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The privilege of mastery: Preserving joy in surgery. 掌握的特权:保留手术的乐趣。
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-15 DOI: 10.1016/j.amjsurg.2025.116785
Dimitrios P Moris, Theodore N Pappas
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引用次数: 0
When supervision works: Analysis of supervisors' and residents' perceptions of 'good supervision' using video-stimulated interviews. 当监督有效:使用视频刺激访谈分析监督员和居民对“良好监督”的看法。
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-12 DOI: 10.1016/j.amjsurg.2025.116774
Martine C Keuning, Bart Lambert, Paul C Jutte, Patrick Nieboer, Agnes D Diemers

Objective: To examine how supervisors and residents perceive real-time instances of good intraoperative supervision and where their perceptions align or differ. By exploring how supervisors guide residents toward operative competence, we aim to align their perceptions to support effective learning.

Methods: Twenty surgical procedures were video recorded in six Dutch teaching hospitals. After each procedure, supervisors and residents independently selected three instances of good supervision. These clips were reviewed in separate video-stimulated interviews. Transcripts were thematically analyzed using a constructivist approach to explore alignment/misalignment in perceptions.

Results: Supervisors emphasized explicitly contributing to residents' learning according to a self-set standard, whereas residents highlighted supervision that fulfilled their learning needs and was communicated professionally. Substantial agreement on the instance of good supervision did not necessarily imply agreement on the underlying rationale. Residents often recognized their supervisor's intentions but did not always interpret the same behaviors similarly. Differences primarily concerned the timing and nature of supervision actions.

Conclusion: Although perspectives differ by role, learner versus teacher, making them explicit can improve alignment and foster more effective, co-regulated learning in the operating room.

目的:研究督导人员和住院医师如何感知良好术中监护的实时情况,以及他们的感知在哪里一致或不同。通过探索主管如何指导住院医生提高操作能力,我们旨在调整他们的看法,以支持有效的学习。方法:对荷兰6所教学医院的20例手术过程进行录像。每个程序结束后,监督员和居民各自选出三个良好的监督实例。这些片段在单独的视频刺激采访中进行了审查。使用建构主义方法对转录本进行主题分析,以探索感知中的对齐/错位。结果:督导医师强调根据自己设定的标准,明确地为住院医师的学习做出贡献,而住院医师则强调满足其学习需求并进行专业沟通的监督。就良好监管的实例达成实质性协议并不一定意味着就基本原理达成一致。住院医生通常会意识到他们的主管的意图,但并不总是对同样的行为做出类似的解释。分歧主要涉及监督行动的时机和性质。结论:尽管观点因角色、学习者和教师的不同而不同,但明确的观点可以改善一致性,促进手术室中更有效、共同调节的学习。
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引用次数: 0
Minority race and ethnicity are underreported in colorectal surgery research: A 14-year systematic review 结直肠手术研究中少数民族和族裔被低估:一项14年的系统回顾。
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-12 DOI: 10.1016/j.amjsurg.2025.116776
Julie S. Hong , Xiaoyue Ma , William Davis , Phillip Hwang , Shahenda Khedr , Vinh Pham , Roger Patron , Christopher Foglia , Daithi S. Heffernan , Steven Y. Chao

Background

Disparities by race and ethnicity have been reported for incidence, access, and outcomes of colorectal disease. We aimed to describe rates of race and ethnicity reporting in clinical colorectal studies published in high-impact journals.

Methods

All prospective and retrospective clinical studies published in two high-impact colorectal journals and two high-impact surgical journals from 2010 to 2023 were identified using PubMed. Subset analyses of studies published in America were performed.

Results

Of 1220 studies, 1110 met inclusion criteria, and 203 were American. In American studies, rates of reporting White (p ​= ​0.076), Black (p ​= ​0.863), Asian (p ​= ​0.509), or Hispanic patients (p ​= ​0.133) remained unchanged over time. Overall, Black (n ​= ​73, 81.1 ​%), Asian (n ​= ​33, 36.7 ​%), and Hispanic patients (n ​= ​33, 36.7 ​%) were reported less often than White patients (n ​= ​87, 96.7 ​%) and were more likely to be represented as Other (n ​= ​72, 80.0 ​%).

Conclusions

Over 14 years, rates of reporting minority race and ethnicity groups in clinical colorectal surgery research remained low.
背景:结直肠疾病的发病率、可及性和结局存在种族和民族差异。我们的目的是描述在高影响力期刊上发表的临床结直肠研究中种族和民族报告的比率。方法:使用PubMed检索2010 - 2023年间发表在两本高影响力结直肠期刊和两本高影响力外科期刊上的所有前瞻性和回顾性临床研究。对在美国发表的研究进行了子集分析。结果:1220项研究中,1110项符合纳入标准,其中203项为美国研究。在美国的研究中,报告白人(p = 0.076)、黑人(p = 0.863)、亚洲人(p = 0.509)或西班牙裔患者(p = 0.133)的比例一直保持不变。总体而言,黑人(n = 73, 81.1%)、亚洲人(n = 33, 36.7%)和西班牙裔患者(n = 33, 36.7%)的报告频率低于白人患者(n = 87, 96.7%),而其他患者(n = 72, 80.0%)的报告频率更高。结论:14年来,在临床结直肠手术研究中报告少数种族和族裔群体的比例仍然很低。
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引用次数: 0
Intestinal discontinuity may be associated with worse outcomes in damage control laparotomy for trauma: An American association for the surgery of trauma prospective multicenter observational study 美国创伤外科协会的一项前瞻性多中心观察性研究表明,创伤控制性剖腹手术中肠不连续性可能与较差的预后相关
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-11 DOI: 10.1016/j.amjsurg.2025.116777
Elizabeth R. Benjamin , Demetrios Demetriades , Camilla Cremonini , Anaar Siletz , Subarna Biswas , Jennifer Mooney , Joe DuBose , Nori Bradley , David J. Skaurpa , Lucyna Krzywon , Paula Ferrada , Pak S. Leung , John D. Berne , Jason Young , Thomas M. Scalea

Introduction

In damage control laparotomy (DCL) for trauma, intestinal injuries are often left in discontinuity. This study compared outcomes in patients with intestinal discontinuity versus immediate anastomosis.

Methods

Prospective multicenter, AAST study, included patients requiring DCL with intestinal resection. Patients were categorized into bowel Discontinuity and Continuity groups.
Data collection included clinical characteristics, injury severity, peritoneal contamination, intraoperative blood products, crystalloids and vasopressors, operative time, takeback operative findings, fascia closure and postoperative complications. Outcomes included mortality, bowel ischemia, postoperative complications, fascia closure, and hospital stay.

Results

246 patients from 16 centers. Using propensity score matching, 132 patients in the Discontinuity group were well-matched with 66 in the Continuity group. Discontinuity was associated with significantly higher mortality and septic complications. Fascia closure was more likely to be achieved in the Continuity group at the 2nd takeback operation.

Conclusions

Intestinal discontinuity in DCL is associated with increased mortality and septic complications.
在创伤控制性剖腹手术(DCL)中,肠损伤往往是不连续的。本研究比较了肠不连续性患者与直接吻合患者的预后。方法前瞻性多中心AAST研究,纳入需要DCL合并肠切除术的患者。患者分为肠不连续性组和肠连续性组。收集的资料包括临床特征、损伤严重程度、腹膜污染、术中血液制品、晶体和血管升压药物、手术时间、恢复手术结果、筋膜闭合和术后并发症。结果包括死亡率、肠缺血、术后并发症、筋膜闭合和住院时间。结果来自16个中心的246例患者。使用倾向评分匹配,间断组132例患者与连续性组66例患者匹配良好。不连续性与明显较高的死亡率和脓毒性并发症相关。连续组在第二次收回手术时更容易实现筋膜闭合。结论DCL患者肠道不连续性与死亡率和脓毒性并发症增加有关。
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引用次数: 0
Artificial intelligence and machine learning applications in ambulatory surgery - A systematic review. 人工智能和机器学习在门诊手术中的应用——系统综述。
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-11 DOI: 10.1016/j.amjsurg.2025.116775
Santosh Patel, Vinaytosh Mishra, Venkatraman Manda

Background: We aimed to systematically review applications of artificial intelligence (AI) technologies for ambulatory surgical patients.

Methods: We systematically searched PubMed, Scopus, Web of Science, and EBSCOhost (2015-2025). Studies were included if they used artificial intelligence in ambulatory surgical populations.

Results: Of 26 studies identified, machine learning was used in 25, with a predominantly orthopaedic (65.3 %) focus. Except for two, all were originated in the USA. We found four themes: (1) Preoperative patient selection (n = 10) - Random forest (RF) and eXtreme gradient boost (XGBoost) algorithms predicted appropriateness with an area under curve (AUC) 0.72-0.85, (2) Same-day discharge prediction (n = 8) - Ensemble models demonstrated the highest AUC values (3) Postoperative management and complications (n = 3) - Artificial neural network incorporating intra- and postoperative features predicted opioid refill needs (4) Cost prediction (n = 4) - Ensemble models consistently outperformed single-model approaches.

Conclusions: Our review underscores the promising potential of machine learning applications in ambulatory surgery, particularly with ensemble methods. We observed inconsistencies in the models; data related issues and a lack of external validation.

背景:我们旨在系统回顾人工智能(AI)技术在门诊外科患者中的应用。方法:系统检索PubMed、Scopus、Web of Science、EBSCOhost(2015-2025)。在门诊手术人群中使用人工智能的研究也包括在内。结果:在确定的26项研究中,25项研究使用了机器学习,主要集中在骨科(65.3%)。除了两种,其他都起源于美国。我们发现了四个主题:(1)术前患者选择(n = 10) -随机森林(RF)和极限梯度增强(XGBoost)算法预测的适宜性曲线下面积(AUC)为0.72-0.85;(2)当日出院预测(n = 8) -集成模型显示最高的AUC值(3)术后管理和并发症(n = 3) -结合术后和术后特征的人工神经网络预测阿片类药物补充需求(4)成本预测(n = 4) -集成模型始终优于单一模型方法。结论:我们的综述强调了机器学习在门诊手术中的应用潜力,特别是集成方法。我们观察到模型的不一致性;数据相关问题和缺乏外部验证。
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引用次数: 0
A balancing act: Evaluating the impact of a massive transfusion response team on early balanced resuscitation in non-traumatic hemorrhage 平衡行为:评估大规模输血反应小组对非创伤性出血早期平衡复苏的影响。
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-11 DOI: 10.1016/j.amjsurg.2025.116778
Annika Bickford Kay , Sean Shughrou , Sarah Majercik , Cempaka Martial , Sarah Ilstrup , Dave Morris

Background

Massive transfusion protocols (MTP) allow for rapid balanced transfusion. In non-traumatic hemorrhage, a hospital-wide MTP Response Team (MTRT) was created. We hypothesized that MTRT utilization would result in improved adherence to MTP.

Methods

Adult non-traumatic hemorrhage patients with MTP order at a Level 1 trauma center January 2019–December 2023 were analyzed. MTPs managed without MTRT (NRT group) were compared to MTP with MTRT (MTRT group). Primary outcome was achievement of red blood cell (RBC) to fresh frozen plasma (FFP) ratio 1:1.

Results

110 MTRT vs. 138 NRT analyzed. MTRT was associated with RBC:FFP ratio 1.1:1 vs NRT 1.5:1 (p ​= ​0.004), shorter time to first RBC (10 vs 17 ​min, p ​= ​0.0008) and less product wastage.

Conclusion

For non-traumatic hemorrhage, MTRT was associated with more balanced RBC:FFP ratios, faster component transfusion, and less wastage. The clinical impact and scalability of this model across healthcare settings should be investigated.
背景:大规模输血方案(MTP)允许快速平衡输血。在非创伤性出血方面,建立了全院MTP反应小组(MTRT)。我们假设MTRT的使用可以提高MTP的依从性。方法:对某一级创伤中心2019年1月- 2023年12月MTP订单的成人非外伤性出血患者进行分析。将无MTRT治疗的MTP (NRT组)与有MTRT治疗的MTP (MTRT组)进行比较。主要观察指标为红细胞(RBC)与新鲜冷冻血浆(FFP)的比例达到1:1。结果:分析了110例MTRT和138例NRT。MTRT与RBC:FFP比为1.1:1,NRT为1.5:1 (p = 0.004),到第一个RBC的时间更短(10 vs 17分钟,p = 0.0008),产品浪费更少。结论:对于非外伤性出血,MTRT与更平衡的RBC:FFP比率、更快的成分输血和更少的浪费有关。应该调查该模型在医疗保健环境中的临床影响和可扩展性。
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引用次数: 0
Neighborhood deprivation is associated with longer hospital stay for common pediatric surgical procedures independent of complication rates 邻里剥夺与常见儿科外科手术住院时间延长有关,与并发症发生率无关
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-09 DOI: 10.1016/j.amjsurg.2025.116773
Phillip J. Hsu , Katherine Khosrovaneh , Nick Kunnath , Cody L. Mullens , Andrew M. Ibrahim , Samir K. Gadepalli

Background

Neighborhood deprivation begets care delays and complications after children's surgery in single center studies. We aimed to better understand these associations through generalizable data.

Methods

We identified children undergoing six common operations using State Inpatient Databases, defining neighborhood deprivation using Child Opportunity Index. Risk-adjusted length of stay (LOS) and complication rates were compared using multivariable regression.

Results

Among 102,399 children, neighborhood deprivation was associated with race, public insurance, and transfer. On risk-adjusted analysis, children with greater neighborhood deprivation had longer LOS for appendectomy (4.36 vs 4.21 days), skin graft (10.80 vs 8.55 days), and skin excision/debridement (10.45 vs 9.51 days). Risk-adjusted complication rates were not different, and LOS differences persisted in children without complications.

Conclusions

Children from deprived neighborhoods stay longer post-operatively, despite similar complication rates. Factors beyond clinical care are thus associated with utilization, and should inform how payment models and quality metrics account for these non-clinical factors.
背景:在单中心研究中,邻里剥夺会导致儿童手术后护理延迟和并发症。我们的目的是通过可推广的数据来更好地理解这些关联。方法使用国家住院患者数据库识别6种常见手术的儿童,使用儿童机会指数定义邻里剥夺。采用多变量回归比较经风险调整的住院时间(LOS)和并发症发生率。结果在102399名儿童中,邻里剥夺与种族、公共保险和转学有关。在风险调整分析中,邻居剥夺程度较高的儿童阑尾切除术(4.36天vs 4.21天)、皮肤移植(10.80天vs 8.55天)和皮肤切除/清创(10.45天vs 9.51天)的LOS较长。经风险调整的并发症发生率无差异,无并发症儿童的LOS差异持续存在。结论贫困社区儿童术后住院时间较长,并发症发生率相似。因此,临床护理之外的因素与利用率有关,并应告知支付模式和质量指标如何解释这些非临床因素。
{"title":"Neighborhood deprivation is associated with longer hospital stay for common pediatric surgical procedures independent of complication rates","authors":"Phillip J. Hsu ,&nbsp;Katherine Khosrovaneh ,&nbsp;Nick Kunnath ,&nbsp;Cody L. Mullens ,&nbsp;Andrew M. Ibrahim ,&nbsp;Samir K. Gadepalli","doi":"10.1016/j.amjsurg.2025.116773","DOIUrl":"10.1016/j.amjsurg.2025.116773","url":null,"abstract":"<div><h3>Background</h3><div>Neighborhood deprivation begets care delays and complications after children's surgery in single center studies. We aimed to better understand these associations through generalizable data.</div></div><div><h3>Methods</h3><div>We identified children undergoing six common operations using State Inpatient Databases, defining neighborhood deprivation using Child Opportunity Index. Risk-adjusted length of stay (LOS) and complication rates were compared using multivariable regression.</div></div><div><h3>Results</h3><div>Among 102,399 children, neighborhood deprivation was associated with race, public insurance, and transfer. On risk-adjusted analysis, children with greater neighborhood deprivation had longer LOS for appendectomy (4.36 vs 4.21 days), skin graft (10.80 vs 8.55 days), and skin excision/debridement (10.45 vs 9.51 days). Risk-adjusted complication rates were not different, and LOS differences persisted in children without complications.</div></div><div><h3>Conclusions</h3><div>Children from deprived neighborhoods stay longer post-operatively, despite similar complication rates. Factors beyond clinical care are thus associated with utilization, and should inform how payment models and quality metrics account for these non-clinical factors.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116773"},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882037","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}
引用次数: 0
Cost analysis in thyroid cancer clinical trials: Toward value-based oncology care 甲状腺癌临床试验的成本分析:走向基于价值的肿瘤护理
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-09 DOI: 10.1016/j.amjsurg.2025.116772
James L. Rogers , Sebastian Henostroza , Adam Fahey , Carmen C. Solórzano

Background

Clinical trials are crucial in advancing novel therapies for thyroid cancer. Given the increased cost of modern healthcare, cost considerations in clinical trials are important yet remain under-reported.

Methods

A search of ClinicalTrials.gov identified thyroid cancer studies including cost in the trial description or as an outcome. Data collected included trial information, cost outcomes, and cost-effectiveness analyses.

Results

Among 46 thyroid cancer-focused clinical trials, only 28 (60.8 ​%) mentioned cost in any capacity, of which 21 (75 ​%) included cost outcomes and 7 (25 ​%) included cost-effectiveness analyses. Overall, cost was a primary outcome in 1 (2.2 ​%) trial, secondary outcome in 20 (43.5 ​%) trials, and exploratory outcome in 7 (15.2 ​%) trials.

Conclusion

The inclusion of cost analysis in thyroid cancer clinical trials is limited. Given rising cost pressures in modern healthcare systems, the low prevalence of cost endpoints and cost-effectiveness analyses underscores the need for increased awareness and investment in this domain.
临床试验是推进甲状腺癌新疗法的关键。鉴于现代医疗保健成本的增加,临床试验中的成本考虑很重要,但仍未得到充分报道。方法在ClinicalTrials.gov网站上搜索甲状腺癌研究,在试验描述或结果中包括成本。收集的数据包括试验信息、成本结果和成本效益分析。结果在46项甲状腺癌临床试验中,只有28项(60.8%)以任何方式提及成本,其中21项(75%)包括成本结果,7项(25%)包括成本-效果分析。总体而言,成本是1项(2.2%)试验的主要结局,20项(43.5%)试验的次要结局,7项(15.2%)试验的探索性结局。结论在甲状腺癌临床试验中纳入成本分析存在局限性。鉴于现代医疗保健系统成本压力的上升,成本端点和成本效益分析的低流行率强调了在这一领域提高认识和投资的必要性。
{"title":"Cost analysis in thyroid cancer clinical trials: Toward value-based oncology care","authors":"James L. Rogers ,&nbsp;Sebastian Henostroza ,&nbsp;Adam Fahey ,&nbsp;Carmen C. Solórzano","doi":"10.1016/j.amjsurg.2025.116772","DOIUrl":"10.1016/j.amjsurg.2025.116772","url":null,"abstract":"<div><h3>Background</h3><div>Clinical trials are crucial in advancing novel therapies for thyroid cancer. Given the increased cost of modern healthcare, cost considerations in clinical trials are important yet remain under-reported.</div></div><div><h3>Methods</h3><div>A search of <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> identified thyroid cancer studies including cost in the trial description or as an outcome. Data collected included trial information, cost outcomes, and cost-effectiveness analyses.</div></div><div><h3>Results</h3><div>Among 46 thyroid cancer-focused clinical trials, only 28 (60.8 ​%) mentioned cost in any capacity, of which 21 (75 ​%) included cost outcomes and 7 (25 ​%) included cost-effectiveness analyses. Overall, cost was a primary outcome in 1 (2.2 ​%) trial, secondary outcome in 20 (43.5 ​%) trials, and exploratory outcome in 7 (15.2 ​%) trials.</div></div><div><h3>Conclusion</h3><div>The inclusion of cost analysis in thyroid cancer clinical trials is limited. Given rising cost pressures in modern healthcare systems, the low prevalence of cost endpoints and cost-effectiveness analyses underscores the need for increased awareness and investment in this domain.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116772"},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733225","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}
引用次数: 0
Robotic assisted versus laparoscopic duodenal switch procedures: A nationwide propensity score matched analysis 机器人辅助与腹腔镜十二指肠切换程序:全国倾向评分匹配分析
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-08 DOI: 10.1016/j.amjsurg.2025.116766
Yuki Liu , Yu-Hsiang Kao , Naomi C. Hamm , Feibi Zheng , Michael A. Edwards

Background

Research comparing the outcomes of robotic-assisted and laparoscopic duodenal switch (DS) procedures in the US have relied primarily on the same data source and have not considered economic outcomes. Studies using alternative data sources are needed to better understand the health and economic impact of surgery modality for patients receiving DS procedures.

Objective

To compare perioperative outcomes and cost between robotic-assisted and laparoscopic DS procedures.

Setting

Data from the Premier Healthcare Database (PHD), a multi-center, hospital-based database.

Methods

A retrospective cohort study from January 1, 2017, to December 31, 2023, including primary robotic-assisted or laparoscopic elective DS procedures. Propensity score matched analysis was performed. Perioperative and 30-day complications and cost were compared.

Results

The study cohort included 4221 DS patients, 36 % robotic and 64 % laparoscopic. Patients receiving an R-DS had a higher BMI and Charlson Comorbidity Index (CCI). After matching, 1073 patients per cohort were analyzed. R-DS procedures had a longer median operative time (230 min vs. 186 min, p < .001) and less gastrointestinal (GI) bleeding (0.2 % vs. 0.9 %, p = .0021). All other adverse outcomes were comparable. For the matched cohort, there was a significant decrease in 30-day cost (p < .001) and complication rates (p < .001) for R-DS, but not L-DS. Median 30-day perioperative costs were similar for R-DS and L-DS in 2023 ($17,156 and $16,476 for R-DS and L-DS, respectively).

Conclusion

R-DS and L-DS have comparable outcomes and costs. Overall complications and costs associated with DS procedures are decreasing. R-DS procedures have longer operation time and lower risk of GI bleeding.
在美国,比较机器人辅助和腹腔镜十二指肠开关(DS)手术结果的研究主要依赖于相同的数据来源,没有考虑经济结果。需要使用其他数据来源进行研究,以更好地了解手术方式对接受退行性椎体滑移手术的患者的健康和经济影响。目的比较机器人辅助和腹腔镜下退行性椎体滑移手术的围手术期疗效和费用。来自Premier Healthcare Database (PHD)的SettingData,这是一个多中心、基于医院的数据库。方法2017年1月1日至2023年12月31日的回顾性队列研究,包括主要机器人辅助或腹腔镜选择性退行性椎体滑移手术。进行倾向评分匹配分析。比较围手术期和30天并发症及费用。结果研究队列包括4221例退行性椎体滑移患者,36%为机器人手术,64%为腹腔镜手术。接受R-DS的患者有较高的BMI和Charlson合并症指数(CCI)。匹配后,每个队列分析1073例患者。R-DS手术的中位手术时间较长(230分钟对186分钟,p < 0.001),胃肠道出血较少(0.2%对0.9%,p = 0.0021)。所有其他不良结果具有可比性。在匹配的队列中,R-DS的30天成本(p < 0.001)和并发症发生率(p < 0.001)显著降低,而L-DS则没有。2023年,R-DS和L-DS的中位30天围手术期费用相似(R-DS和L-DS分别为17,156美元和16,476美元)。结论r - ds和L-DS的预后和成本相当。与DS手术相关的总体并发症和费用正在减少。R-DS手术时间较长,消化道出血风险较低。
{"title":"Robotic assisted versus laparoscopic duodenal switch procedures: A nationwide propensity score matched analysis","authors":"Yuki Liu ,&nbsp;Yu-Hsiang Kao ,&nbsp;Naomi C. Hamm ,&nbsp;Feibi Zheng ,&nbsp;Michael A. Edwards","doi":"10.1016/j.amjsurg.2025.116766","DOIUrl":"10.1016/j.amjsurg.2025.116766","url":null,"abstract":"<div><h3>Background</h3><div>Research comparing the outcomes of robotic-assisted and laparoscopic duodenal switch (DS) procedures in the US have relied primarily on the same data source and have not considered economic outcomes. Studies using alternative data sources are needed to better understand the health and economic impact of surgery modality for patients receiving DS procedures.</div></div><div><h3>Objective</h3><div>To compare perioperative outcomes and cost between robotic-assisted and laparoscopic DS procedures.</div></div><div><h3>Setting</h3><div>Data from the Premier Healthcare Database (PHD), a multi-center, hospital-based database.</div></div><div><h3>Methods</h3><div>A retrospective cohort study from January 1, 2017, to December 31, 2023, including primary robotic-assisted or laparoscopic elective DS procedures. Propensity score matched analysis was performed. Perioperative and 30-day complications and cost were compared.</div></div><div><h3>Results</h3><div>The study cohort included 4221 DS patients, 36 % robotic and 64 % laparoscopic. Patients receiving an R-DS had a higher BMI and Charlson Comorbidity Index (CCI). After matching, 1073 patients per cohort were analyzed. R-DS procedures had a longer median operative time (230 min vs. 186 min, p &lt; .001) and less gastrointestinal (GI) bleeding (0.2 % vs. 0.9 %, p = .0021). All other adverse outcomes were comparable. For the matched cohort, there was a significant decrease in 30-day cost (p &lt; .001) and complication rates (p &lt; .001) for R-DS, but not L-DS. Median 30-day perioperative costs were similar for R-DS and L-DS in 2023 ($17,156 and $16,476 for R-DS and L-DS, respectively).</div></div><div><h3>Conclusion</h3><div>R-DS and L-DS have comparable outcomes and costs. Overall complications and costs associated with DS procedures are decreasing. R-DS procedures have longer operation time and lower risk of GI bleeding.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116766"},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838745","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}
引用次数: 0
The people left behind. 留下来的人。
IF 2.7 3区 医学 Q1 SURGERY Pub Date : 2025-12-08 DOI: 10.1016/j.amjsurg.2025.116770
Lyen C Huang, Kevin D Helling
{"title":"The people left behind.","authors":"Lyen C Huang, Kevin D Helling","doi":"10.1016/j.amjsurg.2025.116770","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116770","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116770"},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740696","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}
引用次数: 0
期刊
American journal of surgery
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