Pub Date : 2025-03-05DOI: 10.1016/j.amjsurg.2025.116290
Mytien Nguyen, Alizeh Abbas, Lamario J Williams, Wendelyn M Oslock, Ranganath G Kathawate, Paula A Ferrada
{"title":"Roses & thorns of academic surgery: Paving the way for others with Dr. Paula Ferrada.","authors":"Mytien Nguyen, Alizeh Abbas, Lamario J Williams, Wendelyn M Oslock, Ranganath G Kathawate, Paula A Ferrada","doi":"10.1016/j.amjsurg.2025.116290","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116290","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116290"},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623239","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}
Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer. This study evaluates oncologic outcomes in IBC patients treated with modern multimodal treatment.
Methods
A retrospective review analyzed clinicopathologic data of 5063 patients, 646 of whom underwent NAC followed by surgery between 2012 and 2024. Survival outcomes were compared across biologic subtypes.
Results
Twenty-six cases of T4dM0 IBC were identified, with 57.7 % HER-2 positive, 26.9 % ER positive/HER-2 negative, and 15.4 % ER negative/HER-2 negative. The total pCR rate was highest in HER-2 positive (53.3 %) and lowest in ER-positive/HER-2 negative patients (p = 0.036). Among 19 patients with ≥3 years of follow-up, 47 % experienced recurrence (78 % distant and 22 % locoregional) and 42 % died of breast cancer. No significant differences in locoregional recurrence, or survival outcomes were found across subtypes.
Conclusion
pCR has limited prognostic value in IBC. Although HER-2 positive patients are more likely to achieve pCR, this does not necessarily translate into improved outcomes.
{"title":"Inflammatory breast cancer response to modern neoadjuvant chemotherapy: Tumor response and survival outcomes","authors":"Dorsa Mousa-Doust , Amy Bazzarelli , Melina Deban , Carol Dingee , Jieun Newman-Bremang , Jin-Si Pao , Rebecca Warburton , Elaine McKevitt","doi":"10.1016/j.amjsurg.2025.116288","DOIUrl":"10.1016/j.amjsurg.2025.116288","url":null,"abstract":"<div><h3>Background</h3><div>Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer. This study evaluates oncologic outcomes in IBC patients treated with modern multimodal treatment.</div></div><div><h3>Methods</h3><div>A retrospective review analyzed clinicopathologic data of 5063 patients, 646 of whom underwent NAC followed by surgery between 2012 and 2024. Survival outcomes were compared across biologic subtypes.</div></div><div><h3>Results</h3><div>Twenty-six cases of T4dM0 IBC were identified, with 57.7 % HER-2 positive, 26.9 % ER positive/HER-2 negative, and 15.4 % ER negative/HER-2 negative. The total pCR rate was highest in HER-2 positive (53.3 %) and lowest in ER-positive/HER-2 negative patients (p = 0.036). Among 19 patients with ≥3 years of follow-up, 47 % experienced recurrence (78 % distant and 22 % locoregional) and 42 % died of breast cancer. No significant differences in locoregional recurrence, or survival outcomes were found across subtypes.</div></div><div><h3>Conclusion</h3><div>pCR has limited prognostic value in IBC. Although HER-2 positive patients are more likely to achieve pCR, this does not necessarily translate into improved outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116288"},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621311","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 : 2025-03-05DOI: 10.1016/j.amjsurg.2025.116284
Jaclyn N Portelli Tremont, Erik H. Ander, Szu-In Lim, Jared R. Gallaher, Trista Reid
Introduction
Social determinants of health (SDoH) may mediate disparities, but their effect on outcomes after trauma is not well known. The purpose of this review is to improve existing gaps of knowledge for a broad range of SDoH and trauma-related outcomes.
Methods
This was a systematic search to identify studies that evaluated the effect of race, insurance status, socioeconomic status (SES), health literacy, and community deprivation on inpatient mortality, morbidity, and post-discharge health care utilization in diverse trauma populations ≥16 years. Data were extracted on study design, patient and injury characteristics, outcomes, and covariates. Qualitative analysis was performed and reported results were stratified by exposure. An overall assessment of the strength of evidence for key clinically relevant comparisons was conducted.
Results
60 studies were included. Overall, race was not meaningfully predictive of mortality or morbidity, with evidence reporting inconsistent or small magnitude of effects. However, African American/Black race was consistently associated with decreased odds of discharge to rehabilitation. Compared to insured patients, uninsured patients may have greater mortality risk and be less likely to discharge to rehabilitation. Studies evaluating health literacy or community deprivation reported conflicting results.
Conclusions
Disparities related to race are most profound for post-discharge health care utilization, while insurance status may be a strong negative predictor of both mortality and discharge disposition. More research is needed on health literacy and community deprivation to better understand mechanisms of disparity after trauma. Interventions targeted at improving continuity of inpatient and outpatient care may be beneficial.
{"title":"The effect of social determinants of health on patient outcomes in acute trauma: A systematic review","authors":"Jaclyn N Portelli Tremont, Erik H. Ander, Szu-In Lim, Jared R. Gallaher, Trista Reid","doi":"10.1016/j.amjsurg.2025.116284","DOIUrl":"10.1016/j.amjsurg.2025.116284","url":null,"abstract":"<div><h3>Introduction</h3><div>Social determinants of health (SDoH) may mediate disparities, but their effect on outcomes after trauma is not well known. The purpose of this review is to improve existing gaps of knowledge for a broad range of SDoH and trauma-related outcomes.</div></div><div><h3>Methods</h3><div>This was a systematic search to identify studies that evaluated the effect of race, insurance status, socioeconomic status (SES), health literacy, and community deprivation on inpatient mortality, morbidity, and post-discharge health care utilization in diverse trauma populations ≥16 years. Data were extracted on study design, patient and injury characteristics, outcomes, and covariates. Qualitative analysis was performed and reported results were stratified by exposure. An overall assessment of the strength of evidence for key clinically relevant comparisons was conducted.</div></div><div><h3>Results</h3><div>60 studies were included. Overall, race was not meaningfully predictive of mortality or morbidity, with evidence reporting inconsistent or small magnitude of effects. However, African American/Black race was consistently associated with decreased odds of discharge to rehabilitation. Compared to insured patients, uninsured patients may have greater mortality risk and be less likely to discharge to rehabilitation. Studies evaluating health literacy or community deprivation reported conflicting results.</div></div><div><h3>Conclusions</h3><div>Disparities related to race are most profound for post-discharge health care utilization, while insurance status may be a strong negative predictor of both mortality and discharge disposition. More research is needed on health literacy and community deprivation to better understand mechanisms of disparity after trauma. Interventions targeted at improving continuity of inpatient and outpatient care may be beneficial.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116284"},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609311","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 : 2025-03-04DOI: 10.1016/j.amjsurg.2025.116289
Talal Al-Assil , Claire Kalina , Madison C. Laird , Ryan C. Olivier , Nataly Dawood , Neya Suresh Kumar , Raven Riordan , Saad Shebrain , Cheryl Dickson , Gitonga Munene
Introduction
Cancer related mortality amongst the homeless and unhoused has been reported to be significantly higher than the housed population. This study explores cancer screening uptake and barriers in a homeless community in Michigan.
Methods
Questionnaires were administered at two homeless shelters focusing on Hepatitis C (HCV), lung, breast, colon, and cervical cancer screenings.
Results
Amongst 143 participants, rates of screening uptake were lowest for breast cancer (44 %), followed by colorectal cancer (45 %), HCV (55 %), and cervical cancer (79 %). The three most common barriers to receiving screenings were lack of transportation (21.8 %), lack of access to or awareness of screenings (20.5 %), and low prioritization of health compared to other insecurities faced while being homeless (17.9 %).
Conclusions
Enhancing the unhoused/homeless community's access to cancer screenings is crucial. High willingness to undergo screenings suggests potential targeted interventions, such as providing transportation tokens and comprehensive educational resources, onsite screenings, and potentially employing social work navigators at shelters.
{"title":"Sheltered yet unscreened: Exploring cancer screening rates and barriers in the unhoused (homeless) population","authors":"Talal Al-Assil , Claire Kalina , Madison C. Laird , Ryan C. Olivier , Nataly Dawood , Neya Suresh Kumar , Raven Riordan , Saad Shebrain , Cheryl Dickson , Gitonga Munene","doi":"10.1016/j.amjsurg.2025.116289","DOIUrl":"10.1016/j.amjsurg.2025.116289","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer related mortality amongst the homeless and unhoused has been reported to be significantly higher than the housed population. This study explores cancer screening uptake and barriers in a homeless community in Michigan.</div></div><div><h3>Methods</h3><div>Questionnaires were administered at two homeless shelters focusing on Hepatitis C (HCV), lung, breast, colon, and cervical cancer screenings.</div></div><div><h3>Results</h3><div>Amongst 143 participants, rates of screening uptake were lowest for breast cancer (44 %), followed by colorectal cancer (45 %), HCV (55 %), and cervical cancer (79 %). The three most common barriers to receiving screenings were lack of transportation (21.8 %), lack of access to or awareness of screenings (20.5 %), and low prioritization of health compared to other insecurities faced while being homeless (17.9 %).</div></div><div><h3>Conclusions</h3><div>Enhancing the unhoused/homeless community's access to cancer screenings is crucial. High willingness to undergo screenings suggests potential targeted interventions, such as providing transportation tokens and comprehensive educational resources, onsite screenings, and potentially employing social work navigators at shelters.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116289"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642280","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 : 2025-03-04DOI: 10.1016/j.amjsurg.2025.116287
Terra M. Hill , Lauren T. Kerivan , Milind Phadnis , Christopher A. Guidry , Robert D. Winfield
Background
Interpersonal firearm violence (IFV) has been connected to the structural racism of redlining. We explored the relationship between historic redlining and IFV with population-level factors.
Methods
A cross-sectional study of IFV within historically graded neighborhoods was performed, and incidence rate ratios (IRRs) between these neighborhoods and the rate of IFV were modeled with a Poisson regression model.
Results
Comparing redlined to non-redlined neighborhoods, the IRRs adjusted for income was 14.9 (p < 0.0001), adjusted for poverty was 14.4 (p < 0.0001), adjusted for uninsured was 15.6 (p < 0.0001), and adjusted for IFV-related mortality was 26.05 (p < 0.0001). After county adjustment, every one unit increase in logarithm of income decreases the IFV rate by 64.7 % (p < 0.0001), whereas every one percent increase of poverty and uninsured, increases the IFV rates by 4.1 % (p < 0.0001) and 3.05 % (p < 0.0002), respectively.
Conclusion
Historically redlined communities have higher rates of IFV in Kansas City, Kansas.
{"title":"From past to present: A comparison of interpersonal firearm violence between historically graded neighborhoods of Kansas City","authors":"Terra M. Hill , Lauren T. Kerivan , Milind Phadnis , Christopher A. Guidry , Robert D. Winfield","doi":"10.1016/j.amjsurg.2025.116287","DOIUrl":"10.1016/j.amjsurg.2025.116287","url":null,"abstract":"<div><h3>Background</h3><div>Interpersonal firearm violence (IFV) has been connected to the structural racism of redlining. We explored the relationship between historic redlining and IFV with population-level factors.</div></div><div><h3>Methods</h3><div>A cross-sectional study of IFV within historically graded neighborhoods was performed, and incidence rate ratios (IRRs) between these neighborhoods and the rate of IFV were modeled with a Poisson regression model.</div></div><div><h3>Results</h3><div>Comparing redlined to non-redlined neighborhoods, the IRRs adjusted for income was 14.9 (p < 0.0001), adjusted for poverty was 14.4 (p < 0.0001), adjusted for uninsured was 15.6 (p < 0.0001), and adjusted for IFV-related mortality was 26.05 (p < 0.0001). After county adjustment, every one unit increase in logarithm of income decreases the IFV rate by 64.7 % (p < 0.0001), whereas every one percent increase of poverty and uninsured, increases the IFV rates by 4.1 % (p < 0.0001) and 3.05 % (p < 0.0002), respectively.</div></div><div><h3>Conclusion</h3><div>Historically redlined communities have higher rates of IFV in Kansas City, Kansas.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116287"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143561742","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}
Pub Date : 2025-03-04DOI: 10.1016/j.amjsurg.2025.116286
Martin Heidinger , Gilles Bilfeld , Nico Föge , Julie M. Loesch , Nadia Maggi , Rama Kiblawi , Ruth S. Eller , Marie Louise Frevert , Fabienne D. Schwab , Christian Kurzeder , Tibor A. Zwimpfer , Walter P. Weber
Introduction
Oncoplastic breast surgery (OPS) with immediate symmetrization is commonly performed. However, its impact on patient-reported outcomes (PROs) remains uncertain.
Methods
Patients with stage 0-III breast cancer who underwent OPS (including oncoplastic breast conserving surgery, or nipple- or skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023 who completed a postoperative BREAST-Q questionnaire were identified from a prospectively maintained database. A generalized linear model was used to detect differences in PROs between those who underwent unilateral versus immediate symmetrizing surgery.
Results
Of 441 eligible patients, 333 (75.5 %) underwent unilateral OPS, while 108 (24.5 %) underwent bilateral OPS. Median time to PRO assessment was 35.1 months (Q1-Q3 13.4–49.5). No differences in PROs were identified between patients who underwent unilateral versus bilateral OPS. Short-term surgical morbidity was more common in patients who underwent symmetrizing surgery, which negatively impacted PROs.
Conclusion
The present study did not demonstrate any impact of immediate symmetrization on PROs.
{"title":"Association of immediate symmetrizing oncoplastic surgery with patient-reported outcomes in patients with breast cancer – A retrospective cohort study","authors":"Martin Heidinger , Gilles Bilfeld , Nico Föge , Julie M. Loesch , Nadia Maggi , Rama Kiblawi , Ruth S. Eller , Marie Louise Frevert , Fabienne D. Schwab , Christian Kurzeder , Tibor A. Zwimpfer , Walter P. Weber","doi":"10.1016/j.amjsurg.2025.116286","DOIUrl":"10.1016/j.amjsurg.2025.116286","url":null,"abstract":"<div><h3>Introduction</h3><div>Oncoplastic breast surgery (OPS) with immediate symmetrization is commonly performed. However, its impact on patient-reported outcomes (PROs) remains uncertain.</div></div><div><h3>Methods</h3><div>Patients with stage 0-III breast cancer who underwent OPS (including oncoplastic breast conserving surgery, or nipple- or skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023 who completed a postoperative BREAST-Q questionnaire were identified from a prospectively maintained database. A generalized linear model was used to detect differences in PROs between those who underwent unilateral versus immediate symmetrizing surgery.</div></div><div><h3>Results</h3><div>Of 441 eligible patients, 333 (75.5 %) underwent unilateral OPS, while 108 (24.5 %) underwent bilateral OPS. Median time to PRO assessment was 35.1 months (Q1-Q3 13.4–49.5). No differences in PROs were identified between patients who underwent unilateral versus bilateral OPS. Short-term surgical morbidity was more common in patients who underwent symmetrizing surgery, which negatively impacted PROs.</div></div><div><h3>Conclusion</h3><div>The present study did not demonstrate any impact of immediate symmetrization on PROs.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116286"},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577165","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}
Pub Date : 2025-02-28DOI: 10.1016/j.amjsurg.2025.116279
Niranjna Swaminathan, C Corbin Frye
{"title":"Parathyroid autotransplantation: Nonsense or nuance?","authors":"Niranjna Swaminathan, C Corbin Frye","doi":"10.1016/j.amjsurg.2025.116279","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116279","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116279"},"PeriodicalIF":2.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571897","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 : 2025-02-27DOI: 10.1016/j.amjsurg.2025.116280
Vaishnavi Krishnan , Stephanie M. Trautmann , Gwyneth A. Sullivan , Talib Chaudhry , Alison C. Coogan , Brian C. Gulack , Ami N. Shah
Background
Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are neighborhood-level measures of social determinants of health. This study compares individual-level Z codes with these neighborhood-level measures through spatial analysis and their associations with postoperative morbidity.
Methods
This retrospective cohort study included patients at an urban hospital between 2015 and 2021. Spatial autocorrelation was assessed using Global Moran's I. A multivariable logistic regression model assessed their association with 30-day postoperative morbidity.
Results
There was no spatial autocorrelation for Z codes (Moran's I: 0.001, p = .96), but there was for ADI (Moran's I:0.013, p < .001) and SVI (Moran's I:0.007, p < .001). Z codes were associated with 90 % increased odds of morbidity [CI:1.39–2.58]. For every one-point increase in ADI, odds of morbidity increased by 7 % [CI:1.04–1.11], but SVI was not associated.
Conclusions
Both individual- and neighborhood-level factors were associated with increased postoperative morbidity. However, Z codes demonstrate greater predictive value than neighborhood-level measures.
{"title":"Individual- versus neighborhood-level social determinants of health-related factors and their associations with postoperative morbidity","authors":"Vaishnavi Krishnan , Stephanie M. Trautmann , Gwyneth A. Sullivan , Talib Chaudhry , Alison C. Coogan , Brian C. Gulack , Ami N. Shah","doi":"10.1016/j.amjsurg.2025.116280","DOIUrl":"10.1016/j.amjsurg.2025.116280","url":null,"abstract":"<div><h3>Background</h3><div>Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are neighborhood-level measures of social determinants of health. This study compares individual-level Z codes with these neighborhood-level measures through spatial analysis and their associations with postoperative morbidity.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients at an urban hospital between 2015 and 2021. Spatial autocorrelation was assessed using Global Moran's I. A multivariable logistic regression model assessed their association with 30-day postoperative morbidity.</div></div><div><h3>Results</h3><div>There was no spatial autocorrelation for Z codes (Moran's I: 0.001, p = .96), but there was for ADI (Moran's I:0.013, p < .001) and SVI (Moran's I:0.007, p < .001). Z codes were associated with 90 % increased odds of morbidity [CI:1.39–2.58]. For every one-point increase in ADI, odds of morbidity increased by 7 % [CI:1.04–1.11], but SVI was not associated.</div></div><div><h3>Conclusions</h3><div>Both individual- and neighborhood-level factors were associated with increased postoperative morbidity. However, Z codes demonstrate greater predictive value than neighborhood-level measures.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116280"},"PeriodicalIF":2.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563477","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}
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