Pub Date : 2025-12-26DOI: 10.1016/j.amjsurg.2025.116811
Tamara Kabbani, Anthony N Eze, Jacob A Greenberg, Lisa McElroy
{"title":"The case for structural reform in medical student research access.","authors":"Tamara Kabbani, Anthony N Eze, Jacob A Greenberg, Lisa McElroy","doi":"10.1016/j.amjsurg.2025.116811","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116811","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116811"},"PeriodicalIF":2.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888837","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}
We sought to investigate racial/ethnic disparities in opioid prescribing patterns among patients undergoing gastrointestinal (GI) cancer surgery.
Methods
Patients who underwent surgery for GI cancer (2016–2023) were identified using the EPIC Cosmos database. Multivariate analyses were conducted to assess differences in opioid prescription patterns postoperatively.
Results
168,220 individuals underwent GI cancer surgery (esophagus: 2.5 %; stomach: 4.1 %, pancreas: 9.7 %; hepatobiliary: 6.4 %; colorectal: 77.3 %); 52.9 % were male, 86.0 % were White with median age of 72 years (IQR: 62–80). Black patients were younger (68 years [IQR: 60–76] vs. 72 years [IQR: 63–81]) and had a lower Charlson Comorbidity Index score (>2) (66.2 % vs. 68.5 %) compared with White patients (both p < 0.001). On multivariable analysis, Black patients had similar odds of receiving opioids as White patients (OR: 1.01, 95 % CI: 0.95–1.08).
Conclusion
No race-based differences were noted in the use of opioid prescriptions, duration of prescriptions, or mode of opioid administration following GI surgery.
{"title":"Investigating racial/ethnic disparities in opioid use among patients undergoing gastrointestinal cancer surgery","authors":"Shahzaib Zindani , Zayed Rashid , Selamawit Woldesenbet , Mujtaba Khalil , Timothy M. Pawlik","doi":"10.1016/j.amjsurg.2025.116799","DOIUrl":"10.1016/j.amjsurg.2025.116799","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to investigate racial/ethnic disparities in opioid prescribing patterns among patients undergoing gastrointestinal (GI) cancer surgery.</div></div><div><h3>Methods</h3><div>Patients who underwent surgery for GI cancer (2016–2023) were identified using the EPIC Cosmos database. Multivariate analyses were conducted to assess differences in opioid prescription patterns postoperatively.</div></div><div><h3>Results</h3><div>168,220 individuals underwent GI cancer surgery (esophagus: 2.5 %; stomach: 4.1 %, pancreas: 9.7 %; hepatobiliary: 6.4 %; colorectal: 77.3 %); 52.9 % were male, 86.0 % were White with median age of 72 years (IQR: 62–80). Black patients were younger (68 years [IQR: 60–76] vs. 72 years [IQR: 63–81]) and had a lower Charlson Comorbidity Index score (>2) (66.2 % vs. 68.5 %) compared with White patients (both p < 0.001). On multivariable analysis, Black patients had similar odds of receiving opioids as White patients (OR: 1.01, 95 % CI: 0.95–1.08).</div></div><div><h3>Conclusion</h3><div>No race-based differences were noted in the use of opioid prescriptions, duration of prescriptions, or mode of opioid administration following GI surgery.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116799"},"PeriodicalIF":2.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916607","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 : 2025-12-24DOI: 10.1016/j.amjsurg.2025.116797
Nicholas Stevens, Raisa Gao-Gibbons, Clayton Wyland, Kayla Flewelling, Theresa McGoff, Austin Brubaker, Laurence E. McCahill
Introduction
For perforated sigmoid diverticulitis, the “gold standard” has traditionally been the Hartmann's Procedure (HP). The LADIES trial published in 2019 suggested that primary anastomosis (PA) is safe. Our study aims to evaluate whether the LADIES trial has influenced the surgical management of perforated diverticulitis at our institution.
Methods
Retrospective cohort study of patients undergoing urgent or emergent colectomy for perforated diverticulitis, divided into Group 1 (2013–2019) and Group 2 (post LADIES Trial, 2020–2024). Inclusion criteria was similar to the LADIES trial and included patients 85 years or younger, not immunocompromised, and without preoperative vasopressor requirements.
Results
There were 88 patients total, 41 patients in Group 1 and 47 in Group 2. No significant difference was noted in procedure performed, though there was an upwards trend for performing PA (19.5 % vs 36.2 %, p = 0.084) and creation of protective ileostomy (7.3 % vs 19.2 %, p = 0.129) in Group2.
Conclusion
After publication in 2019, our institution demonstrated limited adoption of the LADIES trial for surgical management of perforated diverticulitis. Further study is required to better delineate surgeon continued reluctance for PA in this setting.
对于乙状结肠穿孔性憩室炎，传统的“金标准”是哈特曼手术（HP）。2019年发表的LADIES试验表明，初级吻合（PA）是安全的。我们的研究旨在评估LADIES试验是否影响了我们机构穿孔性憩室炎的手术治疗。方法回顾性队列研究，对穿孔性憩室炎患者进行紧急或急诊结肠切除术，分为1组（2013-2019）和2组（LADIES试验后，2020-2024）。纳入标准与LADIES试验相似，纳入年龄在85岁或以下、无免疫功能低下、术前无血管加压药物需求的患者。结果共88例患者，其中1组41例，2组47例。虽然在第二组中进行PA （19.5% vs 36.2%, p = 0.084）和建立保护性回肠造口（7.3% vs 19.2%, p = 0.129）的比例呈上升趋势，但所执行的手术没有显著差异。在2019年发表后，我们的机构证明了在穿孔性憩室炎的手术治疗中有限地采用了LADIES试验。需要进一步的研究来更好地描述外科医生在这种情况下对PA的持续不情愿。
{"title":"Current urgent and emergent management of acute sigmoid diverticulitis … has the LADIES trial impacted change in surgical management at a single institution?","authors":"Nicholas Stevens, Raisa Gao-Gibbons, Clayton Wyland, Kayla Flewelling, Theresa McGoff, Austin Brubaker, Laurence E. McCahill","doi":"10.1016/j.amjsurg.2025.116797","DOIUrl":"10.1016/j.amjsurg.2025.116797","url":null,"abstract":"<div><h3>Introduction</h3><div>For perforated sigmoid diverticulitis, the “gold standard” has traditionally been the Hartmann's Procedure (HP). The LADIES trial published in 2019 suggested that primary anastomosis (PA) is safe. Our study aims to evaluate whether the LADIES trial has influenced the surgical management of perforated diverticulitis at our institution.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients undergoing urgent or emergent colectomy for perforated diverticulitis, divided into Group 1 (2013–2019) and Group 2 (post LADIES Trial, 2020–2024). Inclusion criteria was similar to the LADIES trial and included patients 85 years or younger, not immunocompromised, and without preoperative vasopressor requirements.</div></div><div><h3>Results</h3><div>There were 88 patients total, 41 patients in Group 1 and 47 in Group 2. No significant difference was noted in procedure performed, though there was an upwards trend for performing PA (19.5 % vs 36.2 %, p = 0.084) and creation of protective ileostomy (7.3 % vs 19.2 %, p = 0.129) in Group2.</div></div><div><h3>Conclusion</h3><div>After publication in 2019, our institution demonstrated limited adoption of the LADIES trial for surgical management of perforated diverticulitis. Further study is required to better delineate surgeon continued reluctance for PA in this setting.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116797"},"PeriodicalIF":2.7,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882038","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 : 2025-12-24DOI: 10.1016/j.amjsurg.2025.116795
Gang Wang, Shengjie Pan
Background: Patients undergoing low rectal cancer resection often experience psychological distress, sleep disturbance, nutritional decline, and functional impairment. Evidence for comprehensive supportive interventions is limited.
Methods: In this single-center RCT (n = 188), patients were randomized 1:1 to an integrative psychosocial-sleep-nutrition program or ERAS-based standard care. Outcomes included psychological distress (BDI-II, BAI), sleep quality (PSQI), anorectal (LARS) and sexual function (IIEF-5/FSFI), postoperative inflammatory markers, recovery, and 2-year survival.
Results: At 24 months, intervention patients showed greater reductions in BDI-II (-5.2), BAI (-3.8), and PSQI (-2.9), lower major LARS prevalence (28.7 % vs 46.2 %), and higher IIEF-5/FSFI scores. Postoperative CRP, IL-6, and TNF-α were lower (p < 0.001). Two-year DFS and OS were 90.3 % vs 79.2 % (p = 0.028) and 93.6 % vs 82.5 % (p = 0.019), respectively.
Conclusions: Multimodal psychosocial, sleep, and nutritional support improves psychological, functional, immunologic, and survival outcomes after low rectal cancer surgery.
背景：低位直肠癌切除术患者常出现心理困扰、睡眠障碍、营养下降和功能障碍。综合支持性干预措施的证据有限。方法：在这项单中心随机对照试验（n = 188）中，患者按1:1的比例随机分为综合心理-社会-睡眠-营养计划或基于erass的标准治疗。结果包括心理困扰（BDI-II， BAI）、睡眠质量（PSQI）、肛肠（LARS）和性功能（IIEF-5/FSFI）、术后炎症标志物、恢复情况和2年生存率。结果：在24个月时，干预患者的BDI-II（-5.2）、BAI（-3.8）和PSQI（-2.9）下降幅度更大，主要LARS患病率更低（28.7% vs 46.2%）， IIEF-5/FSFI评分更高。术后CRP、IL-6、TNF-α降低（p < 0.001）。2年DFS和OS分别为90.3% vs 79.2% （p = 0.028）和93.6% vs 82.5% （p = 0.019）。结论：多模式的心理社会、睡眠和营养支持改善低位直肠癌手术后的心理、功能、免疫和生存结果。
{"title":"Integrated psychosocial, sleep, and nutritional support improves postoperative recovery, immune modulation, and survival after curative resection for low rectal cancer: A randomized controlled trial.","authors":"Gang Wang, Shengjie Pan","doi":"10.1016/j.amjsurg.2025.116795","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116795","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing low rectal cancer resection often experience psychological distress, sleep disturbance, nutritional decline, and functional impairment. Evidence for comprehensive supportive interventions is limited.</p><p><strong>Methods: </strong>In this single-center RCT (n = 188), patients were randomized 1:1 to an integrative psychosocial-sleep-nutrition program or ERAS-based standard care. Outcomes included psychological distress (BDI-II, BAI), sleep quality (PSQI), anorectal (LARS) and sexual function (IIEF-5/FSFI), postoperative inflammatory markers, recovery, and 2-year survival.</p><p><strong>Results: </strong>At 24 months, intervention patients showed greater reductions in BDI-II (-5.2), BAI (-3.8), and PSQI (-2.9), lower major LARS prevalence (28.7 % vs 46.2 %), and higher IIEF-5/FSFI scores. Postoperative CRP, IL-6, and TNF-α were lower (p < 0.001). Two-year DFS and OS were 90.3 % vs 79.2 % (p = 0.028) and 93.6 % vs 82.5 % (p = 0.019), respectively.</p><p><strong>Conclusions: </strong>Multimodal psychosocial, sleep, and nutritional support improves psychological, functional, immunologic, and survival outcomes after low rectal cancer surgery.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116795"},"PeriodicalIF":2.7,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877429","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 : 2025-12-23DOI: 10.1016/j.amjsurg.2025.116796
Ryan D. Rosen , Meredith Hazelrigg , Amanda B. Dooley-Romero , Mitchell Rits , Samantha L. Tarras , Heather Dolman
Background
Hyperphosphatemia occurs after trauma due to severe tissue injury. As the kidneys excrete phosphate, we investigate the relationship between hyperphosphatemia and renal failure after trauma, while developing a tool to predict the need for renal replacement therapy (RRT).
Methods
A retrospective study evaluated trauma admissions to the ICU. The primary outcome was RRT initiation within 14 days. Independent predictors of RRT were derived to create the Risk-for-Renal-Replacement-after-Trauma (R3T) Score. The R3T was validated with receiver-operating-characteristic (ROC) curves.
Results
1619 patients were included; 54 (3.3 %) required RRT. Elevated serum phosphate was associated with increased risk for RRT. Seven independent predictors were included in the R3T, yielding an area under the ROC curve of 0.947.
Conclusions
Hyperphosphatemia was associated with increased risk for RRT, suggesting phosphate levels are an inexpensive biomarker for renal failure after trauma. The R3T Score shows promise in identifying those at highest risk for RRT.
{"title":"Hyperphosphatemia as a biomarker for early renal failure after trauma and development of the risk-for-renal-replacement-after-trauma (R3T) score","authors":"Ryan D. Rosen , Meredith Hazelrigg , Amanda B. Dooley-Romero , Mitchell Rits , Samantha L. Tarras , Heather Dolman","doi":"10.1016/j.amjsurg.2025.116796","DOIUrl":"10.1016/j.amjsurg.2025.116796","url":null,"abstract":"<div><h3>Background</h3><div>Hyperphosphatemia occurs after trauma due to severe tissue injury. As the kidneys excrete phosphate, we investigate the relationship between hyperphosphatemia and renal failure after trauma, while developing a tool to predict the need for renal replacement therapy (RRT).</div></div><div><h3>Methods</h3><div>A retrospective study evaluated trauma admissions to the ICU. The primary outcome was RRT initiation within 14 days. Independent predictors of RRT were derived to create the Risk-for-Renal-Replacement-after-Trauma (R3T) Score. The R3T was validated with receiver-operating-characteristic (ROC) curves.</div></div><div><h3>Results</h3><div>1619 patients were included; 54 (3.3 %) required RRT. Elevated serum phosphate was associated with increased risk for RRT. Seven independent predictors were included in the R3T, yielding an area under the ROC curve of 0.947.</div></div><div><h3>Conclusions</h3><div>Hyperphosphatemia was associated with increased risk for RRT, suggesting phosphate levels are an inexpensive biomarker for renal failure after trauma. The R3T Score shows promise in identifying those at highest risk for RRT.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116796"},"PeriodicalIF":2.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877447","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 : 2025-12-22DOI: 10.1016/j.amjsurg.2025.116789
Marquise D Singleterry, Calista M Harbaugh
{"title":"Time is valuable, people are too: Making the most of mentorship, coaching, and sponsorship.","authors":"Marquise D Singleterry, Calista M Harbaugh","doi":"10.1016/j.amjsurg.2025.116789","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116789","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116789"},"PeriodicalIF":2.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848774","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 : 2025-12-22DOI: 10.1016/j.amjsurg.2025.116790
Herbert Chen (Editor-in-Chief)
{"title":"From the Editor – in – Chief","authors":"Herbert Chen (Editor-in-Chief)","doi":"10.1016/j.amjsurg.2025.116790","DOIUrl":"10.1016/j.amjsurg.2025.116790","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116790"},"PeriodicalIF":2.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846521","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 : 2025-12-22DOI: 10.1016/j.amjsurg.2025.116792
Isobel Burridge, Abigail Dixon, Stephanie Jennifer Symons, Sunjay Jain, Chandra Shekhar Biyani, Stephen R Payne
{"title":"Developing and refining the advanced urology boot camp: What we did, what worked, and what we learned.","authors":"Isobel Burridge, Abigail Dixon, Stephanie Jennifer Symons, Sunjay Jain, Chandra Shekhar Biyani, Stephen R Payne","doi":"10.1016/j.amjsurg.2025.116792","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116792","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116792"},"PeriodicalIF":2.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896080","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 : 2025-12-22DOI: 10.1016/j.amjsurg.2025.116791
Hima Bindu Thota, T Clark Howell, Kevin I Ig-Izevbekhai, Ryan M Antiel
{"title":"Why surgeons need the Sabbath.","authors":"Hima Bindu Thota, T Clark Howell, Kevin I Ig-Izevbekhai, Ryan M Antiel","doi":"10.1016/j.amjsurg.2025.116791","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116791","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116791"},"PeriodicalIF":2.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888757","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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