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IF 1.4 Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/S2589-8450(24)00085-X
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引用次数: 0
Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent colorectal peritoneal metastases 复发性结直肠腹膜转移瘤的二次细胞剥脱手术和腹腔内热化疗
IF 1.4 Q3 Medicine Pub Date : 2024-05-31 DOI: 10.1016/j.sopen.2024.05.018
Peter Harald Cashin MD, PhD , Dan Asplund MD, PhD , Elinor Bexe Lindskog MD, PhD , Lana Ghanipour MD, PhD , Ingvar Syk MD, PhD , Wilhelm Graf MD, PhD , Per J. Nilsson MD, PhD , Gabriella Jansson Palmer MD, PhD

Background

Secondary treatment of recurrent colorectal peritoneal metastases after previous cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is poorly investigated.

Objectives

To evaluate the overall survival outcome of secondary (repeat) CRS + HIPEC compared to palliative treatment in recurrent peritoneal disease.

Methods

Patients with colorectal peritoneal metastases treated with an index CRS + HIPEC and subsequently having recurrent peritoneal disease were identified from the prospective Swedish national HIPEC registry. Patients were divided into interventional group (secondary CRS + HIPEC) or palliative group. Multivariable logistic regression, propensity-score matching, and survival outcomes were calculated.

Results

Among 575 patients who underwent complete CRS between 2010 and 2021, 208 (36 %) were diagnosed with a subsequent recurrent peritoneal disease. Forty-two patients (20 %) were offered secondary CRS + HIPEC. Propensity-score matching of secondary interventional cases with palliative cases succeeded in 88 % (n = 37) in which female sex, lower peritoneal cancer index at index surgery, longer disease-free interval, and absence of extra-peritoneal metastases were identified as the most relevant matching covariates. Median OS from date of recurrence was 38 months (95%CI 30–58) in the interventional group and 19 months (95%CI: 15–24) in the palliative group (HR 0.35 95%CI: 0.20–0.63, p = 0.0004). Sensitivity analyses confirmed the results. As reference, the median OS from index CRS + HIPEC in the whole colorectal registry (n = 575) was 41 months (95%CI: 38–45).

Conclusion

After matching for relevant factors, the hazard ratio for death was significantly reduced in patients who were offered a secondary CRS + HIPEC procedure for recurrent peritoneal disease. Selection bias is inherent, but survival outcomes were comparable to those achieved after the initial procedure.

背景对既往接受过囊肿切除手术(CRS)和腹腔内热化疗(HIPEC)后复发的结直肠腹膜转移瘤进行二次治疗的研究很少。目的评估复发性腹膜疾病二次(重复)CRS + HIPEC与姑息治疗相比的总体生存结果。方法从瑞典全国前瞻性 HIPEC 登记中识别出接受过一次 CRS + HIPEC 治疗后腹膜疾病复发的结直肠腹膜转移患者。患者被分为介入组(二次 CRS + HIPEC)或姑息组。结果在2010年至2021年期间接受完全CRS的575名患者中,有208人(36%)被诊断出随后复发腹膜疾病。42名患者(20%)接受了二次CRS+HIPEC治疗。二次介入病例与姑息病例的倾向分数匹配成功率为88%(n = 37),其中女性性别、指数手术时腹膜癌指数较低、无病间隔时间较长以及无腹膜外转移被确定为最相关的匹配协变量。介入组从复发之日起的中位生存期为38个月(95%CI:30-58),姑息组为19个月(95%CI:15-24)(HR 0.35 95%CI:0.20-0.63,P = 0.0004)。敏感性分析证实了上述结果。作为参考,在整个结直肠登记(n = 575)中,指数 CRS + HIPEC 的中位 OS 为 41 个月(95%CI:38-45)。选择偏差是固有的,但生存结果与初次手术后的结果相当。
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引用次数: 0
Real-world assessment of longitudinal opioid use and healthcare resource utilization in patients undergoing colorectal resection 对接受结直肠切除术的患者阿片类药物纵向使用情况和医疗资源利用情况的真实世界评估
IF 1.4 Q3 Medicine Pub Date : 2024-05-31 DOI: 10.1016/j.sopen.2024.05.022
Gary Schwartz , Jennifer H. Lin , Swapnabir Kakoty

Liposomal bupivacaine (LB) has been used in multimodal pain management regimens to improve postsurgical analgesia. This retrospective cohort analysis assessed clinical and economic outcomes of LB vs non-LB analgesia in minimally invasive colorectal resection surgery using real-world patient data from the IQVIA linkage claims databases. Patients who received LB were 1:1 matched to patients who did not receive LB (non-LB) via propensity scores. Outcomes included opioid use during the perioperative (2 weeks before surgery to 2 weeks after discharge), continued (>2 weeks to 3 months after discharge), and persistent (>3 months to 6 months after discharge) periods and healthcare resource utilization (HRU) during the first 3 months after discharge. Mean opioid consumption was lower in the LB (n = 4397) versus non-LB (n = 4397) cohort perioperatively (483 vs 538 morphine milligram equivalents [MMEs]; P = 0.001) and after discharge within ∼3 months (222 vs 328 MMEs; P < 0.0001) and 3–6 months (245 vs 384 MMEs; P < 0.0001). The LB cohort had shorter mean length of stay (5.2 vs 5.7 days; P < 0.0001) and fewer inpatient readmissions (odds ratio [OR], 0.71; P < 0.0001), emergency department visits (OR, 0.78; P < 0.0001), and outpatient/office visits (OR, 0.91; P = 0.028) than the non-LB cohort 3 months after discharge. These data suggest use of LB in minimally invasive colorectal resection surgery may reduce perioperative and postdischarge opioid use as well as HRU. Although additional studies are needed to confirm these findings, this analysis provides valuable real-world data from large claims databases to evaluate clinical and economic outcomes that complement other types of retrospective and prospective studies.

脂质体布比卡因(LB)已被用于多模式疼痛治疗方案,以改善术后镇痛。这项回顾性队列分析利用 IQVIA 链接索赔数据库中的真实患者数据,对微创结直肠切除手术中 LB 镇痛与非 LB 镇痛的临床和经济效果进行了评估。接受枸橼酸镇痛的患者与未接受枸橼酸镇痛(非枸橼酸镇痛)的患者通过倾向评分进行了 1:1 匹配。研究结果包括围手术期(手术前2周至出院后2周)、持续期(出院后2周至3个月)和持续期(出院后3个月至6个月)的阿片类药物使用量以及出院后前3个月的医疗资源利用率(HRU)。在围手术期(483 对 538 吗啡毫克当量 [MMEs];P = 0.001)、出院后 3 个月内(222 对 328 MMEs;P <;0.0001)和 3-6 个月内(245 对 384 MMEs;P <;0.0001),枸橼酸类药物(n = 4397)和非枸橼酸类药物(n = 4397)队列的阿片类药物平均消耗量较低。肺结核患者的平均住院时间(5.2 天 vs 5.7 天;P <;0.0001)比非肺结核患者短,出院 3 个月后住院患者再入院率(几率比 [OR],0.71;P <;0.0001)、急诊就诊率(OR,0.78;P <;0.0001)和门诊/诊室就诊率(OR,0.91;P = 0.028)比非肺结核患者低。这些数据表明,在微创结直肠切除手术中使用 LB 可减少围手术期和出院后阿片类药物的使用以及 HRU。虽然还需要更多的研究来证实这些发现,但这项分析提供了来自大型索赔数据库的宝贵真实数据,用于评估临床和经济结果,对其他类型的回顾性和前瞻性研究起到了补充作用。
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引用次数: 0
Exploring the gender gap: A nationwide comparative analysis of general surgery residency program leadership 探索性别差距:普外科住院医师培训项目领导力的全国比较分析
IF 1.4 Q3 Medicine Pub Date : 2024-05-31 DOI: 10.1016/j.sopen.2024.05.020
Xinfei Miao BS, Reem Sarsour BS, Madeleine Givant BS, Helena Spartz MD, PhD, FCAP

Background

The gender disparity in surgery leadership roles is well-reported. However, the effect of program type and region on mean number of men or women occupying a particular leadership role has yet to be explored. This study aims to investigate the gender disparity of leadership positions in different types of General Surgery Residency Programs (GSRPs).

Methods

Leadership roles of the general surgery departments were collected from the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) database. Each GSRP was categorized by region and program type using FRIEDA. Analysis of the mean number of men and women holding various leadership positions by program type and region was conducted using one-way ANOVA with post-hoc tests.

Results

A total of 345 GSRPs were analyzed. The mean number of women occupying various leadership roles was significantly higher at university-based programs when compared to community-based programs. No significant difference in mean number of women leaders was observed by region.

Conclusions

Women consistently occupy a lower number of GSRP leadership positions when compared to men, regardless of program type or region. University-based GSRP leadership positions have significantly greater gender inclusion compared to community-based GSRPs.

Key messages

University-based general surgery residency programs had a higher mean number of women in all leadership roles compared to other program types. In comparison, region did not appear to be a significant factor impacting the leadership gender disparity. Improvement is needed in community-based general surgery residency programs to bridge the gender gap in leadership roles.

背景手术领导岗位的性别差异已被广泛报道。然而,项目类型和地区对担任特定领导职务的男性或女性平均人数的影响尚未得到探讨。本研究旨在调查不同类型的普外科住院医师培训项目(GSRP)中领导职位的性别差异。方法从研究员和住院医师电子交互式数据库访问系统(FREIDA)数据库中收集普外科的领导职位。使用 FRIEDA 按地区和项目类型对每个 GSRP 进行分类。通过单因素方差分析和事后检验,分析了按项目类型和地区分列的担任各种领导职务的男性和女性的平均人数。与社区项目相比,大学项目中担任各种领导职务的女性平均人数明显较多。结论无论项目类型或地区如何,与男性相比,女性担任 GSRP 领导职位的人数一直较少。基于大学的普外科住院医师培训项目与基于社区的普外科住院医师培训项目相比,其领导岗位的性别包容性明显更高。相比之下,地区似乎不是影响领导层性别差异的重要因素。社区普外科住院医师培训项目需要改进,以缩小领导岗位上的性别差距。
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引用次数: 0
The utility of a CT grading scale in deciding on surgical intervention for patients with suspected small bowel obstruction CT 分级表在决定对疑似小肠梗阻患者进行外科干预时的实用性
IF 1.4 Q3 Medicine Pub Date : 2024-05-31 DOI: 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.

背景为评估疑似小肠梗阻(SBO)患者的计算机断层扫描(CT)制定了一套分级系统。我们假设,CT 扫描中疑似 SBO 等级较高的患者更有可能需要手术治疗。方法对急诊室(ER)中因疑似 SBO 而接受腹部和盆腔 CT 检查的患者进行回顾性病历审查。患者分为 5 组:结果对 655 名患者的 CT 扫描结果进行了分级。在 22 名 1 级 SBO 患者中,只有 1 人接受了手术(4.5%)。二级 SBO 患者 299 人中有 23 人接受了手术(7.7%),三级 SBO 患者 299 人中有 84 人接受了手术(28.1%),四级 SBO 患者 35 人中有 25 人接受了手术(71.4%)。P值为<0.00001。术中最常见的三种发现是单纯粘连引起的 SBO 梗阻(占 48%),其次是嵌顿疝 (12%)和缺血性肠管(9%)。结论 本院制定的 SBO CT 分级表显示,分级与是否手术之间存在很好的相关性,很少出现负面结果,可作为普外科医生决定是否为疑似 SBO 患者手术的有用工具。
{"title":"The utility of a CT grading scale in deciding on surgical intervention for patients with suspected small bowel obstruction","authors":"Marianne Becnel ,&nbsp;Ikaikaolahui Danner ,&nbsp;Maria De Los Santos ,&nbsp;Lindsay J. Escobedo ,&nbsp;Marie Mohrbacher ,&nbsp;Jacob Young ,&nbsp;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 &lt;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":"20 ","pages":"Pages 70-76"},"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}
引用次数: 0
Enhanced recovery after surgery in percutaneous transhepatic cholangioscopic lithotripsy for patients with hepatolithiasis and choledocholithiasis 经皮经肝胆管镜碎石术治疗肝结石和胆总管结石患者术后恢复更快
IF 1.4 Q3 Medicine Pub Date : 2024-05-31 DOI: 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.

背景经皮经肝胆管镜碎石术(PTCSL)是治疗复杂性肝结石和胆总管结石的有效替代手术。术后强化恢复(ERAS)计划是一种循证方法,旨在减轻手术压力并加快术后恢复。然而,人们对 ERAS 中的 PTCSL 却知之甚少。本研究旨在评估ERAS计划中PTCSL的有效性和安全性。患者和方法回顾性审查了2017年11月至2022年11月期间在我院就诊的ERAS计划中接受PTCSL的患者的临床数据。对所有患者的围手术期 ERAS 项目进行了个性化评估。对人口统计学、术中变量和术后结果进行了分析。结果 共有43名接受PTCSL手术的患者被纳入研究。其中男性 13 人,女性 30 人,年龄在 39 至 89 岁之间,平均年龄为 60 岁(60.49 ± 12.37)。首次手术后结石清除率为 77%,最终清除率为 95%。本研究中并发症的发生率为 18.6%(8/43),包括 6 名克拉维恩-丁多 I-II 型患者和 2 名克拉维恩-丁多 III 型患者。胸腔积液、腹腔积液、感染、胆汁渗漏和胆道出血是最常见的并发症,但所有患者在积极治疗后都已痊愈。要最大限度地减少并发症的发生并提供有效的治疗,就需要个性化的 ERAS 项目和精确的疾病管理。
{"title":"Enhanced recovery after surgery in percutaneous transhepatic cholangioscopic lithotripsy for patients with hepatolithiasis and choledocholithiasis","authors":"Peng Zhang ,&nbsp;Xi Dang ,&nbsp;Xiaojie Li ,&nbsp;Bo Liu ,&nbsp;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":"20 ","pages":"Pages 38-44"},"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}
引用次数: 0
Failure to rescue following emergency general surgery: A national analysis 普外科急诊手术后抢救失败:全国分析
IF 1.4 Q3 Medicine Pub Date : 2024-05-31 DOI: 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.

背景抢救失败(FTR)越来越被认为是一项质量指标,但对急诊普外科(EGS)的研究仍然不足。我们试图确定与 FTR 相关的患者和手术因素,以便更好地为标准化指标提供信息,从而减少这一潜在的可预防事件。方法在 2016-2020 年国家再入院数据库中确定了所有因大肠切除术、小肠切除术、穿孔溃疡修补术、开腹手术和粘连裂解术而非选择性住院的成人(≥18 岁)。不包括入院后2天内接受创伤相关手术或程序的患者。FTR定义为急性肾损伤(需要透析)、心肌梗死、肺炎、呼吸衰竭、败血症、中风或血栓栓塞后的院内死亡。结果在 826,548 例符合纳入标准的 EGS 手术中,298,062 例(36.1%)发生了至少一次 MAE。在出现 MAE 的患者中,43,477 人(14.6%)最终未能出院(FTR)。在对固定的医院水平效应进行调整后,只有 3.5% 的 FTR 变异可归因于中心水平的差异。相对于私人保险和最高收入四分位数,医疗补助保险(AOR 1.33;95%CI,1.23-1.43)和最低收入四分位数(AOR 1.22;95%CI,1.17-1.29)与FTR几率增加有关。与私人保险相比,医疗补助保险和无保险状态与围手术期脓毒症、肺炎和 AKI 后发生 FTR 的几率更大相关。
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引用次数: 0
Are routine, daily chest radiographs (CXR) necessary following (VATS and RATS) lobectomies? VATS 和 RATS)肺叶切除术后是否有必要每天进行常规胸部 X 光检查 (CXR)?
IF 1.4 Q3 Medicine Pub Date : 2024-05-30 DOI: 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.

背景关于胸腔镜手术术后成像的数量和必要性尚缺乏共识指南。之前尚未研究过视频辅助(VATS)和机器人辅助(RATS)胸腔镜手术后每日胸片(CXR)在指导管理方面的功效。我们假设,异常临床结果比异常影像学结果更能预测接受 VATS/RATS 肺叶切除术患者的术后并发症。方法在 2019 年 1 月 1 日至 2021 年 12 月 31 日期间,在一家三级转诊中心对 VATS 和 RATS 肺叶切除术患者进行了回顾性审查。对人口统计学、住院过程和影像学进行评估。我们采用了描述性统计、Chi-Square 检验、费雪精确检验、Wilcoxon 秩和检验以及多变量逻辑回归。结果 在 362 例 VATS/RATS 肺叶切除术患者中,15 例患者出现了需要进行手术的术后并发症。几乎所有需要进行手术的患者都有异常的临床症状和体征(14/15;P <;0.001),而 70% 的患者在术后第一天 (POD) 有预期的 CXR 结果(11/15;P = 0.463)。多变量逻辑回归表明,临床症状和体征可独立预测手术需求(几率比 [OR] = 48,95% 置信区间 [CI]:8.5-267),而 POD 1 影像异常则不能。对于延长 LOS 而言,阳性吸烟史(OR = 4.4,95 % CI:1.4-14.1)、CXR 检查次数(OR = 2.4,95 % CI:1.8-3.2)和胸腔造口管(OR = 5.3,95 % CI:1.0-27.3)是独立的预测因素,而临床症状和体征则不是。对于没有临床体征或症状的患者,术后常规 CXR 检查可能是不必要的。关键信息目前还没有关于胸大叶切除术后常规诊断检查有效性的共识指南。微创肺叶切除术后出现异常体征或症状可能比术后常规胸片异常更能预测需要进行其他手术的患者。
{"title":"Are routine, daily chest radiographs (CXR) necessary following (VATS and RATS) lobectomies?","authors":"Nathan J. Alcasid MD ,&nbsp;Kian C. Banks MD ,&nbsp;Sheng-Fang Jiang MS ,&nbsp;Cynthia J. Susai MD ,&nbsp;Diana Hsu MD ,&nbsp;William Carroway MD ,&nbsp;Kenneth Williams MD ,&nbsp;Ashish Patel MD ,&nbsp;Simon Ashiku MD ,&nbsp;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) (&gt;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> &lt; 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":"20 ","pages":"Pages 20-26"},"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}
引用次数: 0
General surgery educational resources for Jordanian medical students 为约旦医科学生提供普通外科教育资源
IF 1.4 Q3 Medicine Pub Date : 2024-05-29 DOI: 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.

背景概述在普外科实习期间被认为对医学生最有益的资源,并研究这些资源与学生的普外科成绩以及人工智能在普外科学习中的应用之间的联系。方法在2023年3月至6月期间,对来自6所大学的约旦医学生进行了回顾性调查,使用了一份包含7个项目的调查问卷,其中涉及有关普外科学习方法和成绩的问题。描述性统计用于评估人口统计学数据。结果受访者的平均年龄为 23.3 岁,54.2% 的受访者为女性,47.8% 的受访者来自穆塔大学。大多数学生(48.2%)依靠导师授课。通过教师授课学习的学生成绩最好(9%为优秀,17%为非常好),其次是使用手术教科书学习的学生(分别为 6.8%和 14.6%)。学习方法与学习成绩之间的关系具有统计学意义(P <0.05)。结论传统的面授学习方式,即教师讲课和外科教科书仍然是获得最高分的最有效方法。医学生对人工智能的利用仍然不足。
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引用次数: 0
Intrahepatic cystic mass and bile duct malformation 肝内囊性肿块和胆管畸形
IF 1.4 Q3 SURGERY Pub Date : 2024-05-29 DOI: 10.1016/j.sopen.2024.05.017
Arianna Pontrelli , Piercarmine Panzera , Francesco Paolo Prete , Enrico Fischetti , Carlotta Testini , Mario Testini
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引用次数: 0
期刊
Surgery open science
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