American journal of surgery最新文献

Background: The optimal antibiotic regimen to empirically treat complicated diverticulitis has not been well established in guidelines.

Methods: A 5-year retrospective cohort study was conducted with 322 patients admitted to Mayo Clinic hospitals for complicated diverticulitis. Outcomes for 89 patients treated with ceftriaxone and metronidazole were compared to 233 patients treated with piperacillin/tazobactam. Patients were included if they received one of the treatment options for at least 96 ​h during hospital admission and did not receive any other diverticulitis antibiotic treatment regimen for at least 96 ​h.

Results: Ceftriaxone and metronidazole was found to be non-inferior to piperacillin/tazobactam for the combined primary outcome of 30-day readmission or all-cause mortality (21.4 ​% vs 15.9 ​%, P ​= ​0.12). No significant differences were found for 30-day antibiotic failure (P ​= ​0.30) or 90-day Clostridioides difficile infection rate (P ​= ​0.96). Patients who received oral antibiotic therapy in the 7 days prior to admission were found to have increased risk of mortality or readmission and antibiotic failure.

Conclusions: Ceftriaxone and metronidazole showed non-inferior outcomes to piperacillin/tazobactam for treating complicated diverticulitis.

Approximately 22 ​% of the United States population communicates in a non-English language, potentially impacting healthcare communication and outcomes. Few studies have examined the association between non-English primary language (NEPL) and surgical outcomes and none to our knowledge in patients undergoing arteriovenous fistula creation within a safety net system. In this study, we conducted a retrospective analysis on adults who underwent AVF creation for hemodialysis access between January 1, 2014, and December 31, 2019. We employed a bivariate logistic regression analysis to assess the relationship between primary language and 30-day ED visits and readmissions, both for all-cause after AVF surgery and those specifically related to arteriovenous fistula (AVF) complications and a multivariate logistic regression to adjust for any cofounders. Among the study population of 1502 patients, 70 ​% were NEPL and predominantly self-identified as Hispanic/Latino. Despite the older age and higher prevalence of diabetes among NEPL patients, there was no statistically significant association of NEPL with 30-day readmission or ED visits post-AVF creation. The availability of certified translators and diverse array of healthcare professionals may have contributed to these findings. Nonetheless, further investigation is warranted to elucidate the impact of language discordance on post-surgical outcomes.

Background: This study aims to identify causal mediators of one-year kidney transplant failure in patients with peripheral vascular disease.

Methods: Standard Transplant Analysis and Research database was queried for adults who underwent kidney transplantation from 1987 to 2021. Multi-organ transplant, prior transplant, and living donor kidneys were excluded. Causal mediation analysis with 2000 percentile bootstrapping interactions identified mediators of one-year kidney transplant failure.

Results: 212,259 patients were included: 16,215 with and 196,044 without peripheral vascular disease. Causal mediators of one-year kidney transplant failure are Kidney Donor Profile Index (proportionate mediation [PM] 17 ​%, p ​< ​0.01, E-value ​= ​1.20), pre-transplant dialysis (PM 19 ​%, p ​< ​0.001, E-value ​= ​1.17), recipient total serum albumin (PM 2 ​%, p ​= ​0.003, E-value ​= ​1.05), and donor hypertension (PM 1 ​%, p ​= ​0.017, E-value ​= ​1.04).

Conclusions: Several causal mediators increase rates of one-year kidney transplant failure in patients with peripheral vascular disease. Understanding these mediators can improve pre-transplant assessments and post-transplant outcomes.

Introduction: Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator.

Methods: We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS).

Results: Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty.

Conclusions: This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility.

Background: Cognitive impairment affects nearly half of vascular surgery patients, but its association with postoperative outcomes remains poorly understood. This study explores the link between preoperative cognitive performance and postoperative complications, including postoperative delirium, in vascular surgery patients.

Methods: A prospective cohort study was conducted on vascular surgery patients aged ≥65. Preoperative cognitive performance was assessed using the Montreal Cognitive Assessment, and postoperative complications were evaluated using the Comprehensive Complication Index. The association was analyzed through multivariable logistic regression.

Results: Among 110 patients (18.2 ​% female, mean age 73.8 ​± ​5.7 years), cognitive impairment was evident in 48.2 ​%. Of the participants, 29 (26.3 ​%) experienced postoperative complications, among which 11 (10 ​%) experienced postoperative delirium. The adjusted odds ratio for the association between cognitive performance and postoperative complications was 1.19 (95 ​% CI 1.02-1.38; p ​= ​0.02).

Conclusion: Worse preoperative cognitive performance correlated with increased odds of postoperative complications and postoperative delirium in vascular surgery patients.

Background: We aim to characterize breast management for patients with genetic mutations and concurrent breast cancer (BC) or prior BC treatment.

Methods: Adults with a BC-related mutation and prior/concurrent BC diagnosis were identified. Groups were stratified by mutation type [BRCA1/2, high penetrance mutation (HPM), moderate penetrance mutation (MPM)] and timing of genetic testing (concurrent with BC versus after BC treatment). Outcomes were compared.

Results: Among 338 patients included, 63 ​% had BRCA1/2 mutations, 9 ​% HPM, and 28 ​% MPM. Approximately 38 ​% had testing concurrent with a BC diagnosis and 62 ​% after BC treatment. Patients with concurrent testing favored bilateral mastectomy (57 ​%) versus 26 ​% lumpectomy, and 16 ​% unilateral mastectomy, which varied by mutation type. Patients previously treated preferred surveillance (92 ​% vs. 8 ​% additional surgery), regardless of mutation type.

Conclusion: The timing of a significant BC-related genetic test result and mutation type may be associated with management decisions among patients with breast cancer.

Background: The benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy.

Method: This is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016-2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)-primary outcome, and length-of-stay (LOS)-secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses.

Results: Of 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91-3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51-10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05).

Conclusion: Drain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR.