American journal of surgery最新文献

Background: This study examines the combined impact of margin status and adjuvant therapy utilization on overall survival (OS) for adrenocortical carcinoma (ACC) patients undergoing surgery with curative intent.

Methods: The 2004-2020 National Cancer Database (NCDB) was queried for ACC patients ≥18yrs undergoing curative surgery (no debulking), subdivided into R0 and R1/R2-groups, and analyzed using inverse-probability-weighted Cox Proportional Hazard-model.

Results: Of 5023 ACC patients, 3193 underwent curative surgery, 2213 (69 ​%) had R0 margins. Compared to the R0, the R1/R2 group had a decreased OS by 15.6 months (HR ​= ​1.89, p ​= ​0.002). While there has been no significant improvement in margin status over the years studied (2008-2017), there has been an overall increase in the proportion of patients receiving adjuvant therapy regardless of margin status, and the adverse impact of a positive margin on survival has decreased [HR 2.20 vs 1.76] CONCLUSIONS: R1/R2 margins are associated with decreased OS. The adverse impact of R1/R2 margins on OS decreased over time while adjuvant therapy utilization increased for all patients.

Background: H-index is an indicator of research productivity considered in faculty promotion. We examine trends in female authorship and effect of student authorship on H-index of principal investigators (PI).

Methods: Author gender, degree, designation as student, PI, or other, were recorded from Journal of Endourology from 2011 to 2020. PI Scopus H-index was recorded. PIs were classified into having student authors (SA) or not (nSA). Analysis conducted with IBM SPSS.

Results: Of 819 total articles, 26 ​% had SA. Articles with SAs increased from 22.2 ​% in 2011 to 31.1 ​% in 2020 (p for trend<0.01). There was an increasing trend in female authorship overall (R² ​= ​0.84). PIs with SA had a significantly higher mean H-index than those without, across all years (SA ​= ​30.91, nSA ​= ​27.45, p ​= ​0.025).

Conclusions: Student authorship is increasing and positively benefits PI H-index. Female authorship is increasing overall within urology. Encouraging mentorship and student research can enhance and support female student interest in urology.

Introduction: Surgical simulation and video-based learning are limited in lower-resource settings. We sought to develop and assess a series of surgical tutorials using a low-cost simulator.

Methods: We created 8 surgical skills and procedures videos using low-cost equipment. We assessed video quality using the DISCERN scale and the Global Quality Scale (GQS).

Results: Videos ranged from surgical techniques to complex procedures. We uploaded these to Youtube and included them in the curriculum of a medical school in Rwanda. Excluding the cost of the kit (25 USD), production costs ranged from 2 to 5 USD. All videos scored a mean DISCERN of 2.44 ​± ​1.05 and GQS of 3.06 ​± ​0.90. Generally, these lacked points on providing additional sources of information and addressing areas of uncertainty.

Conclusions: This study addresses the demand for accessible surgical education resources. Using low-cost, standardized materials ensures consistency, democratization of training, and feasibility.

Background: The benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy.

Method: This is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016-2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)-primary outcome, and length-of-stay (LOS)-secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses.

Results: Of 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91-3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51-10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05).

Conclusion: Drain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR.

Background: The Gender Equity Initiative in Global Surgery organization launched a mentorship program to address the limited opportunities available in low-and-middle-income countries (LMICs). We aimed to evaluate the utility of the virtual program in bridging this critical gap.

Methods: A retrospective review of program surveys containing quantitative and qualitative questions from 2022 to 2023 was performed.

Results: Of n ​= ​193 applicants, 81.3 ​% (157/193) identified as women, and 69.4 ​% (134/193) reported no prior mentorship. Applicants were from 41 countries (35 LMICs). The most requested specialties were general surgery (27.9 ​%, 54/193), neurosurgery (18.1 ​%, 35/193), and cardiothoracic surgery (11.4 ​%, 22/193). 55.9 ​% (108/193) preferred mentors from other countries (United States, United Kingdom, Canada), while 13.9 ​% (27/193) preferred mentors from their country. Ultimately, 48 applicants were matched with 13 mentors.

Conclusions: Demand for the program surpassed capacity, highlighting a need for mentorship opportunities for women overall, particularly in LMICs.

Introduction: Racial disparities in surgical outcomes are well described, but a paucity of literature exists examining trends in outcomes of thyroid cancer. We performed a systematic review of studies on thyroid cancer outcomes to better delineate the impact of race.

Methods: A comprehensive search strategy was performed in several academic databases for articles on thyroid cancer and surgical outcomes in accordance with PRISMA guidelines. A total of 1771 abstracts were reviewed. Abstracts were screened by two independent reviewers with disagreements resolved by a third. Studies that were based in the United States, included single center, unique data, focused on outcomes of differentiated thyroid cancer, were performed on adults >18 years old, and reported race in their results were included. Chi square statistics with Yates correction were calculated on the compiled data. The protocol was registered on PROSPERO (CRD42022300021).

Results: Twelve studies met inclusion criteria with data on 7,221patients. Among the included studies, our study consists of 67 ​% White patients, 22 ​% Black patients, 7 ​% Hispanic patients, and 3 ​% Asian patients. Extrathyroidal extension was observed in 8.4 ​% (n ​= ​13) of White patients. In comparison to White patients, Black (18.4 ​%, n ​= ​21, p ​= ​0.024) and Hispanic patients (28.3 ​%, n ​= ​30, p ​< ​0.001) had a higher incidence of extrathyroidal extension, while a similar incidence was observed in Asian patients (14.0 ​%, n ​= ​8, p ​= ​0.336). Compared to White patients (22.2 ​%, n ​= ​34), Black (12.4 ​%, n ​= ​13, p ​= ​0.065), Hispanic (16.0 ​%, n ​= ​15, p ​= ​0.301), and Asian (18.4 ​%, n ​= ​9, p ​= ​0.709) patients had a similar incidence of T1a stage. White patients had 10.1 ​% (n ​= ​54) recurrence rates, and Black (13.5 ​%, n ​= ​7, p ​= ​0.595), Hispanic (10.5 ​%, n ​= ​2, p ​= ​1.000), and Asian (11.1 ​%, n ​= ​3, p ​= ​1.000) patients had similar recurrence rates.

Conclusions: Race is seldom reported in outcomes on studies of thyroid cancer. From our analysis we conclude that non-White patients may have a higher risk of more advanced local disease at presentation. More data with granular detail on race is necessary to better understand racial disparities in thyroid cancer outcomes and how to alleviate them.