American journal of surgery最新文献

Social drivers of health and perioperative outcomes: Identifying domains and barriers with significant impact 健康和围手术期结果的社会驱动因素：确定具有重大影响的领域和障碍

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-02-28 DOI: 10.1016/j.amjsurg.2026.116890

Michael A. Edwards , Skye Buckner Petty , Kashmira Chawla , Sreya Pattipati , Ryan May , Erin Westfall , Mohanad R. Youssef , Nathan L. Delafield , Jaxon K. Quillen , Adam J. Milam

Objectives

This retrospective cohort of patients undergoing surgery from 2019 to 2023 evaluated the association between individual-level social drivers of health (SDoH) and postoperative outcomes (length of stay, 30-day mortality, 30-day readmission).

Methods

Patients from a multi-site health system who completed a SDoH questionnaire were categorized as high-risk or not high-risk across five SDoH domains (e.g., financial resources) and were stratified into 3 surgical cohorts (elective outpatient, inpatient and emergency surgery). Regression models, adjusted for potential confounders, assessed the association between SDoH and postoperative outcomes.

Results

Among 297,723 patients, 74% completed the SDoH questionnaire. High-risk transportation need was associated with higher unplanned 30-day readmission for all cohorts; for elective surgeries, high-risk transportation was also associated with higher mortality. The other SDoH domains were inconsistently associated with postoperative outcomes.

Conclusions

Individual-level SDoH, particularly transportation needs and financial strain, are linked to adverse postoperative surgical outcomes. Systematic SDoH interventions are crucial to addressing healthcare disparities.

目的：对2019年至2023年接受手术的患者进行回顾性队列研究，评估个人层面的社会健康驱动因素（SDoH）与术后结果（住院时间、30天死亡率、30天再入院）之间的关系。方法来自多站点卫生系统的患者完成SDoH问卷，在5个SDoH领域（如财政资源）将其分类为高风险或非高风险，并分为3个手术队列（选择性门诊、住院和急诊手术）。校正潜在混杂因素的回归模型评估了SDoH与术后预后之间的关系。结果297,723例患者中，74%的患者完成了SDoH问卷。高风险运输需求与所有队列中较高的计划外30天再入院率相关；对于选择性手术，高风险转运也与较高的死亡率相关。其他SDoH结构域与术后结果的相关性不一致。结论个体水平的SDoH，特别是交通需求和经济压力，与术后不良手术结果有关。系统的SDoH干预措施对于解决保健差距至关重要。

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引用次数: 0

Decreased utilization of component separation techniques over time in complex abdominal wall reconstruction following introduction of preoperative botulinum toxin A 术前引入肉毒杆菌毒素A后，随着时间的推移，成分分离技术在复杂腹壁重建中的应用减少

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-03-06 DOI: 10.1016/j.amjsurg.2026.116919

Samantha W. Kerr , William R. Lorenz , Victoria L. Walker , Robert R. Lopez , Robert J. Raible , Lucy Hinton , Alexis M. Holland , Gregory T. Scarola , Kent W. Kercher , Vedra A. Augenstein , B. Todd Heniford , Sullivan A. Ayuso

Introduction

Component separation technique (CST) facilitates anterior fascial closure but can increase wound morbidity and alter abdominal wall anatomy. Preoperative Botulinum toxin A (BTA) relaxes the oblique musculature, potentially reducing CST. This study evaluated trends in CST utilization following the adoption of BTA.

Methods

A prospectively maintained database was reviewed for patients who underwent open AWR (2016-2024). Primary outcome was proportion of CST use over time; secondary analysis compared early (2016-2017) versus late (2023-2024) cohorts.

Results

Among 1484 patients (mean age 58.8 ± 12.3 years; BMI 31.0 ± 5.8 kg/m²; defect size 211.5 ± 165.6 cm²), fascial closure was achieved in 99.5%. CST decreased from 48.0% to 19.9% (OR: 0.88,95% CI: 0.813,0.946;p < 0.001). BTA increased (2.9% to 11.0%), though annual change was not significant (OR: 0.98,95% CI: 0.898,1.071;p = 0.670). Between early and late cohorts (n = 384 vs. 356), defect size was similar (219.1 ± 160.6 vs. 213.8 ± 181.3 cm²;p = 0.367). There was a reduction in wound breakdown (6.5% vs. 0.8%) and recurrence (2.9% vs. 0.6%)(p < 0.05).

Conclusion

Following the introduction of BTA, utilization of CST decreased and was accompanied by a reduction in wound morbidity.

成分分离技术（CST）有助于前筋膜闭合，但可能增加伤口发病率和改变腹壁解剖结构。术前使用肉毒毒素A （BTA）放松斜肌，可能降低CST。本研究评估了采用BTA后CST利用的趋势。方法回顾性分析开放性AWR患者（2016-2024）的前瞻性维护数据库。主要结局是CST的使用比例随时间的变化；二级分析比较了早期（2016-2017）和晚期（2023-2024）队列。结果1484例患者（平均年龄58.8±12.3岁，BMI 31.0±5.8 kg/m2，缺损面积211.5±165.6 cm2）中，99.5%的患者筋膜愈合。CST从48.0%下降到19.9% （OR: 0.88,95% CI: 0.813,0.946;p < 0.001）。BTA增加（2.9% ~ 11.0%），但年度变化不显著（OR: 0.98,95% CI: 0.898,1.071;p = 0.670）。在早期和晚期队列中（n = 384比356），缺陷大小相似（219.1±160.6比213.8±181.3 cm2;p = 0.367）。创面破裂（6.5% vs. 0.8%）和复发率（2.9% vs. 0.6%）均有降低（p < 0.05）。结论引入BTA后，CST的使用率下降，伤口发病率降低。

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引用次数: 0

Teaching residents in the operating room: What driving lessons taught me about surgical judgment 在手术室教住院医师：驾驶课教会了我什么手术判断

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-02-26 DOI: 10.1016/j.amjsurg.2026.116878

David B. Hom MD FACS

引用次数: 0

Randomized pilot study of hybrid telemedicine and in-person pathways to metabolic bariatric surgery 混合远程医疗和亲自代谢性减肥手术途径的随机试点研究

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-02-26 DOI: 10.1016/j.amjsurg.2026.116897

Gretchen E. Ames , Jenna L. Pennella , Michael G. Heckman , Hanna J. Sledge , Scott A. Lynch , Enrique F. Elli

Objective

We investigated the viability of offering a telemedicine pathway to patients seeking metabolic bariatric surgery (MBS).

Methods

Patients were randomized to receive hybrid telemedicine (HTM, n = 21) or face-to-face (F2F, n = 22) care. Patient characteristics, program visit completion, patient satisfaction with visits, time to surgery, and insurance payor collection ratio were compared between groups.

Results

The HTM group had a higher proportion of initial medical visits completed than the F2F group (100.0% vs 72.7%). Groups did not significantly differ in patient satisfaction with visits, time to surgery, or insurance payor collection ratio. In the HTM group, 42.9% of patients underwent MBS, whereas 27.3% underwent MBS in the F2F group. Overall, 30.2% of patients elected to initiate obesity management medications, and 34.8% discontinued the program.

Conclusion

MBS programs may improve treatment access by offering an HTM pathway. Larger investigations are needed to confirm the effect of telemedicine on MBS program access.

目的探讨为寻求代谢性减肥手术（MBS）的患者提供远程医疗途径的可行性。方法将患者随机分为远程医疗（HTM, n = 21）和面对面医疗（F2F, n = 22）两组。比较两组患者特征、项目访视完成率、访视满意度、手术时间和保险支付者回收率。结果HTM组首次就诊完成率高于F2F组（100.0% vs 72.7%）。两组患者对就诊、手术时间或保险支付者收款比例的满意度无显著差异。在HTM组中，42.9%的患者接受了MBS，而在F2F组中，27.3%的患者接受了MBS。总体而言，30.2%的患者选择开始使用肥胖管理药物，34.8%的患者停止了该计划。结论mbs方案可通过提供HTM途径改善治疗可及性。需要更大规模的调查来证实远程医疗对MBS计划访问的影响。

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引用次数: 0

Substance use screening and naloxone prescribing at discharge among injured adolescents 受伤青少年出院时的物质使用筛查和纳洛酮处方

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-03-04 DOI: 10.1016/j.amjsurg.2026.116910

Jenna S. Lee , Ryan G. Spurrier , Shadassa Ourshalimian , Jordan M. Rook , Emma Kirkpatrick , Pradip P. Chaudhari , Lorraine I. Kelley-Quon

Background

Adolescent substance use is closely linked to traumatic injuries. Screening can identify at-risk youth, while naloxone prescribing can reduce fatal overdose. This study examined drug screening and naloxone prescribing among injured adolescents.

Methods

This single-center retrospective cohort study included injured adolescents 12-17y treated January 2021-June 2024. Sociodemographics, clinical factors, and substance use screening associated with naloxone prescribing were analyzed.

Results

Among 813 injured adolescents, 86 (10.6%) underwent biochemical drug screening and 530 (65.2%) underwent interview-based screening. Among those screened, 53 (61.2%) biochemical and 81 (15.3%) interview screenings were positive. Only 28 (3.4%) received naloxone, including three (5.7%) with positive biochemical and four (4.9%) with positive interview-based screens. Adolescents with interview-based screening (p = 0.006) and hospital stays >24 h (p < 0.001) were more likely to receive naloxone. Most (96.4%) naloxone prescriptions were co-prescribed with opioids and muscle relaxants, instead of substance use screening results.

Conclusion

Naloxone prescribing for injured adolescents remains infrequent and unrelated to substance use screening results.

青少年药物使用与创伤性损伤密切相关。筛查可以识别有风险的青少年，而纳洛酮处方可以减少致命的过量服用。本研究调查了受伤青少年的药物筛选和纳洛酮处方。方法该单中心回顾性队列研究纳入了2021年1月至2024年6月接受治疗的12-17岁受伤青少年。分析与纳洛酮处方相关的社会人口统计学、临床因素和物质使用筛查。结果813名受伤青少年中，86名（10.6%）接受了生化药物筛查，530名（65.2%）接受了访谈筛查。其中生化筛查阳性53例（61.2%），访谈筛查阳性81例（15.3%）。只有28例（3.4%）接受纳洛酮治疗，其中3例（5.7%）生化阳性，4例（4.9%）访谈筛查阳性。接受基于访谈的筛查（p = 0.006）和住院24小时（p < 0.001）的青少年更有可能接受纳洛酮。大多数（96.4%）纳洛酮处方与阿片类药物和肌肉松弛剂合用，而不是药物使用筛查结果。结论受伤青少年使用纳洛酮的频率较低，且与药物使用筛查结果无关。

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引用次数: 0

Reflux symptoms in patients with mini gastric bypass-one anastomotic bypass (MGB-OAGB) after failed laparoscopic gastric banding (LAGB) - Long-term follow-up and therapeutic options 腹腔镜胃束带（LAGB）失败后行小型胃旁路-一次吻合口旁路（MGB-OAGB）患者的反流症状-长期随访和治疗选择

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-02-28 DOI: 10.1016/j.amjsurg.2026.116893

Ingeborg Bohlmann, Werner Müller, Claudius Falch

Background

Reflux after Mini-Gastric-Bypass - One-Anastomosis-Gastric-Bypass (MGB-OAGB) is well documented. Although uncommon after primary MGB-OAGB, affected patients may experience a significant reduction in quality of life.

In this study we provide a clinical evaluation of long-term, recurrent reflux symptoms and their impact on daily life in patients who underwent revisional OAGB-MGB after failed laparoscopic gastric banding (LAGB). The median follow-up period was 13 years.

Material and methods

From March 2004 to February 2008 18 patients underwent a revisional MGB-OAGB after failure of LAGB. The main reasons for LAGB failure were penetration, slipping, repeated leakage, intolerance, insufficient weight loss/weight regain. The MGB-OAGB was performed according to Robert Rutledge, the procedure was carried out as a one-step surgery.

In 2017 we conducted a telephone survey with a median of 13 years after revision to MGB-OAGB. We used the standardized GERD- Health Related Quality of Life Questionnaire (GERD-HRQL).

Results

We could reach out to 15 of the 18 patients. The maximum score of the GERD-HRQL is 30, the cut-off for severe reflux symptoms is 12 points. 2/3 of our patients showed a score considerably above 12 points.

Approximately 1/3 of the patients above had to go through a second revision surgery to RYGB.

Conclusion

Based on the results of our survey and clinical symptoms we discontinued to use MGB-OAGB as a revisional option after LAGB. The outcome of this highly selective group of patients cannot be generally applied to revisional bariatric surgery.

背景：Mini-Gastric-Bypass - one -吻合术- gastric - bypass （MGB-OAGB）后的回流有很好的文献记载。虽然在原发性MGB-OAGB后不常见，但受影响的患者可能会经历生活质量的显著下降。在这项研究中，我们对腹腔镜胃束带（LAGB）失败后接受改版OAGB-MGB的患者的长期、复发性反流症状及其对日常生活的影响进行了临床评估。中位随访期为13年。材料和方法从2004年3月到2008年2月，18例患者在LAGB失败后接受了改进性MGB-OAGB。LAGB失效的主要原因是渗透、打滑、反复渗漏、不耐受、减重/增重不足。根据罗伯特·拉特里奇的说法，MGB-OAGB手术是一步完成的。2017年，我们在修订MGB-OAGB后进行了一次电话调查，中位数为13年。我们使用标准化的GERD-健康相关生活质量问卷（GERD- hrql）。结果18例患者中有15例成功接触。GERD-HRQL的最高评分为30分，严重反流症状的分界点为12分。2/3的患者得分明显高于12分。大约三分之一以上的患者必须进行第二次RYGB翻修手术。基于我们的调查结果和临床症状，我们停止使用MGB-OAGB作为LAGB后的修正选择。这一高度选择性患者组的结果不能普遍应用于改进性减肥手术。

{"title":"Reflux symptoms in patients with mini gastric bypass-one anastomotic bypass (MGB-OAGB) after failed laparoscopic gastric banding (LAGB) - Long-term follow-up and therapeutic options","authors":"Ingeborg Bohlmann, Werner Müller, Claudius Falch","doi":"10.1016/j.amjsurg.2026.116893","DOIUrl":"10.1016/j.amjsurg.2026.116893","url":null,"abstract":"<div><h3>Background</h3><div>Reflux after Mini-Gastric-Bypass - One-Anastomosis-Gastric-Bypass (MGB-OAGB) is well documented. Although uncommon after primary MGB-OAGB, affected patients may experience a significant reduction in quality of life.</div><div>In this study we provide a clinical evaluation of long-term, recurrent reflux symptoms and their impact on daily life in patients who underwent revisional OAGB-MGB after failed laparoscopic gastric banding (LAGB). The median follow-up period was 13 years.</div></div><div><h3>Material and methods</h3><div>From March 2004 to February 2008 18 patients underwent a revisional MGB-OAGB after failure of LAGB. The main reasons for LAGB failure were penetration, slipping, repeated leakage, intolerance, insufficient weight loss/weight regain. The MGB-OAGB was performed according to Robert Rutledge, the procedure was carried out as a one-step surgery.</div><div>In 2017 we conducted a telephone survey with a median of 13 years after revision to MGB-OAGB. We used the standardized GERD- Health Related Quality of Life Questionnaire (GERD-HRQL).</div></div><div><h3>Results</h3><div>We could reach out to 15 of the 18 patients. The maximum score of the GERD-HRQL is 30, the cut-off for severe reflux symptoms is 12 points. 2/3 of our patients showed a score considerably above 12 points.</div><div>Approximately 1/3 of the patients above had to go through a second revision surgery to RYGB.</div></div><div><h3>Conclusion</h3><div>Based on the results of our survey and clinical symptoms we discontinued to use MGB-OAGB as a revisional option after LAGB. The outcome of this highly selective group of patients cannot be generally applied to revisional bariatric surgery.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116893"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388408","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

Active surveillance for low-grade ductal carcinoma in situ: A mixed-methods systematic review of patient, clinician, and health-system perspectives 低级别导管原位癌的主动监测：对患者、临床医生和卫生系统观点的混合方法系统回顾

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-03-02 DOI: 10.1016/j.amjsurg.2026.116898

Daniella Hui Xin Poh , Cristal Li Yi Tan , Yaoyi Ng , Kevin Xiang Zhou , Qin Xiang Ng , Serene Si Ning Goh

Background

Low-grade ductal carcinoma in situ (DCIS) is increasingly detected through breast screening, raising concerns about overtreatment. Active surveillance (AS) has emerged as an alternative to immediate surgery. We synthesized patient, clinician, and health-system perspectives relevant to AS adoption.

Methods

We conducted a mixed-methods systematic review (MMSR) following PRISMA, integrating quantitative, qualitative, and mixed-methods studies using a convergent integrated synthesis approach (PROSPERO CRD420250656621). PubMed, Embase, and the Cochrane Library were searched from 2000 to 2025. Risk of bias (RoB) was assessed using standardized tools.

Results

Fourteen studies were included. Patient preferences varied widely and were influenced by anxiety, terminology, perceived risk, and trust. Clinicians highlighted concerns about progression risk, pathology variability, medicolegal exposure, and limited long-term evidence. Institutional readiness was constrained by gaps in surveillance pathways, risk-stratification tools, and implementation support. Overall RoB was low to moderate.

Conclusion

Adoption of AS for low-grade DCIS depends not only on clinical evidence but also on psychological, communication, and organizational factors that shape decision-making across patients, clinicians, and health systems.

背景：低级别导管原位癌（DCIS）越来越多地通过乳腺筛查被发现，这引起了人们对过度治疗的担忧。主动监测（AS）已成为即时手术的替代方案。我们综合了与AS采用相关的患者、临床医生和卫生系统的观点。方法我们在PRISMA之后进行了一项混合方法的系统评价（MMSR），使用收敛综合综合方法（PROSPERO CRD420250656621）整合定量、定性和混合方法的研究。PubMed， Embase和Cochrane图书馆从2000年到2025年进行了检索。使用标准化工具评估偏倚风险（RoB）。结果共纳入14项研究。患者的偏好差异很大，受焦虑、术语、感知风险和信任的影响。临床医生强调了对进展风险、病理变异性、医学法律暴露和有限的长期证据的关注。监测途径、风险分层工具和实施支持方面的差距制约了机构的准备程度。总体而言，RoB处于低至中等水平。结论采用AS治疗低级别DCIS不仅取决于临床证据，还取决于心理、沟通和组织因素，这些因素会影响患者、临床医生和卫生系统的决策。

{"title":"Active surveillance for low-grade ductal carcinoma in situ: A mixed-methods systematic review of patient, clinician, and health-system perspectives","authors":"Daniella Hui Xin Poh , Cristal Li Yi Tan , Yaoyi Ng , Kevin Xiang Zhou , Qin Xiang Ng , Serene Si Ning Goh","doi":"10.1016/j.amjsurg.2026.116898","DOIUrl":"10.1016/j.amjsurg.2026.116898","url":null,"abstract":"<div><h3>Background</h3><div>Low-grade ductal carcinoma in situ (DCIS) is increasingly detected through breast screening, raising concerns about overtreatment. Active surveillance (AS) has emerged as an alternative to immediate surgery. We synthesized patient, clinician, and health-system perspectives relevant to AS adoption.</div></div><div><h3>Methods</h3><div>We conducted a mixed-methods systematic review (MMSR) following PRISMA, integrating quantitative, qualitative, and mixed-methods studies using a convergent integrated synthesis approach (PROSPERO CRD420250656621). PubMed, Embase, and the Cochrane Library were searched from 2000 to 2025. Risk of bias (RoB) was assessed using standardized tools.</div></div><div><h3>Results</h3><div>Fourteen studies were included. Patient preferences varied widely and were influenced by anxiety, terminology, perceived risk, and trust. Clinicians highlighted concerns about progression risk, pathology variability, medicolegal exposure, and limited long-term evidence. Institutional readiness was constrained by gaps in surveillance pathways, risk-stratification tools, and implementation support. Overall RoB was low to moderate.</div></div><div><h3>Conclusion</h3><div>Adoption of AS for low-grade DCIS depends not only on clinical evidence but also on psychological, communication, and organizational factors that shape decision-making across patients, clinicians, and health systems.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116898"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388410","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

Investigating optimal warming techniques for hypothermia in a swine model of ischemia 研究猪缺血模型中低温的最佳加热技术

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-03-03 DOI: 10.1016/j.amjsurg.2026.116912

Hannah Palmerton , Brooklyn Williams , Grace Pak , Bobby Zhang , Beau Prey , Andrew Francis , James Williams , Luke Pumiglia , Erik Roedel , Mike Lallemand , John McClellan , Nicholas Ieronimakis , Jason Bingham

Introduction

With trauma, hypothermia is associated with increased bleeding and worse outcomes yet the pace of rewarming is unproven and its influence unclear. We hypothesized that the rate of rewarming influences outcomes and evaluated its impact in a porcine model of trauma.

Methods

Pigs underwent controlled hemorrhage and hypothermia to 32 °C for 1 h, followed by rapid or slow rewarming for 3 h. Hemodynamics and coagulation were compared along with liver gene expression.

Results

The mean temperature reached between fast (37.9±0.13 °C) and slow groups (34.5±1.2 °C) was significantly different (p < 0.01). The slow group had a lower heart rate and the mean arterial pressure (MAP) was lower with both slow and fast. No major differences in lactate, pH, coagulation or gene expression were observed.

Conclusion

Our study supports rapid rewarming for reversing hypothermia post hemorrhage. Further research is needed to evaluate long-term outcomes within clinical settings.

对于创伤，低体温与出血增加和更糟糕的结果相关，但复温的速度尚未得到证实，其影响也不清楚。我们假设复温率会影响结果，并在猪创伤模型中评估其影响。方法对大鼠进行控制出血和32°C低温1 h，然后快速或缓慢复温3 h，比较血流动力学和凝血以及肝脏基因表达。结果快速组（37.9±0.13°C）与慢速组（34.5±1.2°C）的平均温度差异有统计学意义（p < 0.01）。慢速组心率较低，平均动脉压（MAP）在慢速组和快速组均较低。乳酸、pH、凝血或基因表达均无显著差异。结论：本研究支持出血后快速复温逆转体温过低。需要进一步的研究来评估临床环境中的长期结果。

{"title":"Investigating optimal warming techniques for hypothermia in a swine model of ischemia","authors":"Hannah Palmerton , Brooklyn Williams , Grace Pak , Bobby Zhang , Beau Prey , Andrew Francis , James Williams , Luke Pumiglia , Erik Roedel , Mike Lallemand , John McClellan , Nicholas Ieronimakis , Jason Bingham","doi":"10.1016/j.amjsurg.2026.116912","DOIUrl":"10.1016/j.amjsurg.2026.116912","url":null,"abstract":"<div><h3>Introduction</h3><div>With trauma, hypothermia is associated with increased bleeding and worse outcomes yet the pace of rewarming is unproven and its influence unclear. We hypothesized that the rate of rewarming influences outcomes and evaluated its impact in a porcine model of trauma.</div></div><div><h3>Methods</h3><div>Pigs underwent controlled hemorrhage and hypothermia to 32 °C for 1 h, followed by rapid or slow rewarming for 3 h. Hemodynamics and coagulation were compared along with liver gene expression.</div></div><div><h3>Results</h3><div>The mean temperature reached between fast (37.9±0.13 °C) and slow groups (34.5±1.2 °C) was significantly different (p < 0.01). The slow group had a lower heart rate and the mean arterial pressure (MAP) was lower with both slow and fast. No major differences in lactate, pH, coagulation or gene expression were observed.</div></div><div><h3>Conclusion</h3><div>Our study supports rapid rewarming for reversing hypothermia post hemorrhage. Further research is needed to evaluate long-term outcomes within clinical settings.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116912"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388405","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

Axillary lymph node dissection is not routinely indicated in patients with sentinel lymph node residual micrometastases following neoadjuvant systemic therapy 腋窝淋巴结清扫不是常规指在新辅助全身治疗后前哨淋巴结残留微转移的患者

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-03-03 DOI: 10.1016/j.amjsurg.2026.116901

Kinan Mokbel , Kefah Mokbel

Background

The clinical relevance of residual micrometastatic nodal disease (ypN1mi) detected in the sentinel lymph node (SLN) or following targeted axillary dissection (TAD) after neoadjuvant systemic therapy (NST) remains uncertain, particularly regarding the need for completion axillary lymph node dissection (cALND).

Methods

This narrative review summarizes evidence from registry-based and international cohort studies evaluating axillary recurrence and oncological outcomes in patients with ypN1mi managed with or without cALND after NST.

Results

Analyses from the SEER registry and the OPBC-07/microNAC cohort demonstrate a low incidence of axillary recurrence and no significant differences in oncological outcomes between SLNB alone and cALND. In subgroup analyses of triple-negative breast cancer, microNAC reported lower axillary recurrence rates with cALND; however, no difference in invasive recurrence was observed between groups.

Conclusions

Routine cALND appears unnecessary in most patients with ypN1mi after NST. Future studies should evaluate whether regional nodal irradiation can also be safely omitted.

背景：在新辅助全身治疗（NST）后前哨淋巴结（SLN）或靶向腋窝清扫（TAD）中检测到残留微转移性淋巴结病（ypN1mi）的临床相关性仍不确定，特别是是否需要完全腋窝淋巴结清扫（cALND）。方法：本综述总结了基于注册表和国际队列研究的证据，这些研究评估了NST后使用或不使用cALND治疗的ypN1mi患者腋窝复发和肿瘤预后。结果来自SEER登记和OPBC-07/microNAC队列的分析表明，单纯SLNB和cALND的腋窝复发率低，肿瘤预后无显著差异。在三阴性乳腺癌的亚组分析中，microNAC报告cALND患者腋窝复发率较低；但两组间浸润性复发无差异。结论大多数NST后的ypN1mi患者无需常规cALND。未来的研究应评估是否也可以安全地省略局部淋巴结照射。

{"title":"Axillary lymph node dissection is not routinely indicated in patients with sentinel lymph node residual micrometastases following neoadjuvant systemic therapy","authors":"Kinan Mokbel , Kefah Mokbel","doi":"10.1016/j.amjsurg.2026.116901","DOIUrl":"10.1016/j.amjsurg.2026.116901","url":null,"abstract":"<div><h3>Background</h3><div>The clinical relevance of residual micrometastatic nodal disease (ypN1mi) detected in the sentinel lymph node (SLN) or following targeted axillary dissection (TAD) after neoadjuvant systemic therapy (NST) remains uncertain, particularly regarding the need for completion axillary lymph node dissection (cALND).</div></div><div><h3>Methods</h3><div>This narrative review summarizes evidence from registry-based and international cohort studies evaluating axillary recurrence and oncological outcomes in patients with ypN1mi managed with or without cALND after NST.</div></div><div><h3>Results</h3><div>Analyses from the SEER registry and the OPBC-07/microNAC cohort demonstrate a low incidence of axillary recurrence and no significant differences in oncological outcomes between SLNB alone and cALND. In subgroup analyses of triple-negative breast cancer, microNAC reported lower axillary recurrence rates with cALND; however, no difference in invasive recurrence was observed between groups.</div></div><div><h3>Conclusions</h3><div>Routine cALND appears unnecessary in most patients with ypN1mi after NST. Future studies should evaluate whether regional nodal irradiation can also be safely omitted.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116901"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388409","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

Patients living with HIV in the modern era: Postoperative outcomes and healthcare utilization 现代艾滋病患者：术后结果和医疗保健利用

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-06-01 Epub Date: 2026-03-06 DOI: 10.1016/j.amjsurg.2026.116918

Michael Guo , Michael Budu , Jason Trigg , Tian Shen , Robert Hogg , Sam M. Wiseman

Introduction

Despite advances in antiretroviral therapy (ART), surgical outcomes in people with HIV (PWH) remain poorly understood. This study compared postoperative outcomes and healthcare use between PWH and matched people without HIV (non-PWH) undergoing general surgery in British Columbia, Canada.

Methods

Linked HIV-related and health administrative data (Jan 2008–Mar 2020) identified PWH and matched non-PWH. Outcomes included 30-day readmissions, 30-day re-operations, 30-day mortality, one-year mortality, and healthcare utilization.

Results

Among 1252 PWH and 5008 non-PWH, HIV status was not associated with odds of 30-day readmissions, re-operations, or deaths. However, PWH had higher odds of mortality within one year post op (OR 1.75, 95% CI: 1.12–2.73), shorter hospital stays (RR 0.64, 95% CI: 0.55–0.73), higher likelihood of lab (RR 2.11, 95% CI: 1.86–2.39), and specialist visits (RR 1.16, 95% CI: 1.01–1.35) compared to non-PWH.

Conclusion

PWH experienced similar short-term outcomes but higher one-year mortality and distinct care patterns, suggesting factors beyond perioperative care influence outcomes.

尽管抗逆转录病毒治疗（ART）取得了进展，但艾滋病毒感染者（PWH）的手术结果仍然知之甚少。本研究比较了加拿大不列颠哥伦比亚省接受普外科手术的PWH患者和匹配的无HIV（非PWH）患者的术后结果和医疗保健使用情况。方法将hiv相关和卫生管理数据（2008年1月至2020年3月）联系起来，确定PWH和匹配的非PWH。结果包括30天再入院、30天再手术、30天死亡率、1年死亡率和医疗保健利用率。结果在1252名PWH患者和5008名非PWH患者中，HIV感染状况与30天再入院、再手术或死亡的几率无关。然而，与非PWH相比，PWH术后一年内的死亡率更高（OR 1.75, 95% CI: 1.12-2.73），住院时间更短（RR 0.64, 95% CI: 0.55-0.73），实验室（RR 2.11, 95% CI: 1.86-2.39）和专科就诊（RR 1.16, 95% CI: 1.01-1.35）的可能性更高。结论pwh短期预后相似，但1年死亡率较高，护理模式不同，提示围手术期护理以外的因素影响预后。

{"title":"Patients living with HIV in the modern era: Postoperative outcomes and healthcare utilization","authors":"Michael Guo , Michael Budu , Jason Trigg , Tian Shen , Robert Hogg , Sam M. Wiseman","doi":"10.1016/j.amjsurg.2026.116918","DOIUrl":"10.1016/j.amjsurg.2026.116918","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite advances in antiretroviral therapy (ART), surgical outcomes in people with HIV (PWH) remain poorly understood. This study compared postoperative outcomes and healthcare use between PWH and matched people without HIV (non-PWH) undergoing general surgery in British Columbia, Canada.</div></div><div><h3>Methods</h3><div>Linked HIV-related and health administrative data (Jan 2008–Mar 2020) identified PWH and matched non-PWH. Outcomes included 30-day readmissions, 30-day re-operations, 30-day mortality, one-year mortality, and healthcare utilization.</div></div><div><h3>Results</h3><div>Among 1252 PWH and 5008 non-PWH, HIV status was not associated with odds of 30-day readmissions, re-operations, or deaths. However, PWH had higher odds of mortality within one year post op (OR 1.75, 95% CI: 1.12–2.73), shorter hospital stays (RR 0.64, 95% CI: 0.55–0.73), higher likelihood of lab (RR 2.11, 95% CI: 1.86–2.39), and specialist visits (RR 1.16, 95% CI: 1.01–1.35) compared to non-PWH.</div></div><div><h3>Conclusion</h3><div>PWH experienced similar short-term outcomes but higher one-year mortality and distinct care patterns, suggesting factors beyond perioperative care influence outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"256 ","pages":"Article 116918"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388411","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