Pub Date : 2024-11-10DOI: 10.1016/j.amjsurg.2024.116056
Holly Grunebach, Timothy Madeira, Sanuja Bose, Courtenay Holscher, Roberto G Aru, Christopher J Abularrage, James H Black, Ying Wei Lum, Bruce A Perler, Caitlin W Hicks
Background: This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.
Methods: A CEA pathway was developed with stakeholders. We compared in-hospital outcomes and charges (USD) for patients undergoing CEA 18 months before (11/2019-04/2021) vs. after (05/2021-11/2022) implementation.
Results: 149 patients (mean age 70.2 ± 10.9 years, 60.4 % male, 75.7 % white) underwent CEA (83 pre-initiative, 66 post-initiative). There was significant reduction in intensive care unit (ICU) care (90.4 % vs.46.2 %; P < 0.001) but no changes in stroke (3.6 % vs. 0 %), death (0 % vs. 0 %), or median length-of stay (1.0 vs. 1.0 days) following implementation (all, P > 0.12). After risk adjustment, the pathway was associated with charge reductions of $1631/patient/day (95%CI -$3,008, -$254).
Conclusions: Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.
{"title":"A standardized carotid endarterectomy care pathway is associated with lower ICU admission rates and a significant reduction in hospital charges.","authors":"Holly Grunebach, Timothy Madeira, Sanuja Bose, Courtenay Holscher, Roberto G Aru, Christopher J Abularrage, James H Black, Ying Wei Lum, Bruce A Perler, Caitlin W Hicks","doi":"10.1016/j.amjsurg.2024.116056","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116056","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the outcomes before and after initiation of a postoperative care pathway for carotid endarterectomy (CEA) patients.</p><p><strong>Methods: </strong>A CEA pathway was developed with stakeholders. We compared in-hospital outcomes and charges (USD) for patients undergoing CEA 18 months before (11/2019-04/2021) vs. after (05/2021-11/2022) implementation.</p><p><strong>Results: </strong>149 patients (mean age 70.2 ± 10.9 years, 60.4 % male, 75.7 % white) underwent CEA (83 pre-initiative, 66 post-initiative). There was significant reduction in intensive care unit (ICU) care (90.4 % vs.46.2 %; P < 0.001) but no changes in stroke (3.6 % vs. 0 %), death (0 % vs. 0 %), or median length-of stay (1.0 vs. 1.0 days) following implementation (all, P > 0.12). After risk adjustment, the pathway was associated with charge reductions of $1631/patient/day (95%CI -$3,008, -$254).</p><p><strong>Conclusions: </strong>Initiation of a CEA pathway was associated with lower ICU rates and reduction in hospital charges without compromising patient outcomes.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116056"},"PeriodicalIF":2.7,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685802","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 : 2024-11-10DOI: 10.1016/j.amjsurg.2024.116071
Jenna G Alkhatib, Wendelyn M Oslock
{"title":"Pass/fail and reducing the hidden curriculum for residency applicants.","authors":"Jenna G Alkhatib, Wendelyn M Oslock","doi":"10.1016/j.amjsurg.2024.116071","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116071","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116071"},"PeriodicalIF":2.7,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680061","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 : 2024-11-09DOI: 10.1016/j.amjsurg.2024.116081
Raisa Gao, Kayla Flewelling, Nicholas Stevens, Clayton Wyland, Theresa McGoff, Austin Brubaker, Laurence E. McCahill
Background
For urgent and emergent colectomies, return to the operating room is interpreted as a negative quality indicator. We sought to describe indications, procedures performed, and outcomes of patients undergoing reoperation after colectomy.
Methods
Retrospective study of patients undergoing urgent and emergent colectomy with re-operation at a single institution from 2013 to 2023. Details of the patients and surgeries indexed.
Results
117 patients met the study criteria. Sepsis prior to surgery was noted in 29 % of patients, intraoperative vasopressors were used in 80 % and 52 % were left in gastrointestinal discontinuity. Among re-operations, 60 % of patients underwent a “planned second look”, 17 % had a supportive procedure, and 23 % had an unplanned re-operation, the latter group most reflective of surgical complications.
Conclusion
Patients undergoing urgent and emergent colectomies are very ill at presentation. Planned second look and supportive procedures account for most re-operations, suggesting the current utilization of re-operation as a quality indicator is flawed.
{"title":"Re-operation following urgent and emergent colectomies: An investigation of indications and utility as a quality indicator","authors":"Raisa Gao, Kayla Flewelling, Nicholas Stevens, Clayton Wyland, Theresa McGoff, Austin Brubaker, Laurence E. McCahill","doi":"10.1016/j.amjsurg.2024.116081","DOIUrl":"10.1016/j.amjsurg.2024.116081","url":null,"abstract":"<div><h3>Background</h3><div>For urgent and emergent colectomies, return to the operating room is interpreted as a negative quality indicator. We sought to describe indications, procedures performed, and outcomes of patients undergoing reoperation after colectomy.</div></div><div><h3>Methods</h3><div>Retrospective study of patients undergoing urgent and emergent colectomy with re-operation at a single institution from 2013 to 2023. Details of the patients and surgeries indexed.</div></div><div><h3>Results</h3><div>117 patients met the study criteria. Sepsis prior to surgery was noted in 29 % of patients, intraoperative vasopressors were used in 80 % and 52 % were left in gastrointestinal discontinuity. Among re-operations, 60 % of patients underwent a “planned second look”, 17 % had a supportive procedure, and 23 % had an unplanned re-operation, the latter group most reflective of surgical complications.</div></div><div><h3>Conclusion</h3><div>Patients undergoing urgent and emergent colectomies are very ill at presentation. Planned second look and supportive procedures account for most re-operations, suggesting the current utilization of re-operation as a quality indicator is flawed.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116081"},"PeriodicalIF":2.7,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638561","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 : 2024-11-09DOI: 10.1016/j.amjsurg.2024.116061
Lillian Malach, Saskya Byerly, Cory R Evans, James Babowice, Tyler Holliday, Emily K Lenart, Sara Soule, Andrew J Kerwin, Dina M Filiberto
Background: Penetrating neck injuries can be fatal if not quickly identified; however, operative intervention is not always necessary. Prompt evaluation with imaging studies aids in identifying patients who need intervention.
Methods: A retrospective, single-center study of patients with PNI from 2017 to 2022 was performed. Management, outcomes, and mortality were compared. Sensitivity and specificity were calculated for imaging studies performed.
Results: Of 436 patients with PNI, 72 had an aerodigestive injury: 42(58 %) underwent operative management, and 30(42 %) underwent nonoperative management. There was no difference in mortality. The sensitivity and specificity of computed tomography (CT) esophagography for hypopharyngeal/esophageal injury were 100 %. The sensitivity and specificity of fluoroscopic esophagography were 71 % and 99 %. The sensitivity and specificity of combined fluoroscopic esophagography and flexible esophagoscopy were 100 %.
Conclusion: In select patients with penetrating aerodigestive injuries, nonoperative management is safe. CT esophagography alone may be sufficient to identify a hypopharyngeal/esophageal injury.
{"title":"Penetrating aerodigestive injuries and the role of computed tomography esophagography.","authors":"Lillian Malach, Saskya Byerly, Cory R Evans, James Babowice, Tyler Holliday, Emily K Lenart, Sara Soule, Andrew J Kerwin, Dina M Filiberto","doi":"10.1016/j.amjsurg.2024.116061","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116061","url":null,"abstract":"<p><strong>Background: </strong>Penetrating neck injuries can be fatal if not quickly identified; however, operative intervention is not always necessary. Prompt evaluation with imaging studies aids in identifying patients who need intervention.</p><p><strong>Methods: </strong>A retrospective, single-center study of patients with PNI from 2017 to 2022 was performed. Management, outcomes, and mortality were compared. Sensitivity and specificity were calculated for imaging studies performed.</p><p><strong>Results: </strong>Of 436 patients with PNI, 72 had an aerodigestive injury: 42(58 %) underwent operative management, and 30(42 %) underwent nonoperative management. There was no difference in mortality. The sensitivity and specificity of computed tomography (CT) esophagography for hypopharyngeal/esophageal injury were 100 %. The sensitivity and specificity of fluoroscopic esophagography were 71 % and 99 %. The sensitivity and specificity of combined fluoroscopic esophagography and flexible esophagoscopy were 100 %.</p><p><strong>Conclusion: </strong>In select patients with penetrating aerodigestive injuries, nonoperative management is safe. CT esophagography alone may be sufficient to identify a hypopharyngeal/esophageal injury.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116061"},"PeriodicalIF":2.7,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680068","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 : 2024-11-08DOI: 10.1016/j.amjsurg.2024.116063
Emily E. Evans , Sarah E. Bradley , C. Ann Vitous , Cara Ferguson , R. Evey Aslanian , Shukri H.A. Dualeh , Christina L. Shabet , M. Andrew Millis , Pasithorn A. Suwanabol
Background
Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.
Methods
Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.
Results
Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers.
Conclusions
While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.
{"title":"Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluation","authors":"Emily E. Evans , Sarah E. Bradley , C. Ann Vitous , Cara Ferguson , R. Evey Aslanian , Shukri H.A. Dualeh , Christina L. Shabet , M. Andrew Millis , Pasithorn A. Suwanabol","doi":"10.1016/j.amjsurg.2024.116063","DOIUrl":"10.1016/j.amjsurg.2024.116063","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care remains widely underused for surgical patients, despite a clear benefit for patients with life-limiting illness or nearing the end-of-life.</div></div><div><h3>Methods</h3><div>Interviews exploring end-of-life care among critically-ill surgical patients were conducted with providers from 14 pre-specified Veterans Affairs (VA) hospitals. Data were analyzed iteratively through steps informed by inductive and deductive descriptive content analysis.</div></div><div><h3>Results</h3><div>Six major domains were identified. At the patient and family level, barriers included managing expectations and goal-discordant care. At the provider-level, knowledge of and attitudes towards palliative care and provider role and identity were frequently cited barriers. At the system-level, participants identified institutional resources and culture as significant barriers.</div></div><div><h3>Conclusions</h3><div>While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116063"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643256","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 : 2024-11-08DOI: 10.1016/j.amjsurg.2024.116051
Katherine M. Gerull , Priyanka Parameswaran , Ling Chen , Cara A. Cipriano
Objective
To better understand reasons for the underrepresentation of certain groups in orthopedic surgery, we investigated whether there were differences in medical students’ perceptions of inclusivity in orthopedic surgery between (1) men and women, (2) White, Asian and URiM, and (3) LGBTQIA and non-LGBTQIA students.
Design
A one-time survey consisting of validated and/or previously used instruments measuring students' sense of belonging in orthopedics, prospective belonging uncertainty (an individual's worry that they will not fit in), stereotype threat (the effect of negative stereotypes on stereotyped group-members), and pluralistic ignorance (erroneously believing your beliefs are different than “typical” group-members).
Setting
The survey was distributed at Loyola University, St. Louis University, University of Michigan, and Washington University in St. Louis.
Participants
All medical students at these institutions were offered participation, and 441 medical students completed the survey (∼20% response-rate).
Results
There was a lower sense of belonging for each of the following groups when compared to their majority-group peers: women (mean difference = 0.5, 95% CI 0.3–0.7, p < 0.001), Asian students (mean difference = 0.4, 95% CI 0.1–0.7, p < 0.001), URiM students (mean difference = 0.4, 95% CI 0.07–0.7, p < 0.001) and LGBTQIA students (mean difference = 0.4, 95% CI 0.07–0.6, p = 0.003). Medical students perceived that orthopedic faculty, residents, and the general public believe that men are better orthopedic surgeons than women, and that White surgeons are better surgeons than non-White surgeons. Women reported less confidence to succeed in orthopedics compared to “typical” peers (mean −0.5, SD 1.3), whereas men felt similar confidence compared to their peers (mean 0.1, SD 1.3; mean difference 0.6, 95% CI 0.4–0.9, p < 0.001).
Conclusions
These differences in belonging, prospective belonging uncertainty, stereotype threat, and pluralistic ignorance provide insight into how medical students perceive the inclusivity of orthopedics, which may ultimately play a role in the underrepresentation of minority groups.
目的：为了更好地了解某些群体在骨科手术中代表性不足的原因，我们调查了医科学生对骨科手术包容性的看法是否存在以下差异：（1）男性和女性；（2）白人、亚洲人和乌拉圭人；（3）LGBTQIA 和非 LGBTQIA 学生：设计：一次性调查，由经过验证和/或以前使用过的工具组成，测量学生对骨科的归属感、未来归属的不确定性（个人担心自己无法融入群体）、刻板印象威胁（负面刻板印象对刻板群体成员的影响）和多元无知（错误地认为自己的信仰与 "典型 "群体成员不同）：调查在洛约拉大学、圣路易斯大学、密歇根大学和圣路易斯华盛顿大学进行：441 名医学生完成了调查（回复率为 20%）：结果：与多数群体的同龄人相比，以下每个群体的归属感都较低：女性（平均差异 = 0.5，95% CI 0.3-0.7，p 结论：与多数群体的同龄人相比，以下每个群体的归属感都较低：女性（平均差异 = 0.5，95% CI 0.3-0.7，p这些在归属感、预期归属感不确定性、刻板印象威胁和多元无知方面的差异为医科学生如何看待骨科的包容性提供了启示，这可能最终导致少数群体代表性不足。
{"title":"Impressions of inclusivity within orthopedic surgery: Differences amongst women, minority, and LGBTQIA medical students","authors":"Katherine M. Gerull , Priyanka Parameswaran , Ling Chen , Cara A. Cipriano","doi":"10.1016/j.amjsurg.2024.116051","DOIUrl":"10.1016/j.amjsurg.2024.116051","url":null,"abstract":"<div><h3>Objective</h3><div>To better understand reasons for the underrepresentation of certain groups in orthopedic surgery, we investigated whether there were differences in medical students’ perceptions of inclusivity in orthopedic surgery between (1) men and women, (2) White, Asian and URiM, and (3) LGBTQIA and non-LGBTQIA students.</div></div><div><h3>Design</h3><div>A one-time survey consisting of validated and/or previously used instruments measuring students' sense of belonging in orthopedics, prospective belonging uncertainty (an individual's worry that they will not fit in), stereotype threat (the effect of negative stereotypes on stereotyped group-members), and pluralistic ignorance (erroneously believing your beliefs are different than “typical” group-members).</div></div><div><h3>Setting</h3><div>The survey was distributed at Loyola University, St. Louis University, University of Michigan, and Washington University in St. Louis.</div></div><div><h3>Participants</h3><div>All medical students at these institutions were offered participation, and 441 medical students completed the survey (∼20% response-rate).</div></div><div><h3>Results</h3><div>There was a lower sense of belonging for each of the following groups when compared to their majority-group peers: women (mean difference = 0.5, 95% CI 0.3–0.7, p < 0.001), Asian students (mean difference = 0.4, 95% CI 0.1–0.7, p < 0.001), URiM students (mean difference = 0.4, 95% CI 0.07–0.7, p < 0.001) and LGBTQIA students (mean difference = 0.4, 95% CI 0.07–0.6, p = 0.003). Medical students perceived that orthopedic faculty, residents, and the general public believe that men are better orthopedic surgeons than women, and that White surgeons are better surgeons than non-White surgeons. Women reported less confidence to succeed in orthopedics compared to “typical” peers (mean −0.5, SD 1.3), whereas men felt similar confidence compared to their peers (mean 0.1, SD 1.3; mean difference 0.6, 95% CI 0.4–0.9, p < 0.001).</div></div><div><h3>Conclusions</h3><div>These differences in belonging, prospective belonging uncertainty, stereotype threat, and pluralistic ignorance provide insight into how medical students perceive the inclusivity of orthopedics, which may ultimately play a role in the underrepresentation of minority groups.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116051"},"PeriodicalIF":2.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638559","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 : 2024-11-07DOI: 10.1016/j.amjsurg.2024.116067
Muhammad Musaab Munir, Selamawit Woldesenbet, Mujtaba Khalil, Muhammad Muntazir Mehdi Khan, Mary Dillhoff, Timothy M. Pawlik
Background
We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.
Methods
SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).
Results
2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 %). After accounting for all explanatory variables in the full model, 5.5 % of the residual provider-level variation was attributed to the pathologist, 35.2 % to the surgeon, and 59.3 % to the hospital.
Conclusions
Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.
{"title":"Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital?","authors":"Muhammad Musaab Munir, Selamawit Woldesenbet, Mujtaba Khalil, Muhammad Muntazir Mehdi Khan, Mary Dillhoff, Timothy M. Pawlik","doi":"10.1016/j.amjsurg.2024.116067","DOIUrl":"10.1016/j.amjsurg.2024.116067","url":null,"abstract":"<div><h3>Background</h3><div>We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.</div></div><div><h3>Methods</h3><div>SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).</div></div><div><h3>Results</h3><div>2872 patients underwent pancreaticoduodenectomy by 646 distinct surgeons and 1063 distinct pathologists across 308 hospitals. Patient-related characteristics contributed the most to the variance in adequate lymph node assessment (71.0 %). After accounting for all explanatory variables in the full model, 5.5 % of the residual provider-level variation was attributed to the pathologist, 35.2 % to the surgeon, and 59.3 % to the hospital.</div></div><div><h3>Conclusions</h3><div>Patient-to-patient variation was the greatest underlying contributor to variations in adequate lymph node assessment related to pancreatic cancer surgery. Variation among hospitals was greater than among surgeons or pathologists.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116067"},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638562","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 : 2024-11-07DOI: 10.1016/j.amjsurg.2024.116076
Brittany M Dacier, Manuel Castillo-Angeles, Gezzer Ortega, Minerva A Romero Arenas, Chantal R Reyna
{"title":"Latino Surgical Society: Let's move forward, together.","authors":"Brittany M Dacier, Manuel Castillo-Angeles, Gezzer Ortega, Minerva A Romero Arenas, Chantal R Reyna","doi":"10.1016/j.amjsurg.2024.116076","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.116076","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"116076"},"PeriodicalIF":2.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692679","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 : 2024-11-06DOI: 10.1016/j.amjsurg.2024.116069
Lei Wang, Jianming Zhou, Shengjie Jing, Bin Liu, Jin Fang, Tao Xue
Objective
The aim of our study was to investigate whether sublobar resection is non-inferior to lobar resection in early-stage non-small cell lung cancer less than 2 cm.
Methods
This is a meta-analysis for randomized controlled trials. Databases including PubMed, Web of Science, EMBASE and Cochrane Central Register were searched up to June 3, 2023. The primary outcome was 5-year survival, and the secondary outcomes were 5-year disease-free survival, cancer-related mortality, recurrence rate, postoperative lung function and perioperative events.
Results
A total of 5 studies enrolling 2035 patients were included. Sublobar resection was found to be non-inferior to lobar resection concerning the 5-year survival rate, 5-year disease-free survival rate and cancer-related mortality. However, sublobar resection was associated with higher recurrence rate and less reduction of postoperative lung function.
Conclusions
Sublobar resection was non-inferior to lobar resection in terms of survival outcomes and was associated with better postoperative lung function.
{"title":"Sublobar or lobar resection in early-stage peripheral non-small cell lung cancer less than 2cm: A meta-analysis for randomized controlled trials","authors":"Lei Wang, Jianming Zhou, Shengjie Jing, Bin Liu, Jin Fang, Tao Xue","doi":"10.1016/j.amjsurg.2024.116069","DOIUrl":"10.1016/j.amjsurg.2024.116069","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of our study was to investigate whether sublobar resection is non-inferior to lobar resection in early-stage non-small cell lung cancer less than 2 cm.</div></div><div><h3>Methods</h3><div>This is a meta-analysis for randomized controlled trials. Databases including PubMed, Web of Science, EMBASE and Cochrane Central Register were searched up to June 3, 2023. The primary outcome was 5-year survival, and the secondary outcomes were 5-year disease-free survival, cancer-related mortality, recurrence rate, postoperative lung function and perioperative events.</div></div><div><h3>Results</h3><div>A total of 5 studies enrolling 2035 patients were included. Sublobar resection was found to be non-inferior to lobar resection concerning the 5-year survival rate, 5-year disease-free survival rate and cancer-related mortality. However, sublobar resection was associated with higher recurrence rate and less reduction of postoperative lung function.</div></div><div><h3>Conclusions</h3><div>Sublobar resection was non-inferior to lobar resection in terms of survival outcomes and was associated with better postoperative lung function.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"241 ","pages":"Article 116069"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612296","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 : 2024-11-06DOI: 10.1016/j.amjsurg.2024.116073
Israel Falade, Kayla Switalla, Astrid Quirarte, Molly Baxter, Daniel Soroudi, Harriet Rothschild, Shoko Emily Abe, Karen Goodwin, Merisa Piper, Michael Alvarado, Bao-Quynh Julian, Cheryl Ewing, Jasmine Wong, John Rose, Laura Esserman, Robert Foster, Rita A Mukhtar
Background: The risks of postoperative complications in breast cancer patients vary by patient and tumor characteristics. Elevated BMI and invasive lobular carcinoma (ILC) increase risks of surgical complications and positive margins, respectively.
Methods: We retrospectively analyzed patients with BMI ≥30 kg/m2 from an institutional ILC database. The primary outcome was surgical complication rate by procedure type. The secondary outcome was positive margin rates by surgical approach, stratified by T stage.
Results: Of 154 analyzed patients, standard BCS, lumpectomy with oncoplastic closure, and simple mastectomy had the lowest complication rates (18.2 %, 17.0 %, 11.8 %). Oncoplastic reduction mammoplasty and mastectomy with aesthetic closure had the highest rates (35.5 %, 33.3 %). The overall positive margin rate was 28.5 %, significantly higher in BCS vs. mastectomy (37.4 % vs. 15.0 %, p = 0.003). Oncoplastic surgery significantly reduced positive margin rates in BCS.
Conclusion: In this study, 23.4 % of patients experienced surgical complications, with higher rates in oncoplastic/reconstructive approaches. However, oncoplastic surgery reduced positive margins, highlighting the importance of balancing risks for optimal surgical planning.
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