Pub Date : 2026-04-01Epub Date: 2026-01-17DOI: 10.1016/j.amjsurg.2026.116828
Stephanie Delos Santos , Marta Invernizzi , Cindy Liu , Xin Tong , Jodi Rosen , Lihong V. Wang , Lily L. Lai
Objective
Current breast imaging has limitations. Mammography uses radiation and compression; ultrasound depends on user expertise; MRI requires time and intravenous contrast. Development of novel technologies for breast imaging may be improved with patient surveys.
Methods
Breast cancer patients scheduled for breast operations or undergoing neoadjuvant therapy were enrolled in studies to evaluate photoacoustic computed tomography (PACT) at a single institution. After each imaging session, the patients were surveyed. The survey included Likert scale, multiple choice, and open-ended questions.
Results
Of 49 patients, 86 % completed at least one survey with 42 % completing three. Survey completion took <10 min. Features assessed specific to the imaging technology included water bath, duration, positioning, and environment. Patients overwhelmingly reported ease of PACT over mammography and MRI. Suggestions included better cushioning, improved head support, well-fitting laser safety glasses.
Conclusion
Photoacoustic breast imaging is feasible to breast cancer patients. User feedback informs on clinical technology improvement.
{"title":"Utilizing post-imaging surveys to guide development of photoacoustic computed technology for breast imaging","authors":"Stephanie Delos Santos , Marta Invernizzi , Cindy Liu , Xin Tong , Jodi Rosen , Lihong V. Wang , Lily L. Lai","doi":"10.1016/j.amjsurg.2026.116828","DOIUrl":"10.1016/j.amjsurg.2026.116828","url":null,"abstract":"<div><h3>Objective</h3><div>Current breast imaging has limitations. Mammography uses radiation and compression; ultrasound depends on user expertise; MRI requires time and intravenous contrast. Development of novel technologies for breast imaging may be improved with patient surveys.</div></div><div><h3>Methods</h3><div>Breast cancer patients scheduled for breast operations or undergoing neoadjuvant therapy were enrolled in studies to evaluate photoacoustic computed tomography (PACT) at a single institution. After each imaging session, the patients were surveyed. The survey included Likert scale, multiple choice, and open-ended questions.</div></div><div><h3>Results</h3><div>Of 49 patients, 86 % completed at least one survey with 42 % completing three. Survey completion took <10 min. Features assessed specific to the imaging technology included water bath, duration, positioning, and environment. Patients overwhelmingly reported ease of PACT over mammography and MRI. Suggestions included better cushioning, improved head support, well-fitting laser safety glasses.</div></div><div><h3>Conclusion</h3><div>Photoacoustic breast imaging is feasible to breast cancer patients. User feedback informs on clinical technology improvement.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116828"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036385","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 : 2026-04-01Epub Date: 2026-01-21DOI: 10.1016/j.amjsurg.2026.116842
Jasmine Zhang , Janice J. Wong , Terrance Peng , Yifan V. Mao , Elena G. Hughes , Anna M. Sawka , Masha J. Livhits , Michael W. Yeh , James X. Wu
Background
Chinese language speakers comprise a significant proportion of the United States patient population. This qualitative study seeks to characterize health beliefs among Chinese-speaking patients with thyroid disease to inform culturally competent care.
Methods
Thirteen Chinese-speaking patients (mean age 47; 12 female) participated in semi-structured interviews exploring beliefs about thyroid disease and its management.
Results
Participants reported limited knowledge of thyroid disease and desired more accessible education. Thyroid disease was viewed as minimally disruptive relative to other diseases or malignancies with family history, environmental exposures, and stress as contributors to development. Experiences with conventional thyroid treatment were marked by logistical and relational challenges. While modern medicine was seen as effective, some perceived it to be overly aggressive and believed Traditional Chinese Medicine (TCM) may have a valuable, complementary role in management.
Conclusions
Future research may seek to investigate the integration of TCM and conventional thyroid care to improve therapeutic relationships and health outcomes for Chinese-language patients.
{"title":"Chinese language patients’ perceptions on thyroid disease and treatment: A qualitative study","authors":"Jasmine Zhang , Janice J. Wong , Terrance Peng , Yifan V. Mao , Elena G. Hughes , Anna M. Sawka , Masha J. Livhits , Michael W. Yeh , James X. Wu","doi":"10.1016/j.amjsurg.2026.116842","DOIUrl":"10.1016/j.amjsurg.2026.116842","url":null,"abstract":"<div><h3>Background</h3><div>Chinese language speakers comprise a significant proportion of the United States patient population. This qualitative study seeks to characterize health beliefs among Chinese-speaking patients with thyroid disease to inform culturally competent care.</div></div><div><h3>Methods</h3><div>Thirteen Chinese-speaking patients (mean age 47; 12 female) participated in semi-structured interviews exploring beliefs about thyroid disease and its management.</div></div><div><h3>Results</h3><div>Participants reported limited knowledge of thyroid disease and desired more accessible education. Thyroid disease was viewed as minimally disruptive relative to other diseases or malignancies with family history, environmental exposures, and stress as contributors to development. Experiences with conventional thyroid treatment were marked by logistical and relational challenges. While modern medicine was seen as effective, some perceived it to be overly aggressive and believed Traditional Chinese Medicine (TCM) may have a valuable, complementary role in management.</div></div><div><h3>Conclusions</h3><div>Future research may seek to investigate the integration of TCM and conventional thyroid care to improve therapeutic relationships and health outcomes for Chinese-language patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116842"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074921","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 : 2026-04-01Epub Date: 2026-01-18DOI: 10.1016/j.amjsurg.2026.116824
Jaspinder Sanghera , Ioannis Liapis , Nritya Nair , Michelle Holland , Manish Tripathi , Larry Hearld , Krista Mehari , Smita Bhatia , Annabelle L. Fonseca
Purpose
Many patients with foregut cancers fail to receive guideline-concordant treatment. The perspectives of health system stakeholders who care for these patients, and their insights into feasible solutions, remain underexplored.
Methods
Using grounded theory methodology, 12 semi-structured interviews were conducted to identify multilevel barriers, and health system stakeholders proposed solutions to overcome these barriers.
Results
Participants described barriers across four levels. Individual-level barriers included financial toxicity, transportation challenges, and psychosocial distress. Provider-level barriers included inadequate physician-patient communication and insufficient inter-provider communication. Institutional barriers included delays in accessing specialty care, scheduling inefficiencies, and institutional resource limitations. Policy-level barriers included care fragmentation, inadequate sub-specialty care in rural areas, and inadequate reimbursement. Proposed solutions included strengthening institutional psychiatric support programs, increasing inter-provider engagement, streamlining referral pathways, targeted rural physician recruitment, and reimbursement reform.
Conclusion
Health system stakeholders proposed interventions emphasizing communication, navigation, and system-level integration that may improve the delivery of foregut cancer care in resource-constrained environments.
{"title":"Examining health system stakeholder-reported barriers and solutions to foregut cancer care","authors":"Jaspinder Sanghera , Ioannis Liapis , Nritya Nair , Michelle Holland , Manish Tripathi , Larry Hearld , Krista Mehari , Smita Bhatia , Annabelle L. Fonseca","doi":"10.1016/j.amjsurg.2026.116824","DOIUrl":"10.1016/j.amjsurg.2026.116824","url":null,"abstract":"<div><h3>Purpose</h3><div>Many patients with foregut cancers fail to receive guideline-concordant treatment. The perspectives of health system stakeholders who care for these patients, and their insights into feasible solutions, remain underexplored.</div></div><div><h3>Methods</h3><div>Using grounded theory methodology, 12 semi-structured interviews were conducted to identify multilevel barriers, and health system stakeholders proposed solutions to overcome these barriers.</div></div><div><h3>Results</h3><div>Participants described barriers across four levels. Individual-level barriers included financial toxicity, transportation challenges, and psychosocial distress. Provider-level barriers included inadequate physician-patient communication and insufficient inter-provider communication. Institutional barriers included delays in accessing specialty care, scheduling inefficiencies, and institutional resource limitations. Policy-level barriers included care fragmentation, inadequate sub-specialty care in rural areas, and inadequate reimbursement. Proposed solutions included strengthening institutional psychiatric support programs, increasing inter-provider engagement, streamlining referral pathways, targeted rural physician recruitment, and reimbursement reform.</div></div><div><h3>Conclusion</h3><div>Health system stakeholders proposed interventions emphasizing communication, navigation, and system-level integration that may improve the delivery of foregut cancer care in resource-constrained environments.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116824"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074920","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 : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.amjsurg.2026.116846
Arnav Mahajan
{"title":"One of the good ones","authors":"Arnav Mahajan","doi":"10.1016/j.amjsurg.2026.116846","DOIUrl":"10.1016/j.amjsurg.2026.116846","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116846"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074918","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 : 2026-04-01Epub Date: 2025-12-24DOI: 10.1016/j.amjsurg.2025.116798
David J. Boughanem , Sudeep Gorla , Melissa A. Kendall , Tyler Zander , Rachel L. Wolansky , Shamir Harry , Paul C. Kuo , Joseph Sujka
Background
This study characterizes temporal trends (1980–2020) of Surgery (SUR) research impact compared to Medicine (MED) and Biology (BIO) using Relative Citation Ratio (RCR), Field Citation Ratio (FCR), and Altmetric Attention Score. We hypothesize MED demonstrates significantly higher impact metrics than SUR.
Methods
The 1000 most cited papers in SUR, MED, and BIO were retrieved for each decade (1980–2020) using Web of Science. RCR was generated via iCite; FCR and Attention Score from Dimensions AI API. Keywords were classified using UMLS Semantic Network subjects with MetaMap and entropy metrics assessed topic diversity.
Results
All metrics increased significantly in MED and BIO, while SUR RCR and FCR remained unchanged from 1980 to 1989. MED demonstrated greater collaboration and funding proportions than SUR. Entropy analysis revealed MED and BIO diversified research topics over time, while SUR concentrated in specialized areas.
Conclusions
SUR research shows declining broad relevance with concentrated influence compared to MED and BIO.
{"title":"Distinct paths of impact: A bibliometric analysis of research trends in surgery, medicine, and biology (1980–2020)","authors":"David J. Boughanem , Sudeep Gorla , Melissa A. Kendall , Tyler Zander , Rachel L. Wolansky , Shamir Harry , Paul C. Kuo , Joseph Sujka","doi":"10.1016/j.amjsurg.2025.116798","DOIUrl":"10.1016/j.amjsurg.2025.116798","url":null,"abstract":"<div><h3>Background</h3><div>This study characterizes temporal trends (1980–2020) of Surgery (SUR) research impact compared to Medicine (MED) and Biology (BIO) using Relative Citation Ratio (RCR), Field Citation Ratio (FCR), and Altmetric Attention Score. We hypothesize MED demonstrates significantly higher impact metrics than SUR.</div></div><div><h3>Methods</h3><div>The 1000 most cited papers in SUR, MED, and BIO were retrieved for each decade (1980–2020) using Web of Science. RCR was generated via iCite; FCR and Attention Score from Dimensions AI API. Keywords were classified using UMLS Semantic Network subjects with MetaMap and entropy metrics assessed topic diversity.</div></div><div><h3>Results</h3><div>All metrics increased significantly in MED and BIO, while SUR RCR and FCR remained unchanged from 1980 to 1989. MED demonstrated greater collaboration and funding proportions than SUR. Entropy analysis revealed MED and BIO diversified research topics over time, while SUR concentrated in specialized areas.</div></div><div><h3>Conclusions</h3><div>SUR research shows declining broad relevance with concentrated influence compared to MED and BIO.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116798"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074919","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 : 2026-04-01Epub Date: 2026-01-27DOI: 10.1016/j.amjsurg.2026.116850
Negar Nekooei , Angela Tang-Tan , Anaar E. Siletz , Kazuhide Matsushima , Kenji Inaba , Joseph J. Dubose , Matthew J. Martin
Purpose
Systemic anticoagulation (SAC) is standard in elective arterial repairs but controversial in trauma due to bleeding risks, with unclear benefits in this population. This is the first study to investigate SAC's impact on cervical artery repairs.
Methods
Using the PROOVIT database (2012–2023), we included all cervical arterial injuries (common carotid, internal/external carotid, or vertebral) who underwent surgical or endovascular repair, categorized by intraoperative SAC use. Primary outcomes included in-hospital complications; secondary outcomes were re-intervention, stroke, 24-h packed red blood cell (pRBC) transfusions, and length of stay (LOS).
Results
One hundred forty patients met inclusion criteria. Median age was 34, and 79 % were male. 67.1 % sustained penetrating trauma, and 77 % had moderate to severe head trauma. SAC was used in 41 (29.3 %) patients. SAC use was more common in patients with higher Glasgow Coma Scale (GCS) scores and those undergoing primary surgical repair. Univariate analysis showed similar complication, re-intervention, and stroke rates. Multivariate analysis (adjusted for age, sex, mechanism, ISS, SBP <90, and GCS, see Figure) revealed SAC was associated with higher re-intervention rates (aOR = 3.9, 95 % CI: 1–13, p = 0.03) but not with overall complications (aOR = 2.4, p = 0.07), stroke (aOR = 1.6, p = 0.35), 24-h PRBC transfusions (B = −2.6, p = 0.27), or LOS (B = −4.5, p = 0.40).
Conclusion
SAC during cervical arterial repair was associated with increased re-intervention rates without impacting complications, stroke, or LOS. Further research is needed to clarify its risk-benefit balance in trauma care.
目的：系统性抗凝（SAC）是选择性动脉修复的标准，但由于出血风险，在创伤中存在争议，在这一人群中的益处尚不清楚。这是第一次研究SAC对颈动脉修复的影响。方法使用provit数据库（2012-2023），我们纳入了所有接受手术或血管内修复的颈动脉损伤（颈总动脉、颈内/颈外动脉或椎动脉），并按术中SAC的使用进行分类。主要结局包括院内并发症；次要结局是再干预、卒中、24小时红细胞（pRBC）输注和住院时间（LOS）。结果140例患者符合纳入标准。中位年龄为34岁，79%为男性。67.1%为穿透性外伤，77%为中度至重度颅脑外伤。41例（29.3%）患者使用SAC。在格拉斯哥昏迷评分（GCS）评分较高的患者和接受初级手术修复的患者中，SAC的使用更为常见。单因素分析显示相似的并发症、再干预和卒中发生率。多因素分析（调整了年龄、性别、机制、ISS、SBP <；90和GCS，见图）显示SAC与较高的再干预率相关（aOR = 3.9, 95% CI: 1-13, p = 0.03），但与总体并发症（aOR = 2.4, p = 0.07）、卒中（aOR = 1.6, p = 0.35）、24小时PRBC输注（B = - 2.6, p = 0.27）或LOS （B = - 4.5, p = 0.40）无关。结论颈动脉修复期间sac与再干预率增加相关，且不影响并发症、卒中或LOS。需要进一步的研究来阐明其在创伤护理中的风险-收益平衡。
{"title":"Impact of systemic anticoagulation on traumatic cervical arterial repairs: An analysis of the PROspective Observational Vascular Injury Trial (PROOVIT) registry","authors":"Negar Nekooei , Angela Tang-Tan , Anaar E. Siletz , Kazuhide Matsushima , Kenji Inaba , Joseph J. Dubose , Matthew J. Martin","doi":"10.1016/j.amjsurg.2026.116850","DOIUrl":"10.1016/j.amjsurg.2026.116850","url":null,"abstract":"<div><h3>Purpose</h3><div>Systemic anticoagulation (SAC) is standard in elective arterial repairs but controversial in trauma due to bleeding risks, with unclear benefits in this population. This is the first study to investigate SAC's impact on cervical artery repairs.</div></div><div><h3>Methods</h3><div>Using the PROOVIT database (2012–2023), we included all cervical arterial injuries (common carotid, internal/external carotid, or vertebral) who underwent surgical or endovascular repair, categorized by intraoperative SAC use. Primary outcomes included in-hospital complications; secondary outcomes were re-intervention, stroke, 24-h packed red blood cell (pRBC) transfusions, and length of stay (LOS).</div></div><div><h3>Results</h3><div>One hundred forty patients met inclusion criteria. Median age was 34, and 79 % were male. 67.1 % sustained penetrating trauma, and 77 % had moderate to severe head trauma. SAC was used in 41 (29.3 %) patients. SAC use was more common in patients with higher Glasgow Coma Scale (GCS) scores and those undergoing primary surgical repair. Univariate analysis showed similar complication, re-intervention, and stroke rates. Multivariate analysis (adjusted for age, sex, mechanism, ISS, SBP <90, and GCS, see Figure) revealed SAC was associated with higher re-intervention rates (aOR = 3.9, 95 % CI: 1–13, p = 0.03) but not with overall complications (aOR = 2.4, p = 0.07), stroke (aOR = 1.6, p = 0.35), 24-h PRBC transfusions (B = −2.6, p = 0.27), or LOS (B = −4.5, p = 0.40).</div></div><div><h3>Conclusion</h3><div>SAC during cervical arterial repair was associated with increased re-intervention rates without impacting complications, stroke, or LOS. Further research is needed to clarify its risk-benefit balance in trauma care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116850"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074931","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 : 2026-04-01Epub Date: 2026-01-13DOI: 10.1016/j.amjsurg.2026.116825
Almunthir Alyahya , Yousef Albegamy , Mansour Ahmed Albalawi , Ali Elkarouri , Shroog Alanazi , Lamis Alshehri , Rakan Almokhlef , Jenan Fayez Almutairi , Abdulaziz Alqarni , Najd Alanazi , Abdullah Altamimi , Laksh Kumar , Adarsh Raja
Background
Surgery remains a major contributor to healthcare costs and mortality from perioperative complications, yet long term national mortality trends are poorly defined.
Methods
A population based analysis of U.S. mortality data (1999–2024) was conducted using the CDC WONDER database. High risk surgical deaths were identified by ICD-10 code Y83. Age adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression estimated annual percentage changes (APCs).
Results
Among 470,098 deaths, men comprised 54.7 %, with 76.0 % occurring in medical facilities. National AAMR declined from 8.1 (1999) to 3.4 (2015), rose to 7.9 (2021), then fell to 3.2 (2024). Mortality was highest among men, non Hispanic Black and American Indian/Alaska Native groups, and in non-metropolitan areas; Marked state level variation was observed, with the highest AAMRs in Mississippi, New Mexico, Wyoming, North Dakota, and West Virginia.
Conclusions
U.S. surgical mortality showed a three phase pattern of decline, rise, and reduction, with persistent demographic and state/regional disparities requiring targeted policy action.
{"title":"Trends in mortality from High-Risk surgical procedures: National burden of Transplants, Implants, and Organ removal from 1999 to 2024 in United States","authors":"Almunthir Alyahya , Yousef Albegamy , Mansour Ahmed Albalawi , Ali Elkarouri , Shroog Alanazi , Lamis Alshehri , Rakan Almokhlef , Jenan Fayez Almutairi , Abdulaziz Alqarni , Najd Alanazi , Abdullah Altamimi , Laksh Kumar , Adarsh Raja","doi":"10.1016/j.amjsurg.2026.116825","DOIUrl":"10.1016/j.amjsurg.2026.116825","url":null,"abstract":"<div><h3>Background</h3><div>Surgery remains a major contributor to healthcare costs and mortality from perioperative complications, yet long term national mortality trends are poorly defined.</div></div><div><h3>Methods</h3><div>A population based analysis of U.S. mortality data (1999–2024) was conducted using the CDC WONDER database. High risk surgical deaths were identified by ICD-10 code Y83. Age adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression estimated annual percentage changes (APCs).</div></div><div><h3>Results</h3><div>Among 470,098 deaths, men comprised 54.7 %, with 76.0 % occurring in medical facilities. National AAMR declined from 8.1 (1999) to 3.4 (2015), rose to 7.9 (2021), then fell to 3.2 (2024). Mortality was highest among men, non Hispanic Black and American Indian/Alaska Native groups, and in non-metropolitan areas; Marked state level variation was observed, with the highest AAMRs in Mississippi, New Mexico, Wyoming, North Dakota, and West Virginia.</div></div><div><h3>Conclusions</h3><div>U.S. surgical mortality showed a three phase pattern of decline, rise, and reduction, with persistent demographic and state/regional disparities requiring targeted policy action.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116825"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986689","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 : 2026-04-01Epub Date: 2026-01-13DOI: 10.1016/j.amjsurg.2026.116823
Arkadii Sipok , Sophia Dort , Saima Shafique , Jonathan M. Dort
Background
Opioids are often prescribed after outpatient inguinal hernia repair despite limited evidence of benefit and well-documented risks. We evaluated their impact on complications and patient-reported outcomes.
Methods
This prospective observational study enrolled adults undergoing outpatient inguinal hernia repair (June 2022–October 2024) at a single institution. Pain, satisfaction, hernia-related quality of life (HerQLes), and early (≤1 week) and late (12 weeks) complications were assessed. Opioid use was quantified in morphine milligram equivalents. Logistic regression adjusted for age and comorbidity estimated complication risk.
Results
Among 110 patients, 16 (14.5 %) used opioids. Opioid use was associated with higher early (50 % vs 43.6 %) and late (43.8 % vs 40 %) complications (AOR 1.12, p = .018), with no improvement in pain, medication satisfaction, or quality of life over time.
Conclusions
Even after low-risk surgery, opioids may add harm without benefit. Opioid-sparing regimens should be prioritized for outpatient inguinal hernia repair.
背景：阿片类药物经常在门诊腹股沟疝修补后开处方，尽管有有限的证据表明其有益且有充分的风险。我们评估了它们对并发症和患者报告结果的影响。方法：这项前瞻性观察性研究招募了在单一机构接受门诊腹股沟疝修补术的成年人（2022年6月至2024年10月）。评估疼痛、满意度、疝相关生活质量（HerQLes）以及早期（≤1周）和晚期（12周）并发症。阿片类药物的使用以吗啡毫克当量量化。经年龄和合并症调整后的Logistic回归估计了并发症的风险。结果：110例患者中有16例（14.5%）使用阿片类药物。阿片类药物的使用与较高的早期（50%对43.6%）和晚期（43.8%对40%）并发症相关（AOR 1.12, p = 0.018），随着时间的推移，疼痛、药物满意度或生活质量没有改善。结论：即使在低风险手术后，阿片类药物也可能增加伤害而没有益处。保留阿片类药物的方案应优先用于门诊腹股沟疝修补。
{"title":"Opioids add risk without improving outcomes after outpatient inguinal hernia surgery: A prospective cohort study","authors":"Arkadii Sipok , Sophia Dort , Saima Shafique , Jonathan M. Dort","doi":"10.1016/j.amjsurg.2026.116823","DOIUrl":"10.1016/j.amjsurg.2026.116823","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are often prescribed after outpatient inguinal hernia repair despite limited evidence of benefit and well-documented risks. We evaluated their impact on complications and patient-reported outcomes.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled adults undergoing outpatient inguinal hernia repair (June 2022–October 2024) at a single institution. Pain, satisfaction, hernia-related quality of life (HerQLes), and early (≤1 week) and late (12 weeks) complications were assessed. Opioid use was quantified in morphine milligram equivalents. Logistic regression adjusted for age and comorbidity estimated complication risk.</div></div><div><h3>Results</h3><div>Among 110 patients, 16 (14.5 %) used opioids. Opioid use was associated with higher early (50 % vs 43.6 %) and late (43.8 % vs 40 %) complications (AOR 1.12, p = .018), with no improvement in pain, medication satisfaction, or quality of life over time.</div></div><div><h3>Conclusions</h3><div>Even after low-risk surgery, opioids may add harm without benefit. Opioid-sparing regimens should be prioritized for outpatient inguinal hernia repair.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"254 ","pages":"Article 116823"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146027820","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 : 2026-03-19DOI: 10.1016/j.amjsurg.2026.116924
Anna Maria Rogalska, Micaela Cuneo, Christopher Goei, Ashley Flinn Patterson, Jason Rall, Stephanie S Combs, Theodore G Hart, Marlin Wayne Causey
Introduction: We sought to determine the feasibility of REBOA placement under intravascular ultrasound (IVUS) guidance and to determine flow dynamics while undergoing aortic occlusion of non-compressible torso hemorrhage (NCTH) secondary to aortic branch vessel injury.
Methods: Ten Sus scrofa swine underwent laparotomy to create an artificial arteriovenous shunt between a mesenteric vessel and the IVC to simulate ongoing hemorrhage with auto-resuscitation. An IVUS catheter was advanced to the level of injury. A full- or partial-REBOA was then deployed proximally under IVUS guidance. Continuous hemodynamic data were collected.
Results: All devices were placed successfully using IVUS. Comparing full- and partial-REBOA, femoral pressures were decreased (34% vs. 95%), and carotid pressures were increased (276% vs. 144%). Shunt flow was 26% of baseline for full-REBOA and 75% for partial-REBOA.
Conclusion: Endovascular localization and treatment of hemorrhage has potential to advance combat casualty care through delivery of interventional approaches in a mobile technique with IVUS.
{"title":"Non-compressible torso hemorrhage control with intravascular ultrasound guided resuscitative endovascular balloon occlusion.","authors":"Anna Maria Rogalska, Micaela Cuneo, Christopher Goei, Ashley Flinn Patterson, Jason Rall, Stephanie S Combs, Theodore G Hart, Marlin Wayne Causey","doi":"10.1016/j.amjsurg.2026.116924","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.116924","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to determine the feasibility of REBOA placement under intravascular ultrasound (IVUS) guidance and to determine flow dynamics while undergoing aortic occlusion of non-compressible torso hemorrhage (NCTH) secondary to aortic branch vessel injury.</p><p><strong>Methods: </strong>Ten Sus scrofa swine underwent laparotomy to create an artificial arteriovenous shunt between a mesenteric vessel and the IVC to simulate ongoing hemorrhage with auto-resuscitation. An IVUS catheter was advanced to the level of injury. A full- or partial-REBOA was then deployed proximally under IVUS guidance. Continuous hemodynamic data were collected.</p><p><strong>Results: </strong>All devices were placed successfully using IVUS. Comparing full- and partial-REBOA, femoral pressures were decreased (34% vs. 95%), and carotid pressures were increased (276% vs. 144%). Shunt flow was 26% of baseline for full-REBOA and 75% for partial-REBOA.</p><p><strong>Conclusion: </strong>Endovascular localization and treatment of hemorrhage has potential to advance combat casualty care through delivery of interventional approaches in a mobile technique with IVUS.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"257 ","pages":"116924"},"PeriodicalIF":2.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497521","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 : 2026-03-17DOI: 10.1016/j.amjsurg.2026.116940
Christian Mouawad, Michael Osseis, Marc Pocard
The Peritoneal Cancer Index (PCI) is widely used to quantify disease extent and guide therapeutic decisions for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) across multiple primary tumors. While PCI is a validated prognostic indicator, the use of a single total surgical PCI threshold as a determinant of eligibility for CRS-HIPEC presents significant conceptual and practical limitations. Surgical PCI calculation is subject to inter-surgeon variability, particularly at anatomical region boundaries, where lesion allocation may alter the total score sufficiently to influence treatment decisions. In addition, surgical PCI frequently overestimates disease extent compared with pathological PCI, while laparoscopic assessment may underestimate peritoneal involvement. Increasing evidence indicates that the anatomical distribution of peritoneal metastases, particularly involvement of critical regions such as the hepatoduodenal ligament, small bowel, and mesentery, is more predictive of resectability, morbidity, and oncologic outcome than aggregate PCI alone. Furthermore, the prognostic significance of PCI varies according to primary tumor biology, challenging the applicability of universal threshold values. These considerations suggest that total PCI should not be used in isolation to contraindicate CRS-HIPEC. Decision-making frameworks should instead emphasize regional disease distribution, technical resectability, and tumor-specific behavior to optimize patient selection.
{"title":"Beyond total PCI thresholds: Limitations of the surgical peritoneal cancer index in decision-making for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.","authors":"Christian Mouawad, Michael Osseis, Marc Pocard","doi":"10.1016/j.amjsurg.2026.116940","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2026.116940","url":null,"abstract":"<p><p>The Peritoneal Cancer Index (PCI) is widely used to quantify disease extent and guide therapeutic decisions for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) across multiple primary tumors. While PCI is a validated prognostic indicator, the use of a single total surgical PCI threshold as a determinant of eligibility for CRS-HIPEC presents significant conceptual and practical limitations. Surgical PCI calculation is subject to inter-surgeon variability, particularly at anatomical region boundaries, where lesion allocation may alter the total score sufficiently to influence treatment decisions. In addition, surgical PCI frequently overestimates disease extent compared with pathological PCI, while laparoscopic assessment may underestimate peritoneal involvement. Increasing evidence indicates that the anatomical distribution of peritoneal metastases, particularly involvement of critical regions such as the hepatoduodenal ligament, small bowel, and mesentery, is more predictive of resectability, morbidity, and oncologic outcome than aggregate PCI alone. Furthermore, the prognostic significance of PCI varies according to primary tumor biology, challenging the applicability of universal threshold values. These considerations suggest that total PCI should not be used in isolation to contraindicate CRS-HIPEC. Decision-making frameworks should instead emphasize regional disease distribution, technical resectability, and tumor-specific behavior to optimize patient selection.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"257 ","pages":"116940"},"PeriodicalIF":2.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497486","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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