American journal of surgery最新文献

Background: Laparoscopic cholecystectomy (LC) is a common operation performed worldwide. Indications include acute cholecystitis (AC), with a trend of increasing complexity post-COVID-19. We aim to evaluate the health expenditure on LC at an Australian tertiary centre.

Methods: A retrospective chart review was performed for all LC between July 1, 2022-June 30, 2023 collecting demographics, costs and wait times and comparisons performed between elective and emergency LC.

Results: 125 patients underwent emergency and 78 elective LC. There was no difference between age, sex or ASA. 67 patients (53.6 ​%) had emergency LC within their booking priority category. Average cost for emergency LC was $12,689.90 with a median stay of four days, compared to $7181.10 and one day for elective (p ​< ​0.01). Operative related costs were the majority with emergency LC higher ($4866.5, 38.4 ​% v $3957.6, 55.1 ​% p ​= ​0.02). The largest cost disparity was nursing costs ($2193.7, 17.3 ​% v 648.3, 9 ​% p ​< ​0.01).

Conclusion: Costs are likely driven by access to emergency theatre time and increased length of stay. A semi-emergency theatre model could save costs.

Background: The impact of frailty on outcomes in midlife trauma patients (50-64 ​y) remains understudied. We evaluated the impact of frailty on midlife trauma patients' outcomes.

Methods: This is a retrospective cohort study using TQIP 2021 data. Demographics, injury and hospital information, comorbidities, complications, mortality, and discharge disposition were extracted. Frailty was scored using the modified frailty index-5. Multivariate analyses were performed. P ​< ​0.001 was considered significant.

Results: In 2021, 5.1 ​% midlife trauma patients were frail. On multivariate analysis adjusting for demographics, insurance status, injury severity score, vitals on arrival, and mode of transportation, frailty was associated with increased risk of death (OR ​= ​2.27 [2.01-2.57]), longer hospital and ICU stay (MR ​= ​1.46 [1.43-1.49] and MR ​= ​1.30 [1.24-1.36]), and discharge requiring higher level of care (OR ​= ​2.11 [2.01-2.22]).

Conclusion: Our data support the need for preventative efforts regarding frailty in midlife adults.

Background: Endoscopic submucosal dissection (ESD) is increasingly being adopted for the treatment of early-stage colorectal cancer (CRC) lesions.

Methods: We retrospectively analyzed patients with early-stage CRC treated between 2015 and 2023, using ESD and colectomy databases, categorizing them into three groups: ESD only (n ​= ​24), oncological colorectal resection (OCR) only (n ​= ​90), and OCR after ESD (n ​= ​59). We compared pathological and oncological outcomes among these groups.

Results: The OCR after ESD group demonstrated higher non-granular lesions, and deeper submucosal invasion compared to ESD only group. The primary OCR group showed higher 2-year overall survival compared to ESD-only group (98.9 ​% vs 85.6 ​%, p ​= ​0.01), with no colorectal cancer-related mortality in any of the groups. Notably, 2-year disease-free survival rates were comparable across all groups (93.8 ​% ESD only, 88.0 ​% primary OCR only, and 97.8 ​% for OCR after ESD, p ​= ​0.27).

Conclusion: The current study highlights feasibility the promising potential and oncologic safety of ESD in carefully selected patients with early malignant lesions.

Presidential address delivered at the 2024 Annual meeting of the Midwest Surgical Association, Mackinac Island, MI on August 6th^, 2024.

Background: Main purpose of this study is to investigate impact of tumor size on risk of lymph node metastasis (LNM) in pT1-stage colorectal cancer (CRC), focusing on colon, rectosigmoid junction, and rectum.

Method: Patients diagnosed with primary pT1 CRC between 2015 and 2019 were selected from National Cancer Database, utilizing International Classification of Diseases for Oncology, Third Edition (ICD-O-3) codes. We analyzed factors influencing LNM using uni- and multivariate analysis, then isolated tumor size to study its impact on LNM.

Results: In this study of 27,649 pT1-stage tumor patients, we found that 10 ​% of colon, 16 ​% of rectosigmoid junction, and 13 ​% of rectum were LNM+. The study had 14,339 males (51.97 ​%). Mean age was 64.9 (±11.7). In multivariate analysis, sample was adjusted by excluding confounding factors, isolating impact of tumor size on LNM. Analysis for only tumor size, patients with colon tumors >45 ​mm had 53 ​% increased odds of LNM (95 ​% CI [1.06, 2.23], p ​= ​0.03), whereas tumor size did not significantly affect LNM in rectosigmoid and rectum cases, with odds ratios of 2.05 (95 ​% CI [0.82, 5.09], p ​= ​0.12) and 1.62 (95 ​% CI [0.97, 2.71], p ​= ​0.065) respectively, for tumors ≥45 ​mm compared to those <15 ​mm.

Conclusion: This investigation refines predictors of LNM, crucial for tailoring organ-sparing strategies in early-stage CRC management. While tumor size is significant determinant of LNM in colon cancer, early rectal and rectosigmoid cancers may be associated with lower risk of LNM.

Background: Bariatric surgery is a cornerstone intervention for individuals with severe obesity, offering substantial and sustainable weight loss.

Methods: This retrospective cohort study included 186 patients with obesity and Type2 diabetes who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2009 and 2020 ​at University Hospital Ayr. Optimal clinical response weight loss was defined as excess weight loss (%EWL) ≥50 ​% or total weight loss (%TWL) ≥20 ​%.

Results: At 2-years post-surgery, 43.6 ​% achieved ≥50 %EWL, and 44.1 ​% achieved ≥20%TWL, with 31.8 ​% maintaining this at 5-years. Depending on the definition used, between 11.2 ​% and 45.9 ​% of patients experienced recurrent weight gain. BMI had significant positive association with %TWL but negative with %EWL (p ​< ​0.05). RYGB had significantly higher %TWL compared to SG (p ​< ​0.05).

Conclusion: Most patients experienced weight loss which was maintained over time, however recurrent weight gain was noted. Pre-surgery BMI was significantly associated with weight changes.