American journal of surgery最新文献

Background: The 2021 Hospital Price Transparency Rule mandated hospitals to publicly disclose their service prices to improve competition and lower healthcare costs. Our aim was to characterize commercial price variation for thyroidectomy and parathyroidectomy.

Methods: We performed a national cross-sectional study of hospital price variation in 2022 and 2023 using the Turquoise Health dataset. Our main outcomes were within- and across-hospital 90th-to-10th percentile commercial price ratios and a high commercial-to-Medicare (1.5) price ratio. We performed logistic regressions to identify hospital factors associated with a high commercial-to-Medicare price ratio.

Results: For 16,794 unique commercial rates across 564 facilities, within-hospital price ratios ranged from 2.0 to 2.4, and across-hospital price ratios ranged from 2.7 to 4.1. High market concentration and five-star hospital rating were associated with high commercial-to-Medicare price ratios compared to low market concentration and three-star hospital rating, respectively.

Conclusions: Notable variation exists within and across hospitals signaling facilities have negotiated different payments from insurance companies for the same service. Quality may be a modifiable factor to increase hospital revenue and improve care for patients.

Introduction: Many studies display significant heterogeneity in the reliability of artificial intelligence (AI) assessment of minimally invasive surgical (MIS) skills. Our objective is to investigate whether AI systems utilising standardised objective metrics (SOMs) as the basis of skill assessment can provide a clearer understanding of the current state of such technology.

Methods: We systematically searched Medline, Embase, Scopus, CENTRAL and Web of Science from March 2023 to September 2023. Results were compiled as a narrative review.

Results: Twenty-four citations were analysed. Overall accuracy of AI systems in predicting overall SOM score of a procedure ranged from 63 ​% to 100 ​%. The most frequently used SOM by AI algorithms were Objective Structured Assessment of Technical Skills (OSATS) (8/24) and Global Evaluative Assessment of Robotic Skills (GEARS) (8/24).

Conclusions: Stratifying for AI studies which employed SOMs to assess surgical skill did not reduce heterogeneity of reported reliability. Our study identifies key issues within the current literature, which, once addressed, could allow more meaningful comparisons between studies.

Objective: Breast cancer (BC) is the leading cause of female cancer death in the world and the second leading cause of female cancer death in the U.S, Mortality from breast cancer is even higher in individuals with schizophrenia. The aim of our project was to evaluate the incidence of breast cancer in women with schizophrenia and to compare outcomes between breast cancer patients who were or were not on antipsychotics prior to diagnosis.

Methods: This retrospective study used data from the TriNetX database. Women ≥18 years old diagnosed with schizophrenia were identified. The incidence of primary BC diagnosis between January 2011 and December 2023 was evaluated and stratified by ethnicity. We then conducted a retrospective cohort study to compare outcomes of women ≥18 years who did or did not use antipsychotics one year before BC diagnosis. Patients' propensity score was matched based on age, obesity, tobacco use, socioeconomic status, cancer stage, chemoradiation, axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and hormone therapy use. Outcomes of interest were 5-year overall survival, recurrence, chemotherapy need, and lymphedema.

Results: 1,398,475 women ≥18 years old with schizophrenia were identified. Breast cancer incidence in these patients was 0.53 ​% in 2011 and 0.53 ​% in 2022, with a peak in 2017 (1.29 ​%). Non-Hispanic patients were diagnosed with BC approximately 1.3 times more than Hispanic patients. The outcomes study included 183,062 matched patients, with 91,531 per cohort. 5-year survival with the Kaplan-Meier analysis was significantly greater in women not on antipsychotics (72 ​%) compared to those on antipsychotics (60 ​%), log-rank test p-value <0.0001. The risk of local recurrence (13.4 ​% versus 22.6 ​%, p-value <0.0001), chemotherapy need (41.2 ​% versus 48.4 ​%, p-value <0.0001), and lymphedema (7.7 ​% versus 11.5 ​%, p-value <0.0001) were also significantly lower in women who did not take antipsychotics.

Conclusion: Breast cancer incidence in patients with schizophrenia identified through TriNetX has not experienced a significant uptrend or downtrend over the past decade. Non-Hispanic patients with schizophrenia have a higher incidence of BC than Hispanic patients. Matched breast cancer patients on antipsychotics at least one year prior to diagnosis had higher mortality, recurrence, chemotherapy need, and risk of lymphedema.