Pub Date : 2024-09-17DOI: 10.1016/j.amjsurg.2024.115973
Brandon A. Bellen , Janet S. Lee , Emily Johnson , Nathan Schmoekel , Robert McIntyre Jr. , Michael Cripps , John McVicker , Thomas Schroeppel
Background
Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.
Methods
A retrospective analysis was performed on trauma patients with iTSAH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and pre-injury antiplatelet/anticoagulant use.
Results
276 patients were identified over the 8-year study period. The median number of head CT scans was 2. Neurosurgery consultation was obtained in 80.4 % of patients. A total of 19 (8.6 %) patients had radiographic progression. Six (2.2 %) patients had neurologic deterioration. No patients required operative intervention or readmission. No deaths were related to iTSAH.
Conclusions
There were no patients with iTSAH that required neurosurgical consultation despite a subset of patients having radiographic or neurologic progression. These patients may not require repeat head CT scan or neurosurgical consult, necessitating a change of SAH definitions in the mBIG.
{"title":"Less is more: Streamlining management of isolated traumatic subarachnoid hemorrhage in the modified brain injury guidelines","authors":"Brandon A. Bellen , Janet S. Lee , Emily Johnson , Nathan Schmoekel , Robert McIntyre Jr. , Michael Cripps , John McVicker , Thomas Schroeppel","doi":"10.1016/j.amjsurg.2024.115973","DOIUrl":"10.1016/j.amjsurg.2024.115973","url":null,"abstract":"<div><h3>Background</h3><div>Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on trauma patients with iTSAH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and pre-injury antiplatelet/anticoagulant use.</div></div><div><h3>Results</h3><div>276 patients were identified over the 8-year study period. The median number of head CT scans was 2. Neurosurgery consultation was obtained in 80.4 % of patients. A total of 19 (8.6 %) patients had radiographic progression. Six (2.2 %) patients had neurologic deterioration. No patients required operative intervention or readmission. No deaths were related to iTSAH.</div></div><div><h3>Conclusions</h3><div>There were no patients with iTSAH that required neurosurgical consultation despite a subset of patients having radiographic or neurologic progression. These patients may not require repeat head CT scan or neurosurgical consult, necessitating a change of SAH definitions in the mBIG.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115973"},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322588","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}
Background: In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions.
Methods: We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology.
Results: Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle.
Conclusions: We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.
{"title":"Gender bias in surgery: A systematic review of qualitative studies.","authors":"Gabriele Eckerdt Lech, Lincólin Bardini Goulart, Carolina Hack Alves, Carolina Polidori Aguiar, Luiza Bertolli Lucchese Moraes, Gabriela Rangel Brandão","doi":"10.1016/j.amjsurg.2024.115974","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115974","url":null,"abstract":"<p><strong>Background: </strong>In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology.</p><p><strong>Results: </strong>Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle.</p><p><strong>Conclusions: </strong>We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115974"},"PeriodicalIF":2.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279242","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}
Pub Date : 2024-09-14DOI: 10.1016/j.amjsurg.2024.115972
Jon S. Thompson , Fedja A. Rochling , Elizabeth Lyden , Shaheed Merani , Luciano Vargas , Wendy J. Grant , Alan N. Langnas , David F. Mercer
Background
Textbook outcome (TO) is a single composite score representing ideal care for a procedure or medical condition. Short bowel syndrome (SBS) patients are at high risk for complications and death. Our aim was to determine the incidence of and predictive factors for a TO in SBS patients.
Methods
515 adults with SBS were followed for 12 months after initial hospital discharge for SBS. TO was defined based on eight outcome parameters. Demographic data, intestinal anatomy, and nutritional outcome were compared in patients with and without TO.
Results
78 (15 %) patients had a TO. The frequency of the different components of TO were: PN < 1 year (39 %), BMI >18.5 kg/m2 (89 %), no stoma (59 %), no surgical intervention (71 %), no hospital readmission (56 %), no vascular access infection (62 %), absence of end stage liver disease (96 %), and survival (97 %). Intestinal remnant length and anatomy type were predictive of a TO.
Conclusions
A TO is achieved in 15 % SBS patients using the selected criteria. This is largely attributable to continued need for PN. Intestinal length and anatomy were independent predictors of TO.
背景手册结果（TO）是一个单一的综合评分，代表了手术或医疗条件的理想护理效果。短肠综合征（SBS）患者是并发症和死亡的高危人群。我们的目的是确定SBS患者TO的发生率和预测因素。TO的定义基于八个结果参数。结果78例（15%）患者出现了TO。78例（15%）患者出现了TO，TO的不同组成部分的频率分别为PN<1年（39%）、BMI>18.5 kg/m2（89%）、无造口（59%）、无手术干预（71%）、无再入院（56%）、无血管通路感染（62%）、无终末期肝病（96%）和存活（97%）。结论 根据所选标准，15% 的 SBS 患者可获得 TO。这主要归因于继续需要 PN。肠道长度和解剖类型是预测 TO 的独立因素。
{"title":"Textbook outcome in short bowel syndrome","authors":"Jon S. Thompson , Fedja A. Rochling , Elizabeth Lyden , Shaheed Merani , Luciano Vargas , Wendy J. Grant , Alan N. Langnas , David F. Mercer","doi":"10.1016/j.amjsurg.2024.115972","DOIUrl":"10.1016/j.amjsurg.2024.115972","url":null,"abstract":"<div><h3>Background</h3><p>Textbook outcome (TO) is a single composite score representing ideal care for a procedure or medical condition. Short bowel syndrome (SBS) patients are at high risk for complications and death. Our aim was to determine the incidence of and predictive factors for a TO in SBS patients.</p></div><div><h3>Methods</h3><p>515 adults with SBS were followed for 12 months after initial hospital discharge for SBS. TO was defined based on eight outcome parameters. Demographic data, intestinal anatomy, and nutritional outcome were compared in patients with and without TO.</p></div><div><h3>Results</h3><p>78 (15 %) patients had a TO. The frequency of the different components of TO were: PN < 1 year (39 %), BMI >18.5 kg/m<sup>2</sup> (89 %), no stoma (59 %), no surgical intervention (71 %), no hospital readmission (56 %), no vascular access infection (62 %), absence of end stage liver disease (96 %), and survival (97 %). Intestinal remnant length and anatomy type were predictive of a TO.</p></div><div><h3>Conclusions</h3><p>A TO is achieved in 15 % SBS patients using the selected criteria. This is largely attributable to continued need for PN. Intestinal length and anatomy were independent predictors of TO.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115972"},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270464","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}
Pub Date : 2024-09-12DOI: 10.1016/j.amjsurg.2024.115944
Teagan E. Marshall, Rahma Ibrahim, Yeon J. Lee-Saxton, Abhinay Tumati, Daniel Hubbs, Rasa Zarnegar, Thomas J. Fahey III, Brendan M. Finnerty
Background
Anaplastic thyroid cancer (ATC) is highly aggressive with a poor prognosis. Adjuvant systemic therapy and radiation post-surgery are endorsed by NCCN and ATA guidelines. Our study aimed to identify those at risk of forgoing postoperative adjuvant treatment and to determine survival predictors.
Methods
We used the National Cancer Database (NCDB) to identify ATC patients who underwent upfront thyroidectomy from 2010 to 2017, excluding those opting for palliative care. We compared demographics, characteristics, treatments, and outcomes between those who received adjuvant therapy and those who did not. Predictors of receiving adjuvant therapy were identified using logistic regression, while Cox regression identified survival factors.
Results
Of 563 patients, 160 received no adjuvant treatment, 82 received radiation only, 16 received systemic therapy only, and 305 received combination therapy. Notably, over 75 % of patients who did not receive adjuvant treatment had it excluded from their treatment plan, not due to refusal. Older age (OR 0.92) and non-white race/ethnicity (OR 0.33) were significant predictors of not receiving adjuvant therapy. Undergoing a total thyroidectomy, an R0 or R1 resection, and radiation or combination therapy were associated with better survival, while non-metropolitan location, primary tumor size >7.5 cm, and stage IVC disease were negative factors.
Conclusion
Total thyroidectomy, R0/R1 resection, and adjuvant therapy reduce mortality in ATC patients. However, older patients and minorities are less likely to receive adjuvant therapy, underscoring disparities in treatment adherence.
{"title":"Disparities in postoperative adjuvant therapy utilization and factors impacting survival among anaplastic thyroid cancer patients","authors":"Teagan E. Marshall, Rahma Ibrahim, Yeon J. Lee-Saxton, Abhinay Tumati, Daniel Hubbs, Rasa Zarnegar, Thomas J. Fahey III, Brendan M. Finnerty","doi":"10.1016/j.amjsurg.2024.115944","DOIUrl":"10.1016/j.amjsurg.2024.115944","url":null,"abstract":"<div><h3>Background</h3><div>Anaplastic thyroid cancer (ATC) is highly aggressive with a poor prognosis. Adjuvant systemic therapy and radiation post-surgery are endorsed by NCCN and ATA guidelines. Our study aimed to identify those at risk of forgoing postoperative adjuvant treatment and to determine survival predictors.</div></div><div><h3>Methods</h3><div>We used the National Cancer Database (NCDB) to identify ATC patients who underwent upfront thyroidectomy from 2010 to 2017, excluding those opting for palliative care. We compared demographics, characteristics, treatments, and outcomes between those who received adjuvant therapy and those who did not. Predictors of receiving adjuvant therapy were identified using logistic regression, while Cox regression identified survival factors.</div></div><div><h3>Results</h3><div>Of 563 patients, 160 received no adjuvant treatment, 82 received radiation only, 16 received systemic therapy only, and 305 received combination therapy. Notably, over 75 % of patients who did not receive adjuvant treatment had it excluded from their treatment plan, not due to refusal. Older age (OR 0.92) and non-white race/ethnicity (OR 0.33) were significant predictors of not receiving adjuvant therapy. Undergoing a total thyroidectomy, an R0 or R1 resection, and radiation or combination therapy were associated with better survival, while non-metropolitan location, primary tumor size >7.5 cm, and stage IVC disease were negative factors.</div></div><div><h3>Conclusion</h3><div>Total thyroidectomy, R0/R1 resection, and adjuvant therapy reduce mortality in ATC patients. However, older patients and minorities are less likely to receive adjuvant therapy, underscoring disparities in treatment adherence.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115944"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322700","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}
Pub Date : 2024-09-11DOI: 10.1016/j.amjsurg.2024.115949
Taylor Carter, M Libby Weaver, Brigitte K Smith
{"title":"Using patient satisfaction to assess trainee performance: Is perception reality?","authors":"Taylor Carter, M Libby Weaver, Brigitte K Smith","doi":"10.1016/j.amjsurg.2024.115949","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115949","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"115949"},"PeriodicalIF":2.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279297","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}
Pub Date : 2024-09-10DOI: 10.1016/j.amjsurg.2024.115952
Amir Humza Sohail , Hoang Nguyen , Kevin Martinez , Samuel L. Flesner , Christian Martinez , Mohammed A. Quazi , Aman Goyal , Abu Baker Sheikh , Hassan Aziz , Ammar Asrar Javed , Jennifer Whittington , Loretto Glynn , D'Andrea Joseph , Matthew C. Hernandez
Introduction
Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce.
Methods
A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume.
Results
Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 % increase; τ = 0.610, p = 0.001). There was a concurrent 72.7 % increase in TA cases from a median of 22–38 (τ = 0.574, p = 0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017.
The uptrend in TA cases was associated with the significant increase in colorectal (τ = 0.559, p = 0.001), general surgery-other (τ = 0.404, p = 0.018), and hepatopancreaticobiliary (HPB) (τ = 0.596, p = 0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ = 0.956, p=<0.001), HPB (τ = 0.713, p=<0.001) and colorectal (τ = 0.522, p = 0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ = −0.485, p = 0.006) and vascular surgery (τ = 0.603, p = 0.001) dropped significantly.
The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 %) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023.
Conclusions
Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.
{"title":"See one, do one, teach one - Trends in resident autonomy and teaching assistant cases during general surgery residency in the United States: A nationwide retrospective analysis","authors":"Amir Humza Sohail , Hoang Nguyen , Kevin Martinez , Samuel L. Flesner , Christian Martinez , Mohammed A. Quazi , Aman Goyal , Abu Baker Sheikh , Hassan Aziz , Ammar Asrar Javed , Jennifer Whittington , Loretto Glynn , D'Andrea Joseph , Matthew C. Hernandez","doi":"10.1016/j.amjsurg.2024.115952","DOIUrl":"10.1016/j.amjsurg.2024.115952","url":null,"abstract":"<div><h3>Introduction</h3><div>Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume.</div></div><div><h3>Results</h3><div>Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 % increase; τ = 0.610, p = 0.001). There was a concurrent 72.7 % increase in TA cases from a median of 22–38 (τ = 0.574, p = 0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017.</div><div>The uptrend in TA cases was associated with the significant increase in colorectal (τ = 0.559, p = 0.001), general surgery-other (τ = 0.404, p = 0.018), and hepatopancreaticobiliary (HPB) (τ = 0.596, p = 0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ = 0.956, p=<0.001), HPB (τ = 0.713, p=<0.001) and colorectal (τ = 0.522, p = 0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ = −0.485, p = 0.006) and vascular surgery (τ = 0.603, p = 0.001) dropped significantly.</div><div>The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 %) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023.</div></div><div><h3>Conclusions</h3><div>Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115952"},"PeriodicalIF":2.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142374892","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}
Pub Date : 2024-09-10DOI: 10.1016/j.amjsurg.2024.115957
Herbert Chen (Editor-in-Chief)
{"title":"From the Editor – In – Chief: Featured papers in the November 2024 issue","authors":"Herbert Chen (Editor-in-Chief)","doi":"10.1016/j.amjsurg.2024.115957","DOIUrl":"10.1016/j.amjsurg.2024.115957","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"237 ","pages":"Article 115957"},"PeriodicalIF":2.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279241","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}
Pub Date : 2024-09-07DOI: 10.1016/j.amjsurg.2024.115955
Linda M. Saikali , Christopher D. Herrera , Angela T. Chen , Gina Lepore , Omar I. Ramadan , Doreen Lam , Aaron Anandarajah , Carrie Z. Morales , Matthew Goldshore , Jon B. Morris , Carmen E. Guerra
Background
This study aimed to characterize patient satisfaction with navigators and surgical care accessed through a novel navigation program for under-resourced communities.
Methods
PSN-I and PSQ-18 questionnaires assessed satisfaction with navigators and care, respectively. Primary outcomes were PSN-I and PSQ-18 scores. Secondary analyses tested associations between satisfaction and patient factors and between PSN-I and PSQ-18 scores.
Results
Of 294 patients contacted, 88 (29.9 %) responded. Most were Hispanic/Latinx (76.1 %), Spanish-speaking (71.5 %), and uninsured (85.2 %). Participants were highly satisfied with navigators (mean 38.5, SD 7.6; max. 45) and most care domains except Financial Aspects (mean 3.2, SD 1.0; max. 5) and Accessibility/Convenience (mean 3.5, SD 0.6; max. 5). Higher navigator satisfaction was associated with post-consultation need for surgery (coeff. 5.6, 95 % CI[0.9, 10.3]) and increased the odds of care satisfaction (OR 1.1, 95 % CI[1.0, 1.2]).
Conclusions
Patients are satisfied with navigation services—a previously unstudied aspect of this unique surgical equity program.
{"title":"Evaluating patient experience with a surgical navigation program for under-resourced patients","authors":"Linda M. Saikali , Christopher D. Herrera , Angela T. Chen , Gina Lepore , Omar I. Ramadan , Doreen Lam , Aaron Anandarajah , Carrie Z. Morales , Matthew Goldshore , Jon B. Morris , Carmen E. Guerra","doi":"10.1016/j.amjsurg.2024.115955","DOIUrl":"10.1016/j.amjsurg.2024.115955","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to characterize patient satisfaction with navigators and surgical care accessed through a novel navigation program for under-resourced communities.</p></div><div><h3>Methods</h3><p>PSN-I and PSQ-18 questionnaires assessed satisfaction with navigators and care, respectively. Primary outcomes were PSN-I and PSQ-18 scores. Secondary analyses tested associations between satisfaction and patient factors and between PSN-I and PSQ-18 scores.</p></div><div><h3>Results</h3><p>Of 294 patients contacted, 88 (29.9 %) responded. Most were Hispanic/Latinx (76.1 %), Spanish-speaking (71.5 %), and uninsured (85.2 %). Participants were highly satisfied with navigators (mean 38.5, SD 7.6; max. 45) and most care domains except Financial Aspects (mean 3.2, SD 1.0; max. 5) and Accessibility/Convenience (mean 3.5, SD 0.6; max. 5). Higher navigator satisfaction was associated with post-consultation need for surgery (coeff. 5.6, 95 % CI[0.9, 10.3]) and increased the odds of care satisfaction (OR 1.1, 95 % CI[1.0, 1.2]).</p></div><div><h3>Conclusions</h3><p>Patients are satisfied with navigation services—a previously unstudied aspect of this unique surgical equity program.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115955"},"PeriodicalIF":2.7,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142228618","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}
Pub Date : 2024-09-07DOI: 10.1016/j.amjsurg.2024.115950
Natale Calomino , Gianmario Edoardo Poto , Ludovico Carbone , Giorgio Micheletti , Mattheus Gjoka , Gennaro Giovine , Benito Sepe , Giulio Bagnacci , Stefania Angela Piccioni , Roberto Cuomo , Gian Luigi Adani , Daniele Marrelli
Background
Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34–36 g/m2) and heavy-weight polypropylene (HW-PP, 95 g/m2) meshes.
Methods
Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications.
Results
Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 % and 39.5 %. According to EHS, 31.5 %, 22.3 % and 46.2 % were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities.
Conclusion
1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.
{"title":"Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study","authors":"Natale Calomino , Gianmario Edoardo Poto , Ludovico Carbone , Giorgio Micheletti , Mattheus Gjoka , Gennaro Giovine , Benito Sepe , Giulio Bagnacci , Stefania Angela Piccioni , Roberto Cuomo , Gian Luigi Adani , Daniele Marrelli","doi":"10.1016/j.amjsurg.2024.115950","DOIUrl":"10.1016/j.amjsurg.2024.115950","url":null,"abstract":"<div><h3>Background</h3><p>Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34–36 g/m2) and heavy-weight polypropylene (HW-PP, 95 g/m2) meshes.</p></div><div><h3>Methods</h3><p>Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications.</p></div><div><h3>Results</h3><p>Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 % and 39.5 %. According to EHS, 31.5 %, 22.3 % and 46.2 % were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities.</p></div><div><h3>Conclusion</h3><p>1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"238 ","pages":"Article 115950"},"PeriodicalIF":2.7,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002961024005026/pdfft?md5=88ed331bf46c10bb15c2a4123d4f62aa&pid=1-s2.0-S0002961024005026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168404","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}
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