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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。
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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。
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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":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}
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。
{"title":"General surgery educational resources for Jordanian medical students","authors":"Mohammad Nebih Nofal ,&nbsp;Mahmoud Mousa Al Awayshish ,&nbsp;Ali Jad Yousef ,&nbsp;Ammar Masoud Alamaren ,&nbsp;Zaid Issam Al-Rabadi ,&nbsp;Dina Samer Haddad ,&nbsp;Yaqeen Ahmad Al-Rbaihat ,&nbsp;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 &lt;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> &lt; 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}
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
{"title":"Intrahepatic cystic mass and bile duct malformation","authors":"Arianna Pontrelli ,&nbsp;Piercarmine Panzera ,&nbsp;Francesco Paolo Prete ,&nbsp;Enrico Fischetti ,&nbsp;Carlotta Testini ,&nbsp;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}
引用次数: 0
The impact of rurality on racial disparities in costs of bowel obstruction treatment 农村地区对肠梗阻治疗费用种族差异的影响
IF 1.4 Q3 Medicine Pub Date : 2024-05-29 DOI: 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.

背景黑人种族与小肠梗阻(SBO)手术后资源利用率增加有关。虽然之前的文献也同样证明了城市和农村机构之间的差异,但按种族界定农村对资源利用的影响的工作还很有限。方法采用 2016-2020 年全国住院病人样本,识别因 SBO 非选择性入院后接受粘连溶解手术的成人。主要终点是住院费用。其他结果包括手术延迟(≥住院第 3 天)、住院时间(LOS)和非家庭出院。我们建立了回归模型来确定黑人种族和乡村地区对相关结果的影响,并通过交互项来检验黑人种族与乡村地区的递增关系。结果 在估计的 132390 名患者中,有 11.4% 在年均 377 家乡村医院(占医疗机构的 18.5%)接受治疗。经过调整后,与其他医院相比,农村医院的成本更高(β + 4900 美元,95 % 置信区间 [CI] [4200, 5700])。然而,农村地区与手术延迟几率降低(调整后比值比 [AOR] 0.76,CI[0.69, 0.85])、LOS 减少(β -1.66 天,CI[-1.99, -1.36])和非家庭出院(AOR 0.78,CI[0.70, 0.87])相关。虽然白人患者在城市中心的费用明显降低(26,100 美元 [25,800-26,300] vs 31,000 美元 [30,300-31,700] ),但黑人患者的费用却没有明显降低(30,100 美元 [29,400-30,700] vs 30,800 美元 [29,300-32,400] )。未来的工作重点应放在针对具体环境的干预措施上,以解决每个社区内造成差异的因素。
{"title":"The impact of rurality on racial disparities in costs of bowel obstruction treatment","authors":"Corynn Branche ,&nbsp;Nikhil Chervu MD MS ,&nbsp;Giselle Porter BS ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Sara Sakowitz MS MPH ,&nbsp;Konmal Ali ,&nbsp;Saad Mallick MD ,&nbsp;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}
引用次数: 0
Long gun violence in California versus Texas: How legislation can reduce firearm violence 加利福尼亚州与得克萨斯州的长期枪支暴力对比:立法如何减少枪支暴力
IF 1.4 Q3 Medicine Pub Date : 2024-05-29 DOI: 10.1016/j.sopen.2024.05.011
Jonathan Shipley BS , Areg Grigorian MD , Lourdes Swentek MD , Cristobal Barrios MD , Catherine Kuza MD , Jeffrey Santos MD , Jeffry Nahmias MD, MHPE

Introduction

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 ,&nbsp;Areg Grigorian MD ,&nbsp;Lourdes Swentek MD ,&nbsp;Cristobal Barrios MD ,&nbsp;Catherine Kuza MD ,&nbsp;Jeffrey Santos MD ,&nbsp;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> &lt; 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 &lt; 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}
引用次数: 0
Comparing outcomes of right verse left hepatic approach percutaneous biliary drainage catheters 比较右肝和左肝途径经皮胆道引流导管的疗效
IF 1.4 Q3 Medicine Pub Date : 2024-05-29 DOI: 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.

目的确定右侧或左侧肝脏经皮胆道引流管置入术(PTBD)对胆道狭窄患者的不良事件(AE)是否存在差异。材料& 方法这项回顾性研究纳入了2004年7月28日至2021年3月30日期间在一家机构接受PTBD治疗的良性或恶性胆道狭窄患者。357名患者符合纳入标准,其中77人(21.6%)在左侧接受了PTBD,280人(78.4%)在右侧接受了PTBD。收集并分类了与首次引流管置入或后续干预相关的 AEs。被归为围术期的AE包括:手术、感染、出血和引流管失效。术后AE包括:寒战、导管移位、胆管炎、胆道结石、引流管故障、未经治疗而退烧以及导管周围渗漏。手术被认为是主要的 AE,其余 AE 被归类为轻微 AE。采用逻辑回归分析法进行统计分析,P值小于0.05为有统计学意义。结果总体而言,右侧和左侧引流管在术前和术后的AEs差异无统计学意义(分别为P = 0.832,OR = 0.95和P = 0.808,OR = 0.93)。单独分析轻微意外伤害时,只有胆管炎在右侧发生率较高(p = 0.033,OR = 0.43)。在围手术期,左侧和右侧引流管的主要 AE 发生率没有统计学差异(p = 0.311,OR = 1.37)。除了右侧引流管的胆管炎发生率略高之外,本分析描述了右侧和左侧肝胆管引流管在AEs方面没有统计学意义上的显著差异。
{"title":"Comparing outcomes of right verse left hepatic approach percutaneous biliary drainage catheters","authors":"Brent Smith MD ,&nbsp;Jodi Veach BA ,&nbsp;Carissa Walter MPH ,&nbsp;Alexander Alsup MS ,&nbsp;Kate Young PhD ,&nbsp;Lauren Clark MS ,&nbsp;Yanming Li PhD ,&nbsp;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 &amp; 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}
引用次数: 0
Interhospital variation in the non-operative management of uncomplicated appendicitis in adults 成人无并发症阑尾炎非手术治疗的医院间差异
IF 1.4 Q3 Medicine Pub Date : 2024-05-29 DOI: 10.1016/j.sopen.2024.05.008
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

Background

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.

背景最近的随机试验表明,对于急性无并发症阑尾炎,非手术治疗是阑尾切除术的安全替代方案。然而,治疗方法仍存在很大差异。本研究试图描述全国成人阑尾炎患者队列中非手术治疗的中心水平差异。方法查询了 2016-2020 年全国再入院数据库,以确定所有因急性无并发症阑尾炎住院的成人(≥18 岁)。建立了层次混合效应模型,以确定与非手术治疗相关的因素。贝叶斯方法用于预测随机效应,然后根据医院归因的非手术治疗率的增加情况对中心进行排序。结果 在约 447,500 名患者中,52,523 人(11.7%)接受了非手术治疗。与接受阑尾切除术的患者相比,非手术治疗的患者年龄更大、男性更常见、合并症负担更重。在非手术治疗的变异性中,约有 30% 可归因于医院的影响,经风险调整后的绝对比率从 0.5% 到 22.5% 不等。经过风险调整后,在接受阑尾切除术的患者中,在LOH接受治疗与更高的术后感染、资源利用和非选择性再入院几率有关。结论我们发现,在急性无并发症阑尾炎的非手术治疗利用方面,医院间存在显著差异。此外,我们还发现LOH与手术治疗后的不良预后有关。今后需要开展工作,评估有助于提高非手术疗法利用率的护理路径,并在各机构间推广最佳实践。
{"title":"Interhospital variation in the non-operative management of uncomplicated appendicitis in adults","authors":"Baran Khoraminejad ,&nbsp;Sara Sakowitz MS, MPH ,&nbsp;Giselle Porter BS ,&nbsp;Nikhil Chervu MD ,&nbsp;Konmal Ali ,&nbsp;Saad Mallick MD ,&nbsp;Syed Shahyan Bakhtiyar MD, MBE ,&nbsp;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 (&gt;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}
引用次数: 0
期刊
Surgery open science
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