American journal of surgery最新文献

Objective: Medical device companies rely on surgeons' input to develop safe, effective products. For transparency, industry partners must publicly disclose payments via the Open Payments (OP) program, established through the Sunshine Act. We aim to examine the prevalence and factors influencing consulting payments made to academic vascular surgeons.

Methods: Faculty from integrated vascular surgery residencies were identified, and data on clinical experience, training, and research output were collected using OP, program websites, LinkedIn, and Scopus. Univariate linear, univariate logistic, and multivariate linear regression analyses were performed.

Results: From 75 programs (25% without consultants), 697 vascular surgeons were identified. Of these, 622 (89.2%) received $5,033,069 in total general payments and 117 (19%) received $2,168,496 (43%) in consulting payments in the 2022 fiscal year. Consultants received a general payment median of $12,966, significantly higher than non-consultants' $506 (p < 0.001). Median total consulting fees were $4400, and consultants had significantly more publications (p < 0.001), higher Hirsch indices (P < 0.001), and were less commonly females (p = 0.002) than non-consultants. There was no statistical association between consulting payments and clinical experience, research productivity, or biological sex.

Conclusion: Approximately 1 in 5 academic vascular surgeons receive consulting payments. While consultants have significantly more publications and higher H indices than non-consultants, consulting payments received in dollars are not influenced by these factors. Female academic vascular surgeons are underrepresented in consulting, but the payments made to those who do consult do not significantly differ from their male counterparts.

Background: Mild Autonomous Cortisol Secretion (MACS) is associated with cardiometabolic comorbidities, but the benefit of adrenalectomy remains controversial.

Methods: We retrospectively reviewed patients undergoing adrenalectomy between October 2019 and October 2024. MACS was defined as post-1 mg dexamethasone suppression test cortisol 1.8-5.0 μg/dL without overt Cushing's syndrome. Pre- and postoperative clinical and biochemical outcomes were analyzed.

Results: Thirty-eight patients met inclusion criteria (median age 64 years; 60.5% female). Median post-DST cortisol was 2.9 μg/dL, with a median follow-up of 258 days. Significant postoperative improvements were observed in systolic (p = 0.001) and diastolic (p = 0.004) blood pressure, HbA1c (p = 0.013), and antihypertensive medication burden (p = 0.009). General health status, HbA1c and number of antihypertensive medications improved in 76.3%, 58.4% and 52.8% of the patients, respectively. Clinical outcomes did not differ between patients with cortisol levels <2.5 vs. ≥2.5 μg/dL.

Conclusion: Adrenalectomy in selected MACS patients is associated with improvements in blood pressure, glycemic control, and overall health, independent of preoperative cortisol levels.

Introduction: Although numerous studies have examined small bowel obstruction (SBO) post-bariatric surgery, they are limited by single center design. There is limited broad epidemiologic data on incidence of SBO after bariatric surgery. The aim of this study was to comprehensively evaluate the cumulative incidence of SBO.

Methods: The SPARCS database was used to identify patients with previous Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) who required surgery for SBO at the time of first diagnosis. We analyzed the incidence of and prognostic indicators of surgery for SBO. Multivariable Fine-Gray models were utilized to examine the association between each risk factor and subsequent SBO surgery where death was treated as a competing risk event.

Results: A total of 38,582 RYGB patients and 91,982 SG patients were included with median follow-up time of 1492 and 1074 days, respectively. The cumulative incidence of surgery for SBO for RYGB was 0.46 % (0.39%-0.53%), 1% (0.89-1.12%), 1.89% (1.71-2.08%) at 1, 3 and 6 years, respectively. The cumulative incidence of surgery for SBO for SG was 0.13% (0.11%-0.16%), 0.55% (0.49%-0.61%), and 2.02% (1.87%-2.18%) at 1, 3 and 6 years, respectively. No significant difference existed in risk of SBO between RYGB and SG (p = 0.72). Other prognostic factors for SBO included female gender, chronic pulmonary disease, phlebitis, black ethnicity and Medicare/Medicaid insurance.

Conclusion: Bariatric surgery patients have a low risk of needing subsequent surgery for SBO, with comparable rates between RYGB and SG, indicating minimal added risk with RYGB compared to other intra-abdominal procedures.