Pub Date : 2025-02-10DOI: 10.1016/j.amjsurg.2025.116237
Diego Najera Saltos, Søren Rud Kristensen
Background
England's National Health Service (NHS) has undergone significant reforms, including the internal market in the 1990s and the 2006 patient choice reform. This systematic review examines how economic policies driving hospital competition impact the quality of care, particularly surgical outcomes, using access and effectiveness as indicators.
Methods
This systematic review followed PRISMA guidelines. Studies were identified from four databases (Embase, Global Health, HMIC, and Medline) with inclusion criteria focusing on competition's effect on surgical care within the NHS.
Results
From 308 studies screened, 12 met the inclusion criteria. Competition generally improves surgical quality, though variations exist across quality measures.
Conclusion
Competition in the NHS has improved surgical outcomes, especially in high-volume procedures. These findings are relevant to US surgical practice, where similar competition may drive efficiency and quality. However, policies must address risks of patient selection biases and regional disparities to ensure equitable improvements across surgical specialities.
{"title":"How economic policies which drive competition amongst hospitals impacts quality of care: The case of the English NHS (A systematic review)","authors":"Diego Najera Saltos, Søren Rud Kristensen","doi":"10.1016/j.amjsurg.2025.116237","DOIUrl":"10.1016/j.amjsurg.2025.116237","url":null,"abstract":"<div><h3>Background</h3><div>England's National Health Service (NHS) has undergone significant reforms, including the internal market in the 1990s and the 2006 patient choice reform. This systematic review examines how economic policies driving hospital competition impact the quality of care, particularly surgical outcomes, using access and effectiveness as indicators.</div></div><div><h3>Methods</h3><div>This systematic review followed PRISMA guidelines. Studies were identified from four databases (Embase, Global Health, HMIC, and Medline) with inclusion criteria focusing on competition's effect on surgical care within the NHS.</div></div><div><h3>Results</h3><div>From 308 studies screened, 12 met the inclusion criteria. Competition generally improves surgical quality, though variations exist across quality measures.</div></div><div><h3>Conclusion</h3><div>Competition in the NHS has improved surgical outcomes, especially in high-volume procedures. These findings are relevant to US surgical practice, where similar competition may drive efficiency and quality. However, policies must address risks of patient selection biases and regional disparities to ensure equitable improvements across surgical specialities.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116237"},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419840","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 : 2025-02-08DOI: 10.1016/j.amjsurg.2025.116242
Soban Maan , Amir H. Sohail , Samia Aziz Sulaiman , Linta Mansoor , Ethan M. Cohen , Ayowumi A. Adekolu , Salim Abunnaja , Nova Szoka , Lawrence E. Tabone , Shyam Thakkar , Shailendra Singh
Background
This study compared cardiovascular outcomes associated with metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in individuals with obesity.
Methods
The TriNetX network was used to compare cardiovascular risk in adult patients with BMI ≥35 who underwent MBS with those who received GLP-1 RA therapy for ≥2 years. Primary outcome was cardiovascular disease (CVD), a composite of incident heart failure (HF), coronary artery disease (CAD), and cerebrovascular disease. Patient follow-up lasted up to 10 years.
Results
MBS was associated with lower hazard of the primary composite outcome of CVD (HR, 0.54, 95 % CI, 0.49–0.60), and the secondary outcomes of incident HF (HR, 0.45, 95 % CI, 0.39–0.52), CAD (HR, 0.54, 95 % CI, 0.45–0.66), and cerebrovascular disease (HR, 0.64, 95 % CI, 0.53–0.77).
Conclusions
A lower risk of adverse cardiovascular outcomes was noted after MBS compared with GLP-1 RA therapy in patients with obesity.
{"title":"Metabolic and bariatric surgery versus glucagon-like peptide-1 receptor agonist therapy: A comparison of cardiovascular outcomes in patients with obesity","authors":"Soban Maan , Amir H. Sohail , Samia Aziz Sulaiman , Linta Mansoor , Ethan M. Cohen , Ayowumi A. Adekolu , Salim Abunnaja , Nova Szoka , Lawrence E. Tabone , Shyam Thakkar , Shailendra Singh","doi":"10.1016/j.amjsurg.2025.116242","DOIUrl":"10.1016/j.amjsurg.2025.116242","url":null,"abstract":"<div><h3>Background</h3><div>This study compared cardiovascular outcomes associated with metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in individuals with obesity.</div></div><div><h3>Methods</h3><div>The TriNetX network was used to compare cardiovascular risk in adult patients with BMI ≥35 who underwent MBS with those who received GLP-1 RA therapy for ≥2 years. Primary outcome was cardiovascular disease (CVD), a composite of incident heart failure (HF), coronary artery disease (CAD), and cerebrovascular disease. Patient follow-up lasted up to 10 years.</div></div><div><h3>Results</h3><div>MBS was associated with lower hazard of the primary composite outcome of CVD (HR, 0.54, 95 % CI, 0.49–0.60), and the secondary outcomes of incident HF (HR, 0.45, 95 % CI, 0.39–0.52), CAD (HR, 0.54, 95 % CI, 0.45–0.66), and cerebrovascular disease (HR, 0.64, 95 % CI, 0.53–0.77).</div></div><div><h3>Conclusions</h3><div>A lower risk of adverse cardiovascular outcomes was noted after MBS compared with GLP-1 RA therapy in patients with obesity.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116242"},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419135","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 : 2025-02-08DOI: 10.1016/j.amjsurg.2025.116235
Zuzanna Pelc , Katarzyna Sędłak , Yutaka Endo , Johanna Van Sandick , Suzanne Gisbertz , Manuel Pera , Gian Luca Baiocchi , Paolo Morgagni , Massimo Framarini , Arnulf Hoelscher , Stefan Moenig , Piotr Kołodziejczyk , Ines Gockel , Guillaume Piessen , Clarisse Eveno , Paulo Matos Da Costa , Andrew Davies , Cara Baker , William Allum , Uberto Fumagalli Romario , Karol Rawicz-Pruszyński
Introduction
Palliative chemotherapy is the current standard among advanced gastric cancer (GC) patients with peritoneal metastasis (PM), while the role of gastrectomy with cytoreductive surgery and HIPEC remains unclear. The current study aimed to assess treatment outcomes among GC patients with PM undergoing gastrectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) using multinational cancer registries.
Methods
The analysis (2012–2022) included stage IV GC patients with PM undergoing gastrectomy and HIPEC from the European GASTRODATA Registry (EU cohort) and the American National Cancer Database (NCDB, U.S. cohort). The study outcomes were textbook oncological outcome (TOO) assessment and overall survival (OS).
Results
Among 193 patients, 49.7 % were from the EU cohort and 50.3 % from the U.S. cohort. EU cohort had significantly higher rates of pT4 tumors (EU: 50 % vs U.S.: 40.2 %), metastatic lymph nodes (EU: 68.8 % vs U.S.: 54.6 %), and ≥16 lymph nodes evaluated (EU: 91.7 % vs U.S.: 68 %). Postoperatively, the EU cohort had longer hospital stay (EU: 53.1 % vs 22.2 %, p < 0.001), with no significant differences in 30-day readmission (EU: 14.6 % vs U.S: 7.2 %, p = 0.11) and 90-day mortality (EU: 4.2 % vs U.S.: 9.3 %, p = 0.25). TOO rates were 30.2 % and 32 % for EU and U.S. cohorts, respectively. Within the U.S. cohort, TOO achievement was associated with improved 1- (86.7 % vs. 57.4 %), 3- (55.8 % vs. 29.7 %), and 5-year OS (50.2 % vs. 29.7 %) (p = 0.0025) survival compared with non-TOO.
Conclusions
Among patients with GC and PM undergoing gastrectomy and HIPEC, achievement of TOO was associated with decreased risk of postoperative complications (EU cohort) and improved long-term survival (U.S. cohort).
{"title":"Hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer with peritoneal metastasis - Joint analysis of European GASTRODATA and American national cancer database","authors":"Zuzanna Pelc , Katarzyna Sędłak , Yutaka Endo , Johanna Van Sandick , Suzanne Gisbertz , Manuel Pera , Gian Luca Baiocchi , Paolo Morgagni , Massimo Framarini , Arnulf Hoelscher , Stefan Moenig , Piotr Kołodziejczyk , Ines Gockel , Guillaume Piessen , Clarisse Eveno , Paulo Matos Da Costa , Andrew Davies , Cara Baker , William Allum , Uberto Fumagalli Romario , Karol Rawicz-Pruszyński","doi":"10.1016/j.amjsurg.2025.116235","DOIUrl":"10.1016/j.amjsurg.2025.116235","url":null,"abstract":"<div><h3>Introduction</h3><div>Palliative chemotherapy is the current standard among advanced gastric cancer (GC) patients with peritoneal metastasis (PM), while the role of gastrectomy with cytoreductive surgery and HIPEC remains unclear. The current study aimed to assess treatment outcomes among GC patients with PM undergoing gastrectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) using multinational cancer registries.</div></div><div><h3>Methods</h3><div>The analysis (2012–2022) included stage IV GC patients with PM undergoing gastrectomy and HIPEC from the European GASTRODATA Registry (EU cohort) and the American National Cancer Database (NCDB, U.S. cohort). The study outcomes were textbook oncological outcome (TOO) assessment and overall survival (OS).</div></div><div><h3>Results</h3><div>Among 193 patients, 49.7 % were from the EU cohort and 50.3 % from the U.S. cohort. EU cohort had significantly higher rates of pT4 tumors (EU: 50 % vs U.S.: 40.2 %), metastatic lymph nodes (EU: 68.8 % vs U.S.: 54.6 %), and ≥16 lymph nodes evaluated (EU: 91.7 % vs U.S.: 68 %). Postoperatively, the EU cohort had longer hospital stay (EU: 53.1 % vs 22.2 %, p < 0.001), with no significant differences in 30-day readmission (EU: 14.6 % vs U.S: 7.2 %, p = 0.11) and 90-day mortality (EU: 4.2 % vs U.S.: 9.3 %, p = 0.25). TOO rates were 30.2 % and 32 % for EU and U.S. cohorts, respectively. Within the U.S. cohort, TOO achievement was associated with improved 1- (86.7 % vs. 57.4 %), 3- (55.8 % vs. 29.7 %), and 5-year OS (50.2 % vs. 29.7 %) (p = 0.0025) survival compared with non-TOO.</div></div><div><h3>Conclusions</h3><div>Among patients with GC and PM undergoing gastrectomy and HIPEC, achievement of TOO was associated with decreased risk of postoperative complications (EU cohort) and improved long-term survival (U.S. cohort).</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116235"},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419276","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 : 2025-02-08DOI: 10.1016/j.amjsurg.2025.116243
Steven L Morrison, Gang Han, Faith Elenwa, Stanley P Leong, Mohammed Kashani-Sabet, Barbara Pockaj, Heidi E Kosiorek, Richard L White, Jonathan S Zager, Jane L Messina, Vernon Sondak, Cristina O'Donoghue, John Harrison Howard, Schlomo Schneebaum, Roger Olofsson Bagge, Jukes P Namm, Carlos Garberoglio, Eli Avisar, Graham Fowler, Dale Han, John Vetto
Background: The relationship between tumor infiltrating lymphocytes (TIL) and survival in melanoma is poorly understood. We present a large multicenter study assessing the association between TIL and survival.
Methods: The Sentinel Lymph Node Working Group database was queried from 1993 to 2024 for cases with known TIL and survival data. TIL was analyzed dichotomously and stratified as non-brisk, brisk, and absent. Clinicopathologic factors were correlated with melanoma-specific survival (MSS), overall survival (OS), and recurrence-free survival (RFS).
Results: Among 4957 patients, TIL was present in 3980 (80.2 %) of patients. TIL was prognostic of MSS (p = 0.0033), OS (p = 0.0053), and RFS (p = 0.0011). In the stratified analysis, brisk TIL was more strongly associated with MSS, OS, and RFS than non-brisk TIL (all p < 0.04). Among patients with a positive sentinel lymph node, TIL was prognostic of MSS, OS, and RFS (all p < 0.03).
Conclusions: TIL is strongly predictive of survival in melanoma and may be useful in risk stratification when deciding whether risks of adjuvant therapy outweigh benefits for certain patients.
{"title":"Tumor infiltrating lymphocytes in primary melanoma are associated with a better prognosis.","authors":"Steven L Morrison, Gang Han, Faith Elenwa, Stanley P Leong, Mohammed Kashani-Sabet, Barbara Pockaj, Heidi E Kosiorek, Richard L White, Jonathan S Zager, Jane L Messina, Vernon Sondak, Cristina O'Donoghue, John Harrison Howard, Schlomo Schneebaum, Roger Olofsson Bagge, Jukes P Namm, Carlos Garberoglio, Eli Avisar, Graham Fowler, Dale Han, John Vetto","doi":"10.1016/j.amjsurg.2025.116243","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116243","url":null,"abstract":"<p><strong>Background: </strong>The relationship between tumor infiltrating lymphocytes (TIL) and survival in melanoma is poorly understood. We present a large multicenter study assessing the association between TIL and survival.</p><p><strong>Methods: </strong>The Sentinel Lymph Node Working Group database was queried from 1993 to 2024 for cases with known TIL and survival data. TIL was analyzed dichotomously and stratified as non-brisk, brisk, and absent. Clinicopathologic factors were correlated with melanoma-specific survival (MSS), overall survival (OS), and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Among 4957 patients, TIL was present in 3980 (80.2 %) of patients. TIL was prognostic of MSS (p = 0.0033), OS (p = 0.0053), and RFS (p = 0.0011). In the stratified analysis, brisk TIL was more strongly associated with MSS, OS, and RFS than non-brisk TIL (all p < 0.04). Among patients with a positive sentinel lymph node, TIL was prognostic of MSS, OS, and RFS (all p < 0.03).</p><p><strong>Conclusions: </strong>TIL is strongly predictive of survival in melanoma and may be useful in risk stratification when deciding whether risks of adjuvant therapy outweigh benefits for certain patients.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116243"},"PeriodicalIF":2.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466771","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 : 2025-02-07DOI: 10.1016/j.amjsurg.2025.116241
Marie-Claire R Roberts, Sherene E Sharath, Ernest J Barthélemy, Danylo Orlov, Panos Kougias
{"title":"Conceptual frameworks for study design and team building.","authors":"Marie-Claire R Roberts, Sherene E Sharath, Ernest J Barthélemy, Danylo Orlov, Panos Kougias","doi":"10.1016/j.amjsurg.2025.116241","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116241","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116241"},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424854","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 : 2025-02-06DOI: 10.1016/j.amjsurg.2025.116238
Jose E. Barrera , Shuyan Wei , Chioma G. Obinero , Catherine Tang , Emily Cao , Charles Osamor III , Jessica R. Nye , Gabrielle E. Hatton , Mohin Bhadkamkar , Yuewei Wu-Fienberg , Lillian S. Kao , Matthew R. Greives
Introduction
Morel-Lavallee lesions (MLL) are closed degloving injuries, often requiring complex management when infected. We evaluated if early debridement reduces infection risk compared to observation.
Methods
We conducted a single-center retrospective study of MLL in adults from 2012 to 2022, analyzing diagnoses, infection, demographics, and hospital outcomes. Patients undergoing debridement within 48 h were compared to those initially observed.
Results
Of 219 patients, 79 (36 %) underwent initial surgical debridement, and 140 (64 %) were initially observed. The overall infection rate was 9 %. The surgery group had longer hospital stays (14vs7 days, p < 0.001) and more debridements (2vs0, p < 0.001). While infection rate was higher in the surgery group (13.9%vs6.4 %, p = 0.064), this difference was not statistically significant. Multivariate analysis identified higher BMI, hip location, and RBC transfusions as significant infection predictors.
Conclusion
No significant differences in infection rates were found, but several risk factors were identified. Greater awareness and better study designs are needed for improved MLL management guidelines.
{"title":"Is more better? Evaluating the impact of early surgical debridement on Morel-Lavallee lesions","authors":"Jose E. Barrera , Shuyan Wei , Chioma G. Obinero , Catherine Tang , Emily Cao , Charles Osamor III , Jessica R. Nye , Gabrielle E. Hatton , Mohin Bhadkamkar , Yuewei Wu-Fienberg , Lillian S. Kao , Matthew R. Greives","doi":"10.1016/j.amjsurg.2025.116238","DOIUrl":"10.1016/j.amjsurg.2025.116238","url":null,"abstract":"<div><h3>Introduction</h3><div>Morel-Lavallee lesions (MLL) are closed degloving injuries, often requiring complex management when infected. We evaluated if early debridement reduces infection risk compared to observation.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of MLL in adults from 2012 to 2022, analyzing diagnoses, infection, demographics, and hospital outcomes. Patients undergoing debridement within 48 h were compared to those initially observed.</div></div><div><h3>Results</h3><div>Of 219 patients, 79 (36 %) underwent initial surgical debridement, and 140 (64 %) were initially observed. The overall infection rate was 9 %. The surgery group had longer hospital stays (14vs7 days, p < 0.001) and more debridements (2vs0, p < 0.001). While infection rate was higher in the surgery group (13.9%vs6.4 %, <em>p</em> = 0.064), this difference was not statistically significant. Multivariate analysis identified higher BMI, hip location, and RBC transfusions as significant infection predictors.</div></div><div><h3>Conclusion</h3><div>No significant differences in infection rates were found, but several risk factors were identified. Greater awareness and better study designs are needed for improved MLL management guidelines.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116238"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350842","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 : 2025-02-06DOI: 10.1016/j.amjsurg.2025.116209
Evan Thomas , Salsabeal Al Saedy , Steven Green , Mahedi Hasan , Clair Chavez , Jacob Glaser
Background
Geriatric patients manifest pain and physical findings differently and are associated with higher mortality and complications. We hypothesized that physical exam (PE) is unreliable versus computed tomography (CT) for comprehensive injury identification in geriatric patients. Additionally, we quantified significant incidental radiologic findings.
Study design
Our institution adopted a policy of Pan Scan (PS) CT for trauma activations of patients ≥65 years. PS included CT of head/neck and chest/abdomen/pelvis. PE and imaging findings were extracted from physician reports.
Results
50 % of patients had clinically significant CT traumatic findings. Of these, 75 % had PE correlating to significant CT findings, while 25 % had significant PS findings not identifiable on PE (p < 0.001). The NPV was 0.80 for the PE. 57.7 % had clinically significant incidental findings.
Conclusion
Physical exam alone is not sensitive enough to detect all traumatic injuries in elderly patients. As an added benefit to PS, important incidental findings are identified. These data support use of PS in geriatric trauma to optimize care.
{"title":"Pan scan for geriatric trauma patients: Overkill or necessary?","authors":"Evan Thomas , Salsabeal Al Saedy , Steven Green , Mahedi Hasan , Clair Chavez , Jacob Glaser","doi":"10.1016/j.amjsurg.2025.116209","DOIUrl":"10.1016/j.amjsurg.2025.116209","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients manifest pain and physical findings differently and are associated with higher mortality and complications. We hypothesized that physical exam (PE) is unreliable versus computed tomography (CT) for comprehensive injury identification in geriatric patients. Additionally, we quantified significant incidental radiologic findings.</div></div><div><h3>Study design</h3><div>Our institution adopted a policy of Pan Scan (PS) CT for trauma activations of patients ≥65 years. PS included CT of head/neck and chest/abdomen/pelvis. PE and imaging findings were extracted from physician reports.</div></div><div><h3>Results</h3><div>50 % of patients had clinically significant CT traumatic findings. Of these, 75 % had PE correlating to significant CT findings, while 25 % had significant PS findings not identifiable on PE (p < 0.001). The NPV was 0.80 for the PE. 57.7 % had clinically significant incidental findings.</div></div><div><h3>Conclusion</h3><div>Physical exam alone is not sensitive enough to detect all traumatic injuries in elderly patients. As an added benefit to PS, important incidental findings are identified. These data support use of PS in geriatric trauma to optimize care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116209"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387677","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 : 2025-02-05DOI: 10.1016/j.amjsurg.2025.116239
Nader Zamani , Sherene E. Sharath , Panos Kougias
Introduction
The objective was to characterize the interactive effects of cardiovascular disease (CVD) and chronic kidney disease (CKD) on long-term mortality following major operations.
Methods
We performed a national, retrospective cohort study of patients undergoing high-risk operations from 1991 through 2018 using the VA Corporate Data Warehouse and Surgical Quality Improvement Program. Preoperative exposures included CVD (history of angina, CHF, MI, stroke, peripheral arterial disease, and related procedures) and CKD Stages III-V. The primary outcome was long-term mortality.
Results
514,057 operations were included. After adjustment, the interaction between CVD and CKD Stage III (HR 1.38, 95% CI: 1.35–1.42), Stage IV (HR 1.91, 95% CI: 1.83–2.01), and Stage V (HR 2.70, 95% CI: 2.59–2.81) progressively conferred increasing risk of mortality.
Conclusions
In the setting of major operations, it is more accurate to interpret CVD and CKD in context of one another while accounting for the degree of baseline renal dysfunction.
{"title":"Combined influence of cardiovascular disease and chronic kidney disease on long-term mortality following major operations","authors":"Nader Zamani , Sherene E. Sharath , Panos Kougias","doi":"10.1016/j.amjsurg.2025.116239","DOIUrl":"10.1016/j.amjsurg.2025.116239","url":null,"abstract":"<div><h3>Introduction</h3><div>The objective was to characterize the interactive effects of cardiovascular disease (CVD) and chronic kidney disease (CKD) on long-term mortality following major operations.</div></div><div><h3>Methods</h3><div>We performed a national, retrospective cohort study of patients undergoing high-risk operations from 1991 through 2018 using the VA Corporate Data Warehouse and Surgical Quality Improvement Program. Preoperative exposures included CVD (history of angina, CHF, MI, stroke, peripheral arterial disease, and related procedures) and CKD Stages III-V. The primary outcome was long-term mortality.</div></div><div><h3>Results</h3><div>514,057 operations were included. After adjustment, the interaction between CVD and CKD Stage III (HR 1.38, 95% CI: 1.35–1.42), Stage IV (HR 1.91, 95% CI: 1.83–2.01), and Stage V (HR 2.70, 95% CI: 2.59–2.81) progressively conferred increasing risk of mortality.</div></div><div><h3>Conclusions</h3><div>In the setting of major operations, it is more accurate to interpret CVD and CKD in context of one another while accounting for the degree of baseline renal dysfunction.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116239"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429161","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 : 2025-02-05DOI: 10.1016/j.amjsurg.2025.116240
Eric Bao, Sarah Nathaniel, Nargiz Seyidova, Olachi Oleru, Abigail Tirrell, Peter W Henderson
{"title":"My thoughts: Development of a database selection tool for large database research.","authors":"Eric Bao, Sarah Nathaniel, Nargiz Seyidova, Olachi Oleru, Abigail Tirrell, Peter W Henderson","doi":"10.1016/j.amjsurg.2025.116240","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116240","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116240"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397917","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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