes were analyzed.</p></div><div><h3>Results</h3><p>A total of 43 patients who underwent PTCSL were included in the study. There were 13 men and 30 women aged between 39 and 89 years with an average age of 60 years (60.49 ± 12.37). The stone clearance rate was 77 % after the first operation, and the final clearance rate was 95 %. The incidence of complications in this study is 18.6 % (8/43), including 6 patients with Clavien-Dindo I-II, and 2 patients with Clavien-Dindo III. Pleural effusion, abdominal effusion, infection, bile leakage, and biliary bleeding are the most common complications, however, all patients recovered after aggressive treatment.</p></div><div><h3>Conclusion</h3><p>PTCSL is a relatively safe, feasible, and efficient method for treating complex hepatolithiasis and choledocholithiasis within ERAS programs. Individualized ERAS entries and precise disease management are required to minimize the occurrence of complications and to provide effective treatment.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000782/pdfft?md5=bdbbee23c306c3602e6341cbc91c16a6&pid=1-s2.0-S2589845024000782-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-31DOI: 10.1016/j.sopen.2024.05.013
Jeffrey Balian, Nam Yong Cho BS, Amulya Vadlakonda BS, Oh. Jin Kwon MD, Giselle Porter BS, Saad Mallick MD, Peyman Benharash MD
Background
Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event.
Methods
All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016–2020 National Readmissions Database. Patients undergoing trauma-related operations or procedures ≤2 days of admission were excluded. FTR was defined as in-hospital death following acute kidney injury requiring dialysis (AKI), myocardial infarction, pneumonia, respiratory failure, sepsis, stroke, or thromboembolism. Multilevel mixed-effect models were developed to assess factors linked with FTR.
Results
Among 826,548 EGS operations satisfying inclusion criteria, 298,062 (36.1 %) developed at least one MAE. Of those experiencing MAE, 43,477 (14.6 %) ultimately did not survive to discharge (FTR). Following adjustment for fixed hospital level effects, only 3.5 % of the variance in FTR was attributable to center-level differences. Relative to private insurance and the highest income quartile, Medicaid insurance (AOR 1.33; 95%CI, 1.23–1.43) and the lowest income quartile (AOR 1.22; 95%CI, 1.17–1.29) were linked with increased odds of FTR.
A subset analysis stratified complication-specific rates of FTR by insurance status. Relative to private insurance, Medicaid coverage and uninsured status were linked with greater odds of FTR following perioperative sepsis, pneumonia, and AKI.
Conclusion
Our findings underscore the need for increased screening and vigilance following perioperative complications to mitigate disparities in patient outcomes following high-risk EGS.
{"title":"Failure to rescue following emergency general surgery: A national analysis","authors":"Jeffrey Balian, Nam Yong Cho BS, Amulya Vadlakonda BS, Oh. Jin Kwon MD, Giselle Porter BS, Saad Mallick MD, Peyman Benharash MD","doi":"10.1016/j.sopen.2024.05.013","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event.</p></div><div><h3>Methods</h3><p>All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016–2020 National Readmissions Database. Patients undergoing trauma-related operations or procedures ≤2 days of admission were excluded. FTR was defined as in-hospital death following acute kidney injury requiring dialysis (AKI), myocardial infarction, pneumonia, respiratory failure, sepsis, stroke, or thromboembolism. Multilevel mixed-effect models were developed to assess factors linked with FTR.</p></div><div><h3>Results</h3><p>Among 826,548 EGS operations satisfying inclusion criteria, 298,062 (36.1 %) developed at least one MAE. Of those experiencing MAE, 43,477 (14.6 %) ultimately did not survive to discharge (FTR). Following adjustment for fixed hospital level effects, only 3.5 % of the variance in FTR was attributable to center-level differences. Relative to private insurance and the highest income quartile, Medicaid insurance (AOR 1.33; 95%CI, 1.23–1.43) and the lowest income quartile (AOR 1.22; 95%CI, 1.17–1.29) were linked with increased odds of FTR.</p><p>A subset analysis stratified complication-specific rates of FTR by insurance status. Relative to private insurance, Medicaid coverage and uninsured status were linked with greater odds of FTR following perioperative sepsis, pneumonia, and AKI.</p></div><div><h3>Conclusion</h3><p>Our findings underscore the need for increased screening and vigilance following perioperative complications to mitigate disparities in patient outcomes following high-risk EGS.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000745/pdfft?md5=2c4d4ed6f1b40fbf3f0f67ad56b22c8b&pid=1-s2.0-S2589845024000745-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141314309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-30DOI: 10.1016/j.sopen.2024.05.010
Nathan J. Alcasid MD , Kian C. Banks MD , Sheng-Fang Jiang MS , Cynthia J. Susai MD , Diana Hsu MD , William Carroway MD , Kenneth Williams MD , Ashish Patel MD , Simon Ashiku MD , Jeffrey B. Velotta MD
Background
Consensus guidelines regarding the amount and necessity of post-operative imaging in thoracic surgery are lacking. The efficacy of daily chest radiographs (CXR) following video-assisted (VATS) and robotic-assisted (RATS) thoracoscopic surgery in directing management has not been previously studied. We hypothesize that abnormal clinical findings, rather than abnormal imaging findings, better predict post-operative complications in patients undergoing VATS/RATS lobectomies.
Methods
A retrospective review of VATS and RATS lobectomy patients were performed at a tertiary referral center from 1/1/2019–12/31/2021. Demographics, hospital course, and imaging were evaluated. Descriptive statistics, Chi-Square test, Fisher's exact, Wilcoxon rank sum, and multivariable logistic regression were performed. Our outcomes were post-operative complications requiring a procedure and extended length of stay (LOS) (>2 days post-operatively).
Results
Out of 362 VATS/RATS lobectomy patients, 15 patients had post-operative complications requiring a procedure. Almost all patients who required a procedure had abnormal clinical signs and symptoms (14/15; p < 0.001) while 70 % had expected post-operative day (POD) one CXR findings (11/15; p = 0.463). Multivariable logistic regression demonstrated clinical signs and symptoms independently predicted procedural requirement (odds ratio [OR] = 48, 95 % Confidence Interval [CI]:8.5–267) while abnormal POD one imaging did not. For extended LOS, a positive smoking history (OR = 4.4, 95 % CI:1.4–14.1), number of CXRs (OR = 2.4, 95 % CI:1.8–3.2) and thoracostomy tubes (OR = 5.3, 95 % CI:1.0–27.3) were independent predictors while clinical signs and symptoms was not.
Conclusion
Abnormal clinical findings may guide management more predictably than abnormal CXRs after VATS/RATS. Routine CXR in the post-operative setting may be unnecessary in those without clinical signs or symptoms.
Key message
There are no consensus guidelines regarding the efficacy of routine, post-operative diagnostic studies after major thoracic lobar resections. The presence of abnormal signs or symptoms after minimally invasive lobectomies may better predict those who will require additional procedures better than the presence of abnormal routine, post-operative chest radiographs.
{"title":"Are routine, daily chest radiographs (CXR) necessary following (VATS and RATS) lobectomies?","authors":"Nathan J. Alcasid MD , Kian C. Banks MD , Sheng-Fang Jiang MS , Cynthia J. Susai MD , Diana Hsu MD , William Carroway MD , Kenneth Williams MD , Ashish Patel MD , Simon Ashiku MD , Jeffrey B. Velotta MD","doi":"10.1016/j.sopen.2024.05.010","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><p>Consensus guidelines regarding the amount and necessity of post-operative imaging in thoracic surgery are lacking. The efficacy of daily chest radiographs (CXR) following video-assisted (VATS) and robotic-assisted (RATS) thoracoscopic surgery in directing management has not been previously studied. We hypothesize that abnormal clinical findings, rather than abnormal imaging findings, better predict post-operative complications in patients undergoing VATS/RATS lobectomies.</p></div><div><h3>Methods</h3><p>A retrospective review of VATS and RATS lobectomy patients were performed at a tertiary referral center from 1/1/2019–12/31/2021. Demographics, hospital course, and imaging were evaluated. Descriptive statistics, Chi-Square test, Fisher's exact, Wilcoxon rank sum, and multivariable logistic regression were performed. Our outcomes were post-operative complications requiring a procedure and extended length of stay (LOS) (>2 days post-operatively).</p></div><div><h3>Results</h3><p>Out of 362 VATS/RATS lobectomy patients, 15 patients had post-operative complications requiring a procedure. Almost all patients who required a procedure had abnormal clinical signs and symptoms (14/15; <em>p</em> < 0.001) while 70 % had expected post-operative day (POD) one CXR findings (11/15; <em>p</em> = 0.463). Multivariable logistic regression demonstrated clinical signs and symptoms independently predicted procedural requirement (odds ratio [OR] = 48, 95 % Confidence Interval [CI]:8.5–267) while abnormal POD one imaging did not. For extended LOS, a positive smoking history (OR = 4.4, 95 % CI:1.4–14.1), number of CXRs (OR = 2.4, 95 % CI:1.8–3.2) and thoracostomy tubes (OR = 5.3, 95 % CI:1.0–27.3) were independent predictors while clinical signs and symptoms was not.</p></div><div><h3>Conclusion</h3><p>Abnormal clinical findings may guide management more predictably than abnormal CXRs after VATS/RATS. Routine CXR in the post-operative setting may be unnecessary in those without clinical signs or symptoms.</p></div><div><h3>Key message</h3><p>There are no consensus guidelines regarding the efficacy of routine, post-operative diagnostic studies after major thoracic lobar resections. The presence of abnormal signs or symptoms after minimally invasive lobectomies may better predict those who will require additional procedures better than the presence of abnormal routine, post-operative chest radiographs.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000721/pdfft?md5=dcb502ca969faf20e7c0addbb81ea8a2&pid=1-s2.0-S2589845024000721-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1016/j.sopen.2024.05.009
Mohammad Nebih Nofal , Mahmoud Mousa Al Awayshish , Ali Jad Yousef , Ammar Masoud Alamaren , Zaid Issam Al-Rabadi , Dina Samer Haddad , Yaqeen Ahmad Al-Rbaihat , Yazeed Nabeel Al-Qusous
Background
To outline the resources deemed most beneficial to medical students during their general surgery clerkship, as well as to examine their link to students' general surgery scores and the usage of artificial intelligence in general surgery study.
Methods
A retrospective survey of Jordanian medical students from six universities was done between March and June 2023 using a 7-item questionnaire covering questions concerning general surgery study methods and scores. Descriptive statistics were used to evaluate demographic data. Chi-square is used to evaluate categorical data, with a P value <0.05 deemed significant.
Results
The average age of respondents was 23.3 years, and 54.2 % of the respondents were females, 47.8 % were from Mutah University. Most students (48.2 %) relied on tutor lectures. Students who studied through instructor lectures had the highest grades (9 % excellent, 17 % very good), followed by students who studied using surgery textbooks (6.8 % and 14.6 %, respectively). The relationship between the study method and academic achievement was statistically significant (P < 0.05).
Conclusions
Traditional face-to-face learning with instructor lectures and surgery textbooks is still the most efficient approach to attain the greatest scores. Medical students are still underutilizing artificial intelligence.
{"title":"General surgery educational resources for Jordanian medical students","authors":"Mohammad Nebih Nofal , Mahmoud Mousa Al Awayshish , Ali Jad Yousef , Ammar Masoud Alamaren , Zaid Issam Al-Rabadi , Dina Samer Haddad , Yaqeen Ahmad Al-Rbaihat , Yazeed Nabeel Al-Qusous","doi":"10.1016/j.sopen.2024.05.009","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>To outline the resources deemed most beneficial to medical students during their general surgery clerkship, as well as to examine their link to students' general surgery scores and the usage of artificial intelligence in general surgery study.</p></div><div><h3>Methods</h3><p>A retrospective survey of Jordanian medical students from six universities was done between March and June 2023 using a 7-item questionnaire covering questions concerning general surgery study methods and scores. Descriptive statistics were used to evaluate demographic data. Chi-square is used to evaluate categorical data, with a <em>P</em> value <0.05 deemed significant.</p></div><div><h3>Results</h3><p>The average age of respondents was 23.3 years, and 54.2 % of the respondents were females, 47.8 % were from Mutah University. Most students (48.2 %) relied on tutor lectures. Students who studied through instructor lectures had the highest grades (9 % excellent, 17 % very good), followed by students who studied using surgery textbooks (6.8 % and 14.6 %, respectively). The relationship between the study method and academic achievement was statistically significant (<em>P</em> < 0.05).</p></div><div><h3>Conclusions</h3><p>Traditional face-to-face learning with instructor lectures and surgery textbooks is still the most efficient approach to attain the greatest scores. Medical students are still underutilizing artificial intelligence.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258984502400071X/pdfft?md5=bd8bbe009d764663aa2b574cae0c454d&pid=1-s2.0-S258984502400071X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1016/j.sopen.2024.05.017
Arianna Pontrelli , Piercarmine Panzera , Francesco Paolo Prete , Enrico Fischetti , Carlotta Testini , Mario Testini
{"title":"Intrahepatic cystic mass and bile duct malformation","authors":"Arianna Pontrelli , Piercarmine Panzera , Francesco Paolo Prete , Enrico Fischetti , Carlotta Testini , Mario Testini","doi":"10.1016/j.sopen.2024.05.017","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.017","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000800/pdfft?md5=ec5cbae6a22adc64a329105e7321cf8f&pid=1-s2.0-S2589845024000800-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1016/j.sopen.2024.05.012
Corynn Branche , Nikhil Chervu MD MS , Giselle Porter BS , Amulya Vadlakonda BS , Sara Sakowitz MS MPH , Konmal Ali , Saad Mallick MD , Peyman Benharash MD
Background
Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race.
Methods
The 2016–2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality.
Results
Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β −1.66 days, CI[−1.99, −1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]).
Conclusions
We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.
{"title":"The impact of rurality on racial disparities in costs of bowel obstruction treatment","authors":"Corynn Branche , Nikhil Chervu MD MS , Giselle Porter BS , Amulya Vadlakonda BS , Sara Sakowitz MS MPH , Konmal Ali , Saad Mallick MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2024.05.012","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race.</p></div><div><h3>Methods</h3><p>The 2016–2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality.</p></div><div><h3>Results</h3><p>Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β −1.66 days, CI[−1.99, −1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]).</p></div><div><h3>Conclusions</h3><p>We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000733/pdfft?md5=46d4a4368bffb94fe577354cc209abd0&pid=1-s2.0-S2589845024000733-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Long guns (LGs) are uniquely implicated in firearm violence and mass shootings. On 1/1/2019 California (CA) raised the minimum age to purchase LGs from 18 to 21. This study aimed to evaluate the incidence of LG violence in CA vs. Texas (TX), a state with rising firearm usage and fewer LG regulations, hypothesizing decreased LG firearm incidents in CA vs increased rates in TX after CA LG legislation.
Methods
A retrospective analysis of the Gun Violence Archive (2015–2021) was performed. An additional analysis of all firearm incidents within TX and CA was performed. CA and TX census data were used to calculate incidents of LG violence per 10,000,000 people. The primary outcome was the number of LG-related firearm incidents. Median yearly rates of LG violence per 10,000,000 people were compared for pre (2015–2018) vs post (2019–2021) CA LG legislation (Senate Bill 1100 (SB1100).
Results
Median LG incidents decreased in CA post-SB1100 (4.21 vs 1.52, p < 0.001) by nearly 64 %, whereas any gun firearm violence was similar pre vs post-SB1100 (77.0 vs 74.5 median incidents, p = 0.89). In contrast, median LG incidents increased after SB1100 (4.34 vs 5.17 median incidents, p = 0.011) by nearly 35 % in TX, with any gun incidents increasing by nearly 53 % (83.48 vs 127.46, p < 0.001).
Conclusion
CA LG firearm incidents decreased following SB 1100 legislation whereas the incidence in TX increased during this same time. Meanwhile, the incidence of any firearm violence remained similar in CA but increased in TX. This suggests the sharp decline in CA LG incidents may be related to SB1100. Accordingly, increasing the age to purchase a LG from 18 to 21 at a federal level may help curtail LG violence nationally.
导语:长枪(LG)是枪支暴力和大规模枪击事件的独特牵连。2019 年 1 月 1 日,加利福尼亚州(CA)将购买长枪的最低年龄从 18 岁提高到 21 岁。本研究旨在评估加利福尼亚州与德克萨斯州(Texas)的长枪暴力事件发生率,德克萨斯州的枪支使用率不断上升,但对长枪的监管较少,本研究假设加利福尼亚州长枪立法后,加利福尼亚州的长枪枪支事件减少,而德克萨斯州的枪支事件增加。此外,还对德克萨斯州和加利福尼亚州的所有枪支事件进行了分析。加利福尼亚州和德克萨斯州的人口普查数据用于计算每 10,000,000 人中发生的 LG 暴力事件。主要结果是与 LG 相关的枪支事件数量。比较了加利福尼亚州 LG 立法(参议院法案 1100 (SB1100))之前(2015-2018 年)与之后(2019-2021 年)每 10,000,000 人 LG 暴力事件的年中位数。结果加利福尼亚州在 SB1100 之后的 LG 事件中位数减少了近 64%(4.21 vs 1.52,p < 0.001),而任何枪支暴力事件在 SB1100 之前与之后相似(77.0 vs 74.5 事件中位数,p = 0.89)。相比之下,德克萨斯州的 LG 事件中位数在 SB1100 之后增加了近 35%(4.34 vs 5.17 事件中位数,p = 0.011),任何枪支事件增加了近 53%(83.48 vs 127.46,p <0.001)。与此同时,加利福尼亚州的任何枪支暴力事件发生率保持相似,而德克萨斯州则有所上升。这表明,加利福尼亚州枪支暴力事件的急剧下降可能与 SB1100 法案有关。因此,在联邦一级将购买轻型枪支的年龄从 18 岁提高到 21 岁可能有助于在全国范围内减少轻型枪支暴力事件。
{"title":"Long gun violence in California versus Texas: How legislation can reduce firearm violence","authors":"Jonathan Shipley BS , Areg Grigorian MD , Lourdes Swentek MD , Cristobal Barrios MD , Catherine Kuza MD , Jeffrey Santos MD , Jeffry Nahmias MD, MHPE","doi":"10.1016/j.sopen.2024.05.011","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.011","url":null,"abstract":"<div><h3>Introduction</h3><p>Long guns (LGs) are uniquely implicated in firearm violence and mass shootings. On 1/1/2019 California (CA) raised the minimum age to purchase LGs from 18 to 21. This study aimed to evaluate the incidence of LG violence in CA vs. Texas (TX), a state with rising firearm usage and fewer LG regulations, hypothesizing decreased LG firearm incidents in CA vs increased rates in TX after CA LG legislation.</p></div><div><h3>Methods</h3><p>A retrospective analysis of the Gun Violence Archive (2015–2021) was performed. An additional analysis of all firearm incidents within TX and CA was performed. CA and TX census data were used to calculate incidents of LG violence per 10,000,000 people. The primary outcome was the number of LG-related firearm incidents. Median yearly rates of LG violence per 10,000,000 people were compared for pre (2015–2018) vs post (2019–2021) CA LG legislation (Senate Bill 1100 (SB1100).</p></div><div><h3>Results</h3><p>Median LG incidents decreased in CA post-SB1100 (4.21 vs 1.52, <em>p</em> < 0.001) by nearly 64 %, whereas any gun firearm violence was similar pre vs post-SB1100 (77.0 vs 74.5 median incidents, <em>p</em> = 0.89). In contrast, median LG incidents increased after SB1100 (4.34 vs 5.17 median incidents, <em>p</em> = 0.011) by nearly 35 % in TX, with any gun incidents increasing by nearly 53 % (83.48 vs 127.46, p < 0.001).</p></div><div><h3>Conclusion</h3><p>CA LG firearm incidents decreased following SB 1100 legislation whereas the incidence in TX increased during this same time. Meanwhile, the incidence of any firearm violence remained similar in CA but increased in TX. This suggests the sharp decline in CA LG incidents may be related to SB1100. Accordingly, increasing the age to purchase a LG from 18 to 21 at a federal level may help curtail LG violence nationally.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000757/pdfft?md5=420ffbc8ebf851fc5525b9a9f1ffd560&pid=1-s2.0-S2589845024000757-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1016/j.sopen.2024.05.014
Brent Smith MD , Jodi Veach BA , Carissa Walter MPH , Alexander Alsup MS , Kate Young PhD , Lauren Clark MS , Yanming Li PhD , Aaron Rohr MD, MS
Purpose
Determine if there is a difference in adverse events (AE) between right or left hepatic percutaneous biliary drain placement (PTBD) in patients with biliary strictures.
Materials & methods
This retrospective study included patients with benign or malignant biliary stricture treated with PTBD at a single institution from 7/28/2004–3/30/2021. 357 patients met inclusion criteria, 77 (21.6 %) had PTBD on the left and 280 (78.4 %) on the right. AEs associated with the initial drain placement or during subsequent intervention were collected and categorized. AEs that were grouped as periprocedural included: surgery, infection, hemorrhage, and drain failure. AEs in the postprocedural group included: chills, catheter displacement, cholangitis, biliary stones, drain malfunction, fever resolving without treatment, and pericatheter leakage. Surgery was considered a major AE and the remaining AEs were categorized as minor. Statistical analyses were performed using Logistic Regression Analysis and p-values less than 0.05 were considered statistically significant.
Results
Overall, there was no statistically significant difference in AEs between right and left drains in the periprocedural and postprocedural period (p = 0.832, OR = 0.95 and p = 0.808, OR = 0.93 respectively). When analyzing minor AEs individually, only cholangitis occurred at a higher rate on the right side (p = 0.033, OR = 0.43). There was no statistical difference in the rate of major AEs in the periprocedural period between left and right drains (p = 0.311, OR = 1.37).
Conclusion
Current literature is equivocal when comparing right versus left percutaneous biliary drains. This analysis describes no statistically significant difference in AEs between right and left hepatobiliary drains aside from slightly higher incidence of cholangitis for right sided drains.
{"title":"Comparing outcomes of right verse left hepatic approach percutaneous biliary drainage catheters","authors":"Brent Smith MD , Jodi Veach BA , Carissa Walter MPH , Alexander Alsup MS , Kate Young PhD , Lauren Clark MS , Yanming Li PhD , Aaron Rohr MD, MS","doi":"10.1016/j.sopen.2024.05.014","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.014","url":null,"abstract":"<div><h3>Purpose</h3><p>Determine if there is a difference in adverse events (AE) between right or left hepatic percutaneous biliary drain placement (PTBD) in patients with biliary strictures.</p></div><div><h3>Materials & methods</h3><p>This retrospective study included patients with benign or malignant biliary stricture treated with PTBD at a single institution from 7/28/2004–3/30/2021. 357 patients met inclusion criteria, 77 (21.6 %) had PTBD on the left and 280 (78.4 %) on the right. AEs associated with the initial drain placement or during subsequent intervention were collected and categorized. AEs that were grouped as periprocedural included: surgery, infection, hemorrhage, and drain failure. AEs in the postprocedural group included: chills, catheter displacement, cholangitis, biliary stones, drain malfunction, fever resolving without treatment, and pericatheter leakage. Surgery was considered a major AE and the remaining AEs were categorized as minor. Statistical analyses were performed using Logistic Regression Analysis and <em>p</em>-values less than 0.05 were considered statistically significant.</p></div><div><h3>Results</h3><p>Overall, there was no statistically significant difference in AEs between right and left drains in the periprocedural and postprocedural period (<em>p</em> = 0.832, OR = 0.95 and <em>p</em> = 0.808, OR = 0.93 respectively). When analyzing minor AEs individually, only cholangitis occurred at a higher rate on the right side (<em>p</em> = 0.033, OR = 0.43). There was no statistical difference in the rate of major AEs in the periprocedural period between left and right drains (<em>p</em> = 0.311, OR = 1.37).</p></div><div><h3>Conclusion</h3><p>Current literature is equivocal when comparing right versus left percutaneous biliary drains. This analysis describes no statistically significant difference in AEs between right and left hepatobiliary drains aside from slightly higher incidence of cholangitis for right sided drains.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000770/pdfft?md5=5c845bc137b6c75a917f885c67705ed3&pid=1-s2.0-S2589845024000770-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis.
Methods
The 2016–2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH).
Results
Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.
Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission.
Conclusions
We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.
{"title":"Interhospital variation in the non-operative management of uncomplicated appendicitis in adults","authors":"Baran Khoraminejad , Sara Sakowitz MS, MPH , Giselle Porter BS , Nikhil Chervu MD , Konmal Ali , Saad Mallick MD , Syed Shahyan Bakhtiyar MD, MBE , Peyman Benharash MD","doi":"10.1016/j.sopen.2024.05.008","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.008","url":null,"abstract":"<div><h3>Background</h3><p>Recent randomized trials have suggested non-operative management to be a safe alternative to appendectomy for acute uncomplicated appendicitis. Yet, there remains significant variability in treatment approach. This study sought to characterize center-level variation in non-operative management within a national cohort of adults presenting with appendicitis.</p></div><div><h3>Methods</h3><p>The 2016–2020 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for acute uncomplicated appendicitis. Hierarchical, mixed-effects models were developed to ascertain factors linked with non-operative management. Bayesian methodology was applied to predict random effects, which were then used to rank centers by increasing hospital-attributed rate of non-operative management. Institutions with high center-specific rates of non-operative management (>90th percentile) were considered low-operating hospitals (LOH).</p></div><div><h3>Results</h3><p>Of an estimated 447,500 patients, 52,523 (11.7 %) were managed non-operatively. Compared to those undergoing appendectomy, the non-operative cohort was older, more commonly male, and of a higher comorbidity burden. Approximately 30 % in the variability of non-operative management was attributable to hospital effects, with absolute, risk-adjusted rates ranging from 0.5 to 22.5 %. Centers with non-operative management rates ≥90th percentile were considered LOH.</p><p>Following risk adjustment, among patients undergoing appendectomy, care at LOH was linked with greater odds of postoperative infection, resource utilization, and non-elective readmission.</p></div><div><h3>Conclusions</h3><p>We identified significant interhospital variation in the utilization of non-operative management for acute uncomplicated appendicitis. Further, we found LOH to be associated with inferior outcomes following surgical management. Future work is needed to assess the care pathways that contribute to increased utilization of non-operative strategies, and disseminate best practices across institutions.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000708/pdfft?md5=a593c1cc294d364a0447249e1da735c9&pid=1-s2.0-S2589845024000708-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}