American journal of surgery最新文献

Family planning impact on medical students’ surgery interest and current policies in the United States: A scoping review 计划生育对医科学生手术兴趣的影响以及美国的现行政策：范围审查。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-14 DOI: 10.1016/j.amjsurg.2024.116086

Sophia Dittrich , Madeline Ebert , Grace Elizabeth Lawson , Kimberly M. Ramonell , Sophie Dream

Introduction

Previous reviews have examined female residents' experiences while ante- and postpartum. However, to our knowledge, no review exists that synthesizes medical students’ perception of family planning during surgical residencies. We wanted to synthesize current literature on the perceptions of family planning of medical students interested in surgical fields and current medical school policies or resources related to family planning.

Methods

A scoping review was performed of databases including MEDLINE (OVID), Scopus, and PubMed in April and September of 2023. Studies were excluded if they were conducted outside the US, occurred before 2003, were opinions, reviews, or editorials, included only non-surgical specialties, focused on only attending years or training years after medical school, and only mentioned “work/life balance” or “lifestyle.”

Results

2295 studies were identified, and a final 19 studies were included. Four major themes were identified among the studies, including family planning as a barrier to a career in surgery, fertility, onsite childcare, and parental leave. Most studies examined general barriers medical students perceive about surgery and included at least one survey question related to family planning. Only two studies focused solely on medical students’ knowledge of oocyte preservation, one on on-site childcare at medical schools and one on parental leave during medical school.

Conclusion

There is a lack of research examining medical students’ knowledge of family planning during a surgical residency and current childbearing policies and resources offered during residency.

简介以往的综述研究了女性住院医师在产前和产后的经历。然而，据我们所知，目前还没有综述医学生在外科实习期间对计划生育的看法。我们希望综合目前的文献资料，了解对外科领域感兴趣的医学生对计划生育的看法，以及医学院目前与计划生育相关的政策或资源：我们在 2023 年 4 月和 9 月对 MEDLINE (OVID)、Scopus 和 PubMed 等数据库进行了范围审查。如果研究是在美国境外进行的，发生在 2003 年之前，是观点、评论或社论，只包括非外科专业，只关注医学院毕业后的就读年限或培训年限，以及只提及 "工作/生活平衡 "或 "生活方式"，则排除在外。这些研究确定了四大主题，包括作为外科职业障碍的计划生育、生育、现场育儿和育儿假。大多数研究探讨了医学生对外科职业的一般看法，并包含至少一个与计划生育相关的调查问题。只有两项研究仅关注医学生对卵母细胞保存的了解，一项是关于医学院的现场儿童保育，另一项是关于医学院期间的育儿假：结论：目前缺乏对医学生在外科实习期间对计划生育的了解以及实习期间提供的现行生育政策和资源的研究。

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引用次数: 0

Risk factors and outcomes of cardiac arrest in pediatric traumatic brain injury patients 小儿脑外伤患者心脏骤停的风险因素和结果。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-13 DOI: 10.1016/j.amjsurg.2024.116087

Irim Salik , Sima Vazquez , Nisha Palla , Norbert Smietalo , Richard Wang , Monica Vavilala , Jose F. Dominguez , Iwan Sofjan , Jared M. Pisapia

Background

Cardiac arrest (CA) in pediatric traumatic brain injury (pTBI) is associated with morbidity. Our objective is to investigate the incidence, risk factors, and outcomes for CA following pTBI.

Methods

The Kid Inpatient Database (KID) was queried for patients with pTBI. Patients who experienced CA were identified. Demographics, comorbidities, hospital course, and complications were compared between patients who developed CA and who did not. Risk factors for CA were explored using multivariate analysis.

Results

CA patients were more likely to have hypertension, hypertrophic cardiomyopathy, and heart defects (p < 0.01). CA was more likely in patients with subdural bleeding, cerebral edema, herniation, coma, or mechanical ventilation (p < 0.001). CA patients had higher odds of vasopressor and transfusions, tracheostomy, percutaneous endoscopic gastrotomy (p < 0.001), and mortality (p < 0.01). Mechanical ventilation, cerebral edema, heart, vasopressor use, and transfusions were associated with CA on multivariate analysis.

Conclusion

Risk factors for CA in pTBI patients include severity of injury and underlying cardiovascular abnormalities. CA was associated with morbidity and resource utilization in pTBI patients.

背景：小儿创伤性脑损伤（pTBI）中的心脏骤停（CA）与发病率有关。我们的目的是调查 pTBI 后心脏骤停的发生率、风险因素和结果：方法：对儿童住院患者数据库（KID）中的 pTBI 患者进行查询。方法：对儿童住院患者数据库（KID）中的 pTBI 患者进行查询，确定了发生 CA 的患者。比较了发生CA和未发生CA的患者的人口统计学特征、合并症、住院过程和并发症。通过多变量分析探讨了CA的风险因素：结果：CA 患者更有可能患有高血压、肥厚型心肌病和心脏缺陷（p 结论：CA 患者更有可能患有高血压、肥厚型心肌病和心脏缺陷：创伤后应激障碍患者发生 CA 的风险因素包括损伤的严重程度和潜在的心血管异常。CA与创伤性脑损伤患者的发病率和资源利用率有关。

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引用次数: 0

The criticality of reasonable accommodations: A scoping review revealing gaps in care for patients with blindness and low vision 合理便利的重要性：范围审查揭示了盲人和低视力患者护理方面的差距。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-13 DOI: 10.1016/j.amjsurg.2024.116085

Grace Keegan , John-Ross Rizzo , Megan A. Morris , Kathie-Ann Joseph

Background

Health and healthcare disparities for surgical patients with blindness and low vision (pBLV) stem from inaccessible healthcare systems that lack universal design principles or, at a minimum, reasonable accommodations (RA).

Objectives

We aimed to identify barriers to developing and implementing RAs in the surgical setting and provide a review of best practices for providing RAs.

Methods

We conducted a search of PubMed for evidence of reasonable accommodations, or lack thereof, in the surgical setting. Articles related to gaps and barriers to providing RAs for pBLV or best practices for supporting RAs were reviewed for the study.

Results

Barriers to the implementation of reasonable accommodations, and, accordingly, best practices for achieving equity for pBLV, relate to policies and systems, staff knowledge and attitudes, and materials and technology.

Conclusions

These inequities for pBLV require comprehensive frameworks that offer, maintain, and support education about disability disparities and RAs in the surgical field. Providing RAs for surgical pBLV, and all patients with disabilities is an important and impactful step towards creating a more equitable and anti-ableist health system.

背景：盲人和低视力手术患者（pBLV）在健康和医疗保健方面的不平等源于医疗保健系统缺乏通用设计原则，或至少缺乏合理便利（RA）：我们旨在确定在手术环境中制定和实施合理便利措施的障碍，并对提供合理便利措施的最佳实践进行回顾：我们在 PubMed 上搜索了手术环境中合理便利或缺乏合理便利的证据。本研究审查了与为 pBLV 提供合理便利的差距和障碍或支持合理便利的最佳实践相关的文章：结果：实施合理便利措施的障碍以及实现 pBLV 公平的最佳实践涉及政策和制度、员工的知识和态度以及材料和技术：结论：pBLV 存在的这些不公平现象需要建立全面的框架，提供、维护和支持有关外科领域残疾差异和合理便利的教育。为手术治疗的残障人士和所有残障患者提供康复治疗是建立一个更加公平和反残障主义的医疗系统的重要一步，也是具有影响力的一步。

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引用次数: 0

Re-operation following urgent and emergent colectomies: An investigation of indications and utility as a quality indicator 紧急结肠切除术后的再次手术：作为质量指标的适应症和效用调查。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-09 DOI: 10.1016/j.amjsurg.2024.116081

Raisa Gao, Kayla Flewelling, Nicholas Stevens, Clayton Wyland, Theresa McGoff, Austin Brubaker, Laurence E. McCahill

Background

For urgent and emergent colectomies, return to the operating room is interpreted as a negative quality indicator. We sought to describe indications, procedures performed, and outcomes of patients undergoing reoperation after colectomy.

Methods

Retrospective study of patients undergoing urgent and emergent colectomy with re-operation at a single institution from 2013 to 2023. Details of the patients and surgeries indexed.

Results

117 patients met the study criteria. Sepsis prior to surgery was noted in 29 % of patients, intraoperative vasopressors were used in 80 % and 52 % were left in gastrointestinal discontinuity. Among re-operations, 60 % of patients underwent a “planned second look”, 17 % had a supportive procedure, and 23 % had an unplanned re-operation, the latter group most reflective of surgical complications.

Conclusion

Patients undergoing urgent and emergent colectomies are very ill at presentation. Planned second look and supportive procedures account for most re-operations, suggesting the current utilization of re-operation as a quality indicator is flawed.

背景：对于紧急和急诊结肠切除术而言，返回手术室被视为一项负面的质量指标。我们试图描述结肠切除术后再次手术患者的适应症、手术过程和结果：方法：对 2013 年至 2023 年期间在一家医疗机构接受紧急结肠切除术并再次手术的患者进行回顾性研究。结果：117 名患者符合研究标准：117例患者符合研究标准。29%的患者在手术前出现败血症，80%的患者在术中使用了血管加压药，52%的患者在术后出现胃肠道中断。在再次手术中，60%的患者接受了 "有计划的二次观察"，17%的患者接受了支持性手术，23%的患者接受了计划外再次手术，后者最能反映手术并发症的情况：结论：接受紧急结肠切除术的患者在就诊时病情都很严重。结论：接受紧急和急诊结肠切除术的患者在就诊时病情都很严重，计划中的二次探视和支持性手术占再次手术的大多数，这表明目前将再次手术作为质量指标的做法存在缺陷。

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引用次数: 0

Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation 退伍军人健康管理局医院围手术期姑息治疗的障碍：定性评估。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-08 DOI: 10.1016/j.amjsurg.2024.116063

Emily E. Evans , Sarah E. Bradley , C. Ann Vitous , Cara Ferguson , R. Evey Aslanian , Shukri H.A. Dualeh , Christina L. Shabet , M. Andrew Millis , Pasithorn A. Suwanabol

Background

Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.

Methods

Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.

Results

Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers.

Conclusions

While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.

背景：尽管姑息关怀对患局限性疾病或临近生命末期的患者有明显的益处，但对外科手术患者的使用仍普遍不足：尽管姑息治疗对患局限性疾病或临近生命末期的病人有明显的益处，但外科病人对姑息治疗的使用仍然普遍不足：对 14 家预先指定的退伍军人事务（VA）医院的医护人员进行了访谈，探讨了重症手术患者的临终关怀。结果：确定了六个主要领域：结果：确定了六个主要领域。在患者和家属层面，障碍包括管理期望值和目标不一致的护理。在医护人员层面，对姑息关怀的认识和态度以及医护人员的角色和身份是经常提到的障碍。在系统层面，参与者认为机构资源和文化是重大障碍：尽管医疗服务提供者认识到姑息关怀和临终关怀的重要性，但在不同层面上都存在使用姑息关怀的障碍。对这些障碍的识别突出了未来工作的重点领域，以提高退伍军人姑息关怀和临终关怀的质量。

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引用次数: 0

Impressions of inclusivity within orthopedic surgery: Differences amongst women, minority, and LGBTQIA medical students 矫形外科的包容性印象：女性、少数民族和 LGBTQIA 医学生之间的差异。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-08 DOI: 10.1016/j.amjsurg.2024.116051

Katherine M. Gerull , Priyanka Parameswaran , Ling Chen , Cara A. Cipriano

Objective

To better understand reasons for the underrepresentation of certain groups in orthopedic surgery, we investigated whether there were differences in medical students’ perceptions of inclusivity in orthopedic surgery between (1) men and women, (2) White, Asian and URiM, and (3) LGBTQIA and non-LGBTQIA students.

Design

A one-time survey consisting of validated and/or previously used instruments measuring students' sense of belonging in orthopedics, prospective belonging uncertainty (an individual's worry that they will not fit in), stereotype threat (the effect of negative stereotypes on stereotyped group-members), and pluralistic ignorance (erroneously believing your beliefs are different than “typical” group-members).

Setting

The survey was distributed at Loyola University, St. Louis University, University of Michigan, and Washington University in St. Louis.

Participants

All medical students at these institutions were offered participation, and 441 medical students completed the survey (∼20% response-rate).

Results

There was a lower sense of belonging for each of the following groups when compared to their majority-group peers: women (mean difference = 0.5, 95% CI 0.3–0.7, p < 0.001), Asian students (mean difference = 0.4, 95% CI 0.1–0.7, p < 0.001), URiM students (mean difference = 0.4, 95% CI 0.07–0.7, p < 0.001) and LGBTQIA students (mean difference = 0.4, 95% CI 0.07–0.6, p = 0.003). Medical students perceived that orthopedic faculty, residents, and the general public believe that men are better orthopedic surgeons than women, and that White surgeons are better surgeons than non-White surgeons. Women reported less confidence to succeed in orthopedics compared to “typical” peers (mean −0.5, SD 1.3), whereas men felt similar confidence compared to their peers (mean 0.1, SD 1.3; mean difference 0.6, 95% CI 0.4–0.9, p < 0.001).

Conclusions

These differences in belonging, prospective belonging uncertainty, stereotype threat, and pluralistic ignorance provide insight into how medical students perceive the inclusivity of orthopedics, which may ultimately play a role in the underrepresentation of minority groups.

目的：为了更好地了解某些群体在骨科手术中代表性不足的原因，我们调查了医科学生对骨科手术包容性的看法是否存在以下差异：（1）男性和女性；（2）白人、亚洲人和乌拉圭人；（3）LGBTQIA 和非 LGBTQIA 学生：设计：一次性调查，由经过验证和/或以前使用过的工具组成，测量学生对骨科的归属感、未来归属的不确定性（个人担心自己无法融入群体）、刻板印象威胁（负面刻板印象对刻板群体成员的影响）和多元无知（错误地认为自己的信仰与 "典型 "群体成员不同）：调查在洛约拉大学、圣路易斯大学、密歇根大学和圣路易斯华盛顿大学进行：441 名医学生完成了调查（回复率为 20%）：结果：与多数群体的同龄人相比，以下每个群体的归属感都较低：女性（平均差异 = 0.5，95% CI 0.3-0.7，p 结论：与多数群体的同龄人相比，以下每个群体的归属感都较低：女性（平均差异 = 0.5，95% CI 0.3-0.7，p这些在归属感、预期归属感不确定性、刻板印象威胁和多元无知方面的差异为医科学生如何看待骨科的包容性提供了启示，这可能最终导致少数群体代表性不足。

{"title":"Impressions of inclusivity within orthopedic surgery: Differences amongst women, minority, and LGBTQIA medical students","authors":"Katherine M. Gerull , Priyanka Parameswaran , Ling Chen , Cara A. Cipriano","doi":"10.1016/j.amjsurg.2024.116051","DOIUrl":"10.1016/j.amjsurg.2024.116051","url":null,"abstract":"<div><h3>Objective</h3><div>To better understand reasons for the underrepresentation of certain groups in orthopedic surgery, we investigated whether there were differences in medical students’ perceptions of inclusivity in orthopedic surgery between (1) men and women, (2) White, Asian and URiM, and (3) LGBTQIA and non-LGBTQIA students.</div></div><div><h3>Design</h3><div>A one-time survey consisting of validated and/or previously used instruments measuring students' sense of belonging in orthopedics, prospective belonging uncertainty (an individual's worry that they will not fit in), stereotype threat (the effect of negative stereotypes on stereotyped group-members), and pluralistic ignorance (erroneously believing your beliefs are different than “typical” group-members).</div></div><div><h3>Setting</h3><div>The survey was distributed at Loyola University, St. Louis University, University of Michigan, and Washington University in St. Louis.</div></div><div><h3>Participants</h3><div>All medical students at these institutions were offered participation, and 441 medical students completed the survey (∼20% response-rate).</div></div><div><h3>Results</h3><div>There was a lower sense of belonging for each of the following groups when compared to their majority-group peers: women (mean difference = 0.5, 95% CI 0.3–0.7, p < 0.001), Asian students (mean difference = 0.4, 95% CI 0.1–0.7, p < 0.001), URiM students (mean difference = 0.4, 95% CI 0.07–0.7, p < 0.001) and LGBTQIA students (mean difference = 0.4, 95% CI 0.07–0.6, p = 0.003). Medical students perceived that orthopedic faculty, residents, and the general public believe that men are better orthopedic surgeons than women, and that White surgeons are better surgeons than non-White surgeons. Women reported less confidence to succeed in orthopedics compared to “typical” peers (mean −0.5, SD 1.3), whereas men felt similar confidence compared to their peers (mean 0.1, SD 1.3; mean difference 0.6, 95% CI 0.4–0.9, p < 0.001).</div></div><div><h3>Conclusions</h3><div>These differences in belonging, prospective belonging uncertainty, stereotype threat, and pluralistic ignorance provide insight into how medical students perceive the inclusivity of orthopedics, which may ultimately play a role in the underrepresentation of minority groups.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116051"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital? 胰腺癌切除术后淋巴结评估的差异：患者、外科医生、病理学家还是医院？

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-07 DOI: 10.1016/j.amjsurg.2024.116067

Muhammad Musaab Munir, Selamawit Woldesenbet, Mujtaba Khalil, Muhammad Muntazir Mehdi Khan, Mary Dillhoff, Timothy M. Pawlik

Background

We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.

Methods

SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).

Results

2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 %). After accounting for all explanatory variables in the full model, 5.5 % of the residual provider-level variation was attributed to the pathologist, 35.2 % to the surgeon, and 59.3 % to the hospital.

Conclusions

Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.

背景：我们试图确定患者、外科医生、病理学家和医院对胰腺癌切除术后淋巴结评估的个人贡献：方法：确定了接受胰腺癌切除术的 SEER-Medicare 受益人。结果：2872 名患者在 308 家医院由 646 名不同的外科医生和 1063 名不同的病理学家进行了胰十二指肠切除术。患者相关特征对淋巴结充分评估的差异影响最大（71.0%）。在考虑了完整模型中的所有解释变量后，病理学家、外科医生和医院分别占提供者水平差异的5.5%、35.2%和59.3%：结论：患者与患者之间的差异是导致胰腺癌手术淋巴结充分评估差异的最大根本原因。医院之间的差异大于外科医生或病理学家之间的差异。

{"title":"Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital?","authors":"Muhammad Musaab Munir, Selamawit Woldesenbet, Mujtaba Khalil, Muhammad Muntazir Mehdi Khan, Mary Dillhoff, Timothy M. Pawlik","doi":"10.1016/j.amjsurg.2024.116067","DOIUrl":"10.1016/j.amjsurg.2024.116067","url":null,"abstract":"<div><h3>Background</h3><div>We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.</div></div><div><h3>Methods</h3><div>SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).</div></div><div><h3>Results</h3><div>2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 %). After accounting for all explanatory variables in the full model, 5.5 % of the residual provider-level variation was attributed to the pathologist, 35.2 % to the surgeon, and 59.3 % to the hospital.</div></div><div><h3>Conclusions</h3><div>Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116067"},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sublobar or lobar resection in early-stage peripheral non-small cell lung cancer less than 2cm: A meta-analysis for randomized controlled trials 小于 2 厘米的早期周围非小细胞肺癌的叶下或叶状切除术：随机对照试验的荟萃分析。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-06 DOI: 10.1016/j.amjsurg.2024.116069

Lei Wang, Jianming Zhou, Shengjie Jing, Bin Liu, Jin Fang, Tao Xue

Objective

The aim of our study was to investigate whether sublobar resection is non-inferior to lobar resection in early-stage non-small cell lung cancer less than 2 cm.

Methods

This is a meta-analysis for randomized controlled trials. Databases including PubMed, Web of Science, EMBASE and Cochrane Central Register were searched up to June 3, 2023. The primary outcome was 5-year survival, and the secondary outcomes were 5-year disease-free survival, cancer-related mortality, recurrence rate, postoperative lung function and perioperative events.

Results

A total of 5 studies enrolling 2035 patients were included. Sublobar resection was found to be non-inferior to lobar resection concerning the 5-year survival rate, 5-year disease-free survival rate and cancer-related mortality. However, sublobar resection was associated with higher recurrence rate and less reduction of postoperative lung function.

Conclusions

Sublobar resection was non-inferior to lobar resection in terms of survival outcomes and was associated with better postoperative lung function.

研究目的我们的研究旨在探讨在小于 2 厘米的早期非小细胞肺癌中，叶下切除术是否不优于叶状切除术：这是一项随机对照试验的荟萃分析。检索的数据库包括 PubMed、Web of Science、EMBASE 和 Cochrane Central Register，截止日期为 2023 年 6 月 3 日。主要结果为5年生存率，次要结果为5年无病生存率、癌症相关死亡率、复发率、术后肺功能和围手术期事件：共有 5 项研究纳入了 2035 名患者。结果：共纳入了 5 项研究，2035 名患者。研究发现，在 5 年生存率、5 年无病生存率和癌症相关死亡率方面，叶下切除术并不优于叶上切除术。然而，叶下切除术的复发率较高，术后肺功能下降较少：结论：就生存率而言，叶下切除术并不比肺叶切除术差，而且术后肺功能更好。

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引用次数: 0

Malignancy risk associated with radioactive iodine therapy for Graves’ disease 与放射性碘治疗巴塞杜氏病相关的恶性肿瘤风险。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-06 DOI: 10.1016/j.amjsurg.2024.116075

Sruthi Ramesh , Jason C. Fisher , Paige Curcio , Gary D. Rothberger , Jason Prescott , John Allendorf , Insoo Suh , Kepal N. Patel

Background

Radioactive iodine therapy (RAI) is a frequently chosen therapy for Graves' disease. The aim of this study was to determine whether RAI for Graves’ disease increases the risk of thyroid malignancy.

Methods

A retrospective analysis was performed of all Graves’ disease patients who underwent thyroidectomy at a single institution between 2013 and 2022. Comparative analyses were performed with cohorts based on RAI therapy as the primary grouping variable.

Results

413 patients were identified, of which 38 received RAI prior to surgery. RAI treated patients were more likely to undergo surgery for known malignancy or indeterminate nodules. RAI patients were also more likely to have malignancies larger than 1 cm. Among RAI treated patients, those who developed malignancy were older at the time of Graves’ diagnosis and received early RAI therapy.

Conclusions

Use of RAI for treatment of Graves’ disease increases the progression of thyroid carcinoma, but not the prevalence. Older age and early RAI therapy may be risk factors for malignancy in RAI treated patients.

背景：放射性碘治疗（RAI）是巴塞杜氏病的常用疗法。本研究旨在确定RAI治疗巴塞杜氏病是否会增加甲状腺恶性肿瘤的风险：对2013年至2022年间在一家机构接受甲状腺切除术的所有巴塞杜氏病患者进行了回顾性分析。以 RAI 治疗为主要分组变量的队列进行了比较分析：共发现413例患者，其中38例在手术前接受了RAI治疗。接受 RAI 治疗的患者更有可能因已知的恶性肿瘤或不确定的结节而接受手术。接受 RAI 治疗的患者也更有可能患有大于 1 厘米的恶性肿瘤。在接受RAI治疗的患者中，出现恶性肿瘤的患者在确诊为巴塞杜氏综合征时年龄较大，并且接受RAI治疗的时间较早：结论：使用RAI治疗巴塞杜氏病增加了甲状腺癌的进展，但并没有增加其发病率。年龄较大和早期接受RAI治疗可能是RAI治疗患者发生恶性肿瘤的危险因素。

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引用次数: 0

Variation in commercial prices for thyroidectomy and parathyroidectomy at US hospitals. 美国医院甲状腺切除术和甲状旁腺切除术的商业价格差异。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-11-06 DOI: 10.1016/j.amjsurg.2024.116072

Samuel J Enumah, David C Chang, Nancy L Cho, Carrie E Cunningham, Gerard M Doherty, Matthew A Nehs, Gregory W Randolph, Jason B Liu

Background: The 2021 Hospital Price Transparency Rule mandated hospitals to publicly disclose their service prices to improve competition and lower healthcare costs. Our aim was to characterize commercial price variation for thyroidectomy and parathyroidectomy.

Methods: We performed a national cross-sectional study of hospital price variation in 2022 and 2023 using the Turquoise Health dataset. Our main outcomes were within- and across-hospital 90th-to-10th percentile commercial price ratios and a high commercial-to-Medicare (1.5) price ratio. We performed logistic regressions to identify hospital factors associated with a high commercial-to-Medicare price ratio.

Results: For 16,794 unique commercial rates across 564 facilities, within-hospital price ratios ranged from 2.0 to 2.4, and across-hospital price ratios ranged from 2.7 to 4.1. High market concentration and five-star hospital rating were associated with high commercial-to-Medicare price ratios compared to low market concentration and three-star hospital rating, respectively.

Conclusions: Notable variation exists within and across hospitals signaling facilities have negotiated different payments from insurance companies for the same service. Quality may be a modifiable factor to increase hospital revenue and improve care for patients.

背景：2021 年《医院价格透明规则》规定，医院必须公开披露其服务价格，以促进竞争并降低医疗成本。我们的目的是描述甲状腺切除术和甲状旁腺切除术的商业价格变化：我们使用 Turquoise Health 数据集对 2022 年和 2023 年的医院价格变化进行了全国横断面研究。我们的主要结果是医院内和医院间第 90 个百分点到第 10 个百分点的商业价格比，以及高商业与医保（1.5）价格比。我们进行了逻辑回归，以确定与高商业与医保价格比相关的医院因素：结果：在 564 家医院的 16,794 个不同的商业价格中，医院内价格比在 2.0 到 2.4 之间，医院间价格比在 2.7 到 4.1 之间。与低市场集中度和三星级医院相比，高市场集中度和五星级医院评级分别与高商业与医保价格比率相关：结论：医院内部和医院之间存在显著差异，这表明医院就相同的服务与保险公司协商了不同的支付方式。质量可能是增加医院收入和改善患者护理的一个可调节因素。

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引用次数: 0