American journal of surgery最新文献

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The ethical problems with informed consent: How inconsistencies undermine patient autonomy 知情同意的伦理问题：不一致性如何破坏患者的自主权

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-01-09 DOI: 10.1016/j.amjsurg.2026.116821

Charlotte L. Harrington , Clara M. Bosco , Sean C. Wightman , Baddr A. Shakhsheer

Objective

To identify inconsistencies in informed consent (IC) and evaluate how these variations impact patient autonomy.

Methods

A review of IC policies at different institutions and literature was conducted, analyzing variations in consent practices.

Results

Significant variability exists in IC implementation. Thresholds for consent often seem arbitrary, with comparable-risk procedures requiring different approaches (e.g., arterial lines needing written consent while peripheral IVs do not). Context also drives disclosure; the risk of nerve injury may be emphasized before a mastectomy but not a cardiac procedure. Bundled consents, such as ICU admission forms covering multiple interventions, can obscure individual risks. Efficiency pressures can dictate who obtains consent, leading less experienced providers to perform it. Witness requirements are inconsistent, varying between phone and in-person discussions.

Conclusion

Current IC practices are fragmented, influenced by factors beyond patient-centered care. These inconsistencies result in gaps in the support of patient decision-making. Standardized, patient-centered policies are needed to protect patient autonomy.

目的识别知情同意（IC）的不一致性，并评估这些差异如何影响患者的自主性。方法回顾了不同机构的知情同意书政策和文献，分析了知情同意书实践的差异。结果IC的实施存在显著的可变性。同意的阈值通常似乎是武断的，具有相同风险的程序需要不同的方法（例如，动脉导管需要书面同意，而外周静脉注射则不需要）。背景也会推动信息披露；神经损伤的风险可能在乳房切除术前被强调，而不是在心脏手术前。捆绑同意书，如涵盖多种干预措施的ICU入院表，可能会模糊个人风险。效率压力可以决定谁获得同意，导致经验不足的提供者执行同意。证人的要求不一致，在电话和面对面的讨论中有所不同。结论目前的IC实践是碎片化的，受以患者为中心的护理以外的因素影响。这些不一致导致在支持患者决策方面存在差距。需要标准化的、以患者为中心的政策来保护患者的自主权。

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引用次数: 0

A chasm is growing between clinical care and education: Who will train the next surgeons? 临床护理和教育之间的鸿沟正在扩大：谁来培训下一批外科医生？

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-01-09 DOI: 10.1016/j.amjsurg.2026.116822

Kevin Y Pei

引用次数: 0

The unseen complication: Relationship strain in surgical practice. 看不见的并发症：手术实践中的关系紧张。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-01-07 DOI: 10.1016/j.amjsurg.2026.116820

Amanda L Smith, Kathryn E Engelhardt

引用次数: 0

Emeritus Editorial Board 名誉编辑委员会

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-01-07 DOI: 10.1016/S0002-9610(25)00630-0

引用次数: 0

The general surgery match in the step 1 pass/fail era: Leveling the playing field or moving the goalpost? 第一步及格/不及格时代的普外科比赛：公平竞争还是移动门柱？

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-01-05 DOI: 10.1016/j.amjsurg.2026.116818

Carla N Holcomb, Thomas H Shoultz

引用次数: 0

Statewide episode spending variation of thyroidectomy for lower-risk thyroid cancer 低风险甲状腺癌甲状腺切除术的全州发作花费变化

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-12-31 DOI: 10.1016/j.amjsurg.2025.116816

Catherine B. Jensen , Steven Xie , Aayushi Sinha , Elizabeth M. Bacon , Hunter J. Underwood , Hari Nathan , Susan C. Pitt

Background

This study aimed to evaluate variation in spending for thyroidectomy for patients with thyroid cancer.

Methods

This retrospective cohort study analyzed risk-adjusted, price-standardized Michigan-based claims data from 2015 to 2022 and included patients who underwent thyroidectomy for lower-risk thyroid cancer. The primary outcome was 90-day spending. A mixed linear model with facility as a random effect identified factors associated with spending variability.

Results

In total, 2516 patients underwent thyroidectomy at 81 facilities. Unadjusted 90-day spending ranged from $5917 to $25,630 across facilities (median $8993). Spending was lowest for lobectomy (median $7755) and highest for lobectomy followed by completion thyroidectomy (median $14,181). On regression, factors significantly associated with increased spending were patient age and readmission. The interaction between occurrence of post-operative complications and lengths of stay >2 nights contributed to dramatically higher spending.

Conclusions

Reducing complications and associated length of stay as well hospital readmissions represent opportunities to improve the value of thyroidectomy.

本研究旨在评估甲状腺癌患者甲状腺切除术费用的变化。方法：本回顾性队列研究分析了2015年至2022年风险调整、价格标准化的密歇根州索赔数据，其中包括因低风险甲状腺癌接受甲状腺切除术的患者。主要结果是90天的支出。将设施作为随机效应的混合线性模型确定了与支出可变性相关的因素。结果81家医院共2516例患者行甲状腺切除术。未经调整的90天支出从5917美元到25,630美元不等（中位数为8993美元）。肺叶切除术的费用最低（中位数为7755美元），肺叶切除术后完成甲状腺切除术的费用最高（中位数为14181美元）。在回归分析中，与支出增加显著相关的因素是患者年龄和再入院率。术后并发症的发生与住院时间（2晚）之间的相互作用导致了住院费用的显著增加。结论减少并发症和相关住院时间以及再入院率是提高甲状腺切除术价值的机会。

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引用次数: 0

The proverbial glass ceiling: You might need a new tool when it's seemingly made of concrete 众所周知的玻璃天花板：你可能需要一个新的工具，当它看起来是由混凝土制成的。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-12-30 DOI: 10.1016/j.amjsurg.2025.116814

Alana L. Beres MDCM, MPH, FRCSC, FACS, FAAP

引用次数: 0

Statewide trends in routine pre-operative testing before low-risk surgery 低风险手术前常规术前检查的全州趋势

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-12-29 DOI: 10.1016/j.amjsurg.2025.116815

Nicole M. Mott , Erin Kim , Faelan Jacobson-Davies , Michael J. Englesbe , Hari Nathan , Lesly A. Dossett

Background

Routine pre-operative testing before low-risk surgery remains common despite guidelines against it.

Methods

We conducted a retrospective cohort study of adults undergoing low-risk surgery (cholecystectomy, hernia repair, lumpectomy, thyroidectomy, mastectomy) in Michigan from 2015 to 2024. The primary outcome was testing performed within 30 days of surgery. Linear mixed models identified predictors of testing, and the results of a pilot quality improvement (QI) initiative to reduce testing at 31 hospitals were examined.

Results

Among 99,501 patients, testing rates declined from 44 % to 39 % from 2019 to 2024. Older age, comorbidity burden, and undergoing a pre-operative history and physical were associated with testing. Hospital testing rates varied from 13 % to 93 %. In the QI-participating hospitals, testing declined from 38 % to 33 % in the measurement period compared to the baseline period (p = 0.035).

Conclusions

Pre-operative testing remains common and variable. QI initiatives help reduce testing, but broader de-implementation strategies may promote sustained improvement.

背景：尽管指南反对在低风险手术前进行常规术前检查，但这种做法仍然很普遍。方法对2015年至2024年在密歇根州接受低风险手术（胆囊切除术、疝修补术、乳房肿瘤切除术、甲状腺切除术、乳房切除术）的成年人进行回顾性队列研究。主要结果是手术后30天内进行的测试。线性混合模型确定了检测的预测因素，并检查了31家医院减少检测的试点质量改进（QI）倡议的结果。结果在99501例患者中，检测率从2019年的44%下降到2024年的39%。年龄较大、合并症负担、术前病史和体格检查与检测有关。医院检测率从13%到93%不等。在参与qi的医院中，与基线期相比，检测率从38%下降到33% （p = 0.035）。结论术前检测普遍存在，且存在差异。QI计划有助于减少测试，但是更广泛的去实现策略可能促进持续的改进。

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引用次数: 0

Can Artificial Intelligence and Machine Learning help us improve motor vehicle crash trauma triage? 人工智能和机器学习能帮助我们改善机动车碰撞创伤分诊吗？

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-12-26 DOI: 10.1016/j.amjsurg.2025.116810

Raymond A Jean, Akbar K Waljee, Maggie Makar, Christopher J Tignanelli, Mark R Hemmila, Justin B Dimick

引用次数: 0

The case for structural reform in medical student research access. 医学生研究机会结构改革的案例。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-12-26 DOI: 10.1016/j.amjsurg.2025.116811

Tamara Kabbani, Anthony N Eze, Jacob A Greenberg, Lisa McElroy

引用次数: 0

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