American journal of surgery最新文献

Background: Although controversial, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to manage liver injuries. This matched cohort study evaluated outcomes in severe liver injuries treated with REBOA or without REBOA.

Methods: Trauma Quality Improvement Program database study. Patients with high-grade liver injuries (IV and V) treated with REBOA were propensity score matched (1:2) with similar patients managed without REBOA. Outcomes included mortality and complications.

Results: 252 patients treated with REBOA were matched with 503 patients managed without REBOA. Overall mortality was significantly higher in the REBOA group [57.9 ​% vs. 35.2 ​% (p ​< ​0.001)]. The REBOA group patients had higher blood product transfusion requirements.

Conclusion: REBOA use in patients with high-grade liver injuries may be associated with poorer outcomes.

Introduction: Despite myriad wellness programs, training demands restrict resident access. This study aimed to evaluate barriers to accessing mental health resources(MHR) and determine if differences exist between medical(MT) and surgical trainees(ST).

Methods: A cross-sectional survey was performed in one health system assessing awareness of and barriers to accessing MHR. Subjects were either ST(general surgery/surgical subspecialty) or MT(internal medicine/specialty). Descriptive and univariate statistics were performed.

Results: There were 87 responders(19 ​%); 55(63.2 ​%)MT and 32(36.8 ​%)ST, with a median age of 30 years(IQR29-33). Women comprised (44)55 ​%. Most trainees(62; 71 ​%) perceive availability of time as the biggest barrier to accessing MHR(27(85 ​%) ST vs 35(64 ​%) MT; p ​= ​0.04), and (20)63%ST couldn't find additional weekly time regardless of their mental/emotional state(vs 19(35 ​%)) MT, p ​= ​0.01). Trainees don't share vulnerable emotions to avoid appearing weak (54(51 ​%)). They demonstrate statistically significant poor self-compassion regarding MHR utilization.

Conclusions: Trainees' lack of time, internal stigma, and poor self-compassion are significant barriers to accessing MHR. More than MT, ST would not schedule counseling despite their emotional state. Understanding the barriers keeping residents from pursuing MHR provides direction for targeted wellness initiatives.

Background: Laparoscopic cholecystectomy (LC) is a common operation performed worldwide. Indications include acute cholecystitis (AC), with a trend of increasing complexity post-COVID-19. We aim to evaluate the health expenditure on LC at an Australian tertiary centre.

Methods: A retrospective chart review was performed for all LC between July 1, 2022-June 30, 2023 collecting demographics, costs and wait times and comparisons performed between elective and emergency LC.

Results: 125 patients underwent emergency and 78 elective LC. There was no difference between age, sex or ASA. 67 patients (53.6 ​%) had emergency LC within their booking priority category. Average cost for emergency LC was $12,689.90 with a median stay of four days, compared to $7181.10 and one day for elective (p ​< ​0.01). Operative related costs were the majority with emergency LC higher ($4866.5, 38.4 ​% v $3957.6, 55.1 ​% p ​= ​0.02). The largest cost disparity was nursing costs ($2193.7, 17.3 ​% v 648.3, 9 ​% p ​< ​0.01).

Conclusion: Costs are likely driven by access to emergency theatre time and increased length of stay. A semi-emergency theatre model could save costs.

Background: Endoscopic submucosal dissection (ESD) is increasingly being adopted for the treatment of early-stage colorectal cancer (CRC) lesions.

Methods: We retrospectively analyzed patients with early-stage CRC treated between 2015 and 2023, using ESD and colectomy databases, categorizing them into three groups: ESD only (n ​= ​24), oncological colorectal resection (OCR) only (n ​= ​90), and OCR after ESD (n ​= ​59). We compared pathological and oncological outcomes among these groups.

Results: The OCR after ESD group demonstrated higher non-granular lesions, and deeper submucosal invasion compared to ESD only group. The primary OCR group showed higher 2-year overall survival compared to ESD-only group (98.9 ​% vs 85.6 ​%, p ​= ​0.01), with no colorectal cancer-related mortality in any of the groups. Notably, 2-year disease-free survival rates were comparable across all groups (93.8 ​% ESD only, 88.0 ​% primary OCR only, and 97.8 ​% for OCR after ESD, p ​= ​0.27).

Conclusion: The current study highlights feasibility the promising potential and oncologic safety of ESD in carefully selected patients with early malignant lesions.