American journal of surgery最新文献

Background

Female surgeons face increased rates of fertility challenges compared to the general population. We aim to understand surgical trainees’ understanding and perspectives on family planning.

Methods

A 35-question survey was emailed to program directors at all US surgical residency programs for distribution to residents. Descriptive analyses were performed to evaluate resident understanding and perspectives on family planning and fertility treatments.

Results

A total of 121 residents responded to the survey. Most were female (n ​= ​78; 65 ​%). Responders indicated the need to postpone pregnancy during training (female: n ​= ​48, 64 ​% vs male n ​= ​18, 45 ​%; p ​= ​0.09). Potential negative career consequences (n ​= ​50; 42 ​%), limited leave benefits (n ​= ​47; 39 ​%), and lack of childcare (n ​= ​45; 38 ​%) were primary reasons for postponing pregnancy. Only nine responders (8 ​%) received fertility-preservation education.

Conclusion

Surgical trainees delay pregnancy for career and social support concerns and are interested in reproductive preservation. Fertility education could provide needed support for trainees.

Background

The risks associated with blood product administration and venous thromboembolic events remains unclear. We sought to determine which blood products were associated with the development of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Methods

We analyzed data from patients ≥18 years of age in the Trauma Quality Improvement Program (TQIP) database that received ≥1 blood product and survived ≥24 ​h.

Results

There were 42,399 that met inclusion, of whom, 2086 had at least one VTE event. In our multivariable logistic regression model, we found that WB had a unit odds ratio (uOR) of 1.05 (95 ​% CI 1.02–1.08) for DVT and 1.08 (1.05–1.12) for PE. Compared to WB, platelets had a higher uOR for DVT of 1.09 (1.04–1.13) but similar uOR for PE of 1.08 (1.03–1.14).

Conclusions

We found an association of both DVT and PE with early whole blood and platelets.

Introduction

Reintubation in unplanned scenarios, carries inherent risks and potential complications particularly in vulnerable populations such as geriatric trauma patients. We sought to identify preadmission risk factors for unplanned re-intubation (URI) in geriatric trauma patients and its effects on outcomes.

Methods

Analysis of TQIP (2017–2019) of intubated geriatric trauma patients, classified into two groups, those who were successfully extubated and those who required URI. We used logistic regression to assess for preadmission risk factors of URI.

Results

Among 23,572 patients, 20.2 ​% underwent URI. URI had higher mortality (13.7%vs.8.1 ​%, p ​< ​0.001), in-hospital complications (p ​< ​0.05), longer hospital and ICU LOS (p ​< ​0.001 for both). Higher age (OR ​= ​1.017), smoking (OR ​= ​1.418), CRF(OR ​= ​1.414), COPD (OR ​= ​1.410), alcohol use (OR ​= ​1.365), functionally dependent health status (OR ​= ​1.339), and anticoagulant use (OR ​= ​1.148), increased the risks of URI (p ​< ​0.05 for all).

Conclusion

Geriatric patients with comorbidities including age, smoking, CRF, COPD, alcohol use, dependent status, and anticoagulant use are at higher risks of URI that could in turn, be associated with increased rates of mortality, complications, and longer hospital and ICU length of stay.

Level of evidence

Level III retrospective study.

Introduction

Methods

Results

Conclusion

Introduction

Peri-intubation hypotension is associated with increased hospital length of stay and morbidity. Propofol is associated with alterations in hemodynamics. We hypothesize that using propofol for induction leads to peri-intubation hypotension in trauma critical care patients.

Methods

Patients that underwent unplanned intubation in the trauma intensive care unit (TICU) were prospectively enrolled. Peri-intubation vitals and medications were recorded to assess hypotension within 10 ​min of intubation. Patients were divided into propofol (PROP) or other medication (OTR) groups.

Results

Data was complete for 69 patients; 31 PROP and 38 OTR. In OTR there was an 8.8-point (−21.1, 3.6) SBP decrease (p ​= ​0.159) and in PROP there was a 30.8-point (−45.6, −16.0) SBP decrease (p ​= ​0.0002) with significant increases in heart rate (HR) and shock index (SI) (HR p ​= ​0.001, SI p ​< ​0.0001).

Conclusion

In patients without hypotension prior to intubation, we observed a statistically significant drop in the patients’ SBP with use of propofol. In trauma critical care unit patients, we recommend considering an induction medication for unplanned intubation other than propofol.

Background

Previous studies showed comparable outcomes for common in-patient general surgery operations, but it is unknown if this extends to outpatient operations. Our aim was to compare outpatient cholecystectomy outcomes between rural and urban hospitals.

Methods

A retrospective cohort analysis was done using the Nationwide Ambulatory Surgery Sample for patients 20-years-and-older undergoing cholecystectomy between 2016 and 2018 ​at rural and urban hospitals. Survey-weighted multivariable regression analysis was performed with primary outcomes including use-of-laparoscopy, complications, and patient discharge disposition.

Results

The most common indication for operation was cholecystitis in both hospital settings. On multivariable analysis, rural hospitals were associated with higher transfers to short-term hospitals (adjusted odds ratio [aOR] 2.40, 95%CI 1.61-3.58, p ​< ​0.01) and complications (aOR 1.39, 95%CI 1.11-1.75, p ​< ​0.01). No difference was detected with laparoscopy (aOR 1.93, 95%CI 0.73-5.13, p ​= ​0.19), routine discharge (aOR 1.50, 95%C I0.91-2.45, p ​= ​0.11), or mortality (aOR 3.23, 95%CI 0.10–100.0, p ​= ​0.51).

Conclusions

Patients cared for at rural hospitals were more likely to be transferred to short-term hospitals and have higher complications. No differences were detected in laparoscopy, routine discharge or mortality.