Pub Date : 2024-09-18DOI: 10.1016/j.amjsurg.2024.115976
Purpose
The surgical clerkship provides medical students with valuable hands-on experience. This study examined why medical students speak or remain silent in the OR to improve progression from novice to engaged surgical team member.
Methods
Using Constructivist Grounded Theory 37 interviews were conducted concerning expectations and behaviors that encourage or discourage students from speaking during their clerkship. Transcripts were coded, analyzed, and triangulated to develop a conceptual model.
Results
Students’ decision to speak or remain silent was based on their perception of the OR as a safe learning space. Our findings suggest that better preparation, awareness of critical moments, and informal communication with team members encouraged student speech.
Conclusions
Medical students remain conflicted about their speaking in the OR and their evaluation. Key to improving students’ psychological safety is establishment of interpersonal relationships, awareness of OR mood, and assignment of case-related tasks to assist with OR assimilation and improved learning.
{"title":"To speak or not to speak: Factors influencing medical students’ speech and silence in the operating room","authors":"","doi":"10.1016/j.amjsurg.2024.115976","DOIUrl":"10.1016/j.amjsurg.2024.115976","url":null,"abstract":"<div><h3>Purpose</h3><div>The surgical clerkship provides medical students with valuable hands-on experience. This study examined why medical students speak or remain silent in the OR to improve progression from novice to engaged surgical team member.</div></div><div><h3>Methods</h3><div>Using Constructivist Grounded Theory 37 interviews were conducted concerning expectations and behaviors that encourage or discourage students from speaking during their clerkship. Transcripts were coded, analyzed, and triangulated to develop a conceptual model.</div></div><div><h3>Results</h3><div>Students’ decision to speak or remain silent was based on their perception of the OR as a safe learning space. Our findings suggest that better preparation, awareness of critical moments, and informal communication with team members encouraged student speech.</div></div><div><h3>Conclusions</h3><div>Medical students remain conflicted about their speaking in the OR and their evaluation. Key to improving students’ psychological safety is establishment of interpersonal relationships, awareness of OR mood, and assignment of case-related tasks to assist with OR assimilation and improved learning.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322587","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 : 2024-09-18DOI: 10.1016/j.amjsurg.2024.115982
Introduction
The aim was to leverage electronic health record (EHR) smartphrases to improve compliance with the modified Brain Injury Guidelines (mBIG).
Methods
Smartphrases were developed for the trauma team and radiology and implemented December 2022. Traumatic brain injury (TBI) patients meeting mBIG inclusion from 03/2021- 07/2023 were reviewed. Smartphrase usage and clinical compliance with mBIG (measured by percent reduction of repeat head imaging, ICU admissions, and neurosurgery consults) were compared pre- and post-intervention.
Results
268 cases were examined. Post-intervention, mBIG1 patients had significantly fewer neurosurgery consults (82.4 % vs. 50.0 %, OR = 0.21, p = 0.03), while mBIG2 patients had significantly fewer repeat head CTs (91.0 % vs. 66.7 %, OR = 0.2, p = 0.01), ICU admissions (66.7 % vs. 38.5 %, OR = 0.31, p = 0.02) and neurosurgery consults (93.9 % vs. 56.4 %, OR = 0.08, p < 0.01).
Conclusion
Standardized smartphrases can streamline workflow and significantly improve trauma team compliance with best practice guidelines for TBI and reduce unnecessary imaging, consults, and costly ICU admissions.
{"title":"Leveraging an EHR tool to improve provider adherence to the modified brain injury guidelines","authors":"","doi":"10.1016/j.amjsurg.2024.115982","DOIUrl":"10.1016/j.amjsurg.2024.115982","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim was to leverage electronic health record (EHR) smartphrases to improve compliance with the modified Brain Injury Guidelines (mBIG).</div></div><div><h3>Methods</h3><div>Smartphrases were developed for the trauma team and radiology and implemented December 2022. Traumatic brain injury (TBI) patients meeting mBIG inclusion from 03/2021- 07/2023 were reviewed. Smartphrase usage and clinical compliance with mBIG (measured by percent reduction of repeat head imaging, ICU admissions, and neurosurgery consults) were compared pre- and post-intervention.</div></div><div><h3>Results</h3><div>268 cases were examined. Post-intervention, mBIG1 patients had significantly fewer neurosurgery consults (82.4 % vs. 50.0 %, OR = 0.21, p = 0.03), while mBIG2 patients had significantly fewer repeat head CTs (91.0 % vs. 66.7 %, OR = 0.2, p = 0.01), ICU admissions (66.7 % vs. 38.5 %, OR = 0.31, p = 0.02) and neurosurgery consults (93.9 % vs. 56.4 %, OR = 0.08, p < 0.01).</div></div><div><h3>Conclusion</h3><div>Standardized smartphrases can streamline workflow and significantly improve trauma team compliance with best practice guidelines for TBI and reduce unnecessary imaging, consults, and costly ICU admissions.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315927","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 : 2024-09-18DOI: 10.1016/j.amjsurg.2024.115983
Background
Early identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers.
Methods
A retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013–2015 and 2017–2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration.
Results
The study comprised 902,231 trauma patients (N2013–2015 = 180,601; N2017–2019 = 721,630), with a median age of 52 in both periods, 64–65 % male, and approximately 90 % sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013–2015) versus 9 (2017–2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 %, VAP incidence was 0.7 %. The original model demonstrated good to excellent discrimination for both periods (c-statistic2013–2015 0.84, 95%CI 0.83–0.84; c-statistic2017–2019 0.92, 95%CI 0.91–0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved.
Conclusions
The Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.
{"title":"Predicting nosocomial pneumonia risk in level-1 trauma patients: An external validation study using the trauma quality improvement program","authors":"","doi":"10.1016/j.amjsurg.2024.115983","DOIUrl":"10.1016/j.amjsurg.2024.115983","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers.</div></div><div><h3>Methods</h3><div>A retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013–2015 and 2017–2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration.</div></div><div><h3>Results</h3><div>The study comprised 902,231 trauma patients (N<sub>2013–2015</sub> = 180,601; N<sub>2017–2019</sub> = 721,630), with a median age of 52 in both periods, 64–65 % male, and approximately 90 % sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013–2015) versus 9 (2017–2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 %, VAP incidence was 0.7 %. The original model demonstrated good to excellent discrimination for both periods (c-statistic<sub>2013–2015</sub> 0.84, 95%CI 0.83–0.84; c-statistic<sub>2017–2019</sub> 0.92, 95%CI 0.91–0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved.</div></div><div><h3>Conclusions</h3><div>The Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387354","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 : 2024-09-18DOI: 10.1016/j.amjsurg.2024.115977
Bridget Foy, Abigail Ludwigson, Nicole M Mott, Monica Adams, Madeline G Higgins, Sudheer Vemuru, Dulcy Wolverton, Jeniann Yi, Sharon Sams, Chen-Tan Lin, Randy Miles, Nancy Taft, Erin Baurle, Ethan Cumbler, Sarah Tevis
Background: Through online health portals, patients receive complex medical reports without interpretation from their healthcare provider. This study evaluated the usability of MedEd, a patient engagement tool providing definitions of medical terminology in breast pathology and radiology reports.
Methods: Individuals who underwent a normal screening mammogram were invited to complete semi-structured interviews where they downloaded MedEd and discussed their download experience. Acceptability, appropriateness, and feasibility of MedEd were evaluated.
Results: 143 individuals were invited to participate, and 14 semi-structured interviews were completed. Participants reported ease of downloading and navigating MedEd with concerns about privacy and others' abilities to download. Participants demonstrated high acceptability (mean 4.48/5, SD 0.95), appropriateness (mean 4.66/5, SD 0.83), and feasibility (mean 4.48/5, SD 1.04) scores.
Conclusion: Participants expressed excitement for future use of MedEd and provided suggestions for improvements. Next steps include evaluating comprehension of real breast reports while using MedEd and expanding patient access.
{"title":"Helping patients navigate the immediate release of medical records: MedEd, a novel patient engagement technology.","authors":"Bridget Foy, Abigail Ludwigson, Nicole M Mott, Monica Adams, Madeline G Higgins, Sudheer Vemuru, Dulcy Wolverton, Jeniann Yi, Sharon Sams, Chen-Tan Lin, Randy Miles, Nancy Taft, Erin Baurle, Ethan Cumbler, Sarah Tevis","doi":"10.1016/j.amjsurg.2024.115977","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115977","url":null,"abstract":"<p><strong>Background: </strong>Through online health portals, patients receive complex medical reports without interpretation from their healthcare provider. This study evaluated the usability of MedEd, a patient engagement tool providing definitions of medical terminology in breast pathology and radiology reports.</p><p><strong>Methods: </strong>Individuals who underwent a normal screening mammogram were invited to complete semi-structured interviews where they downloaded MedEd and discussed their download experience. Acceptability, appropriateness, and feasibility of MedEd were evaluated.</p><p><strong>Results: </strong>143 individuals were invited to participate, and 14 semi-structured interviews were completed. Participants reported ease of downloading and navigating MedEd with concerns about privacy and others' abilities to download. Participants demonstrated high acceptability (mean 4.48/5, SD 0.95), appropriateness (mean 4.66/5, SD 0.83), and feasibility (mean 4.48/5, SD 1.04) scores.</p><p><strong>Conclusion: </strong>Participants expressed excitement for future use of MedEd and provided suggestions for improvements. Next steps include evaluating comprehension of real breast reports while using MedEd and expanding patient access.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339488","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 : 2024-09-17DOI: 10.1016/j.amjsurg.2024.115978
Background
Primary hyperparathyroidism (PHPT) is a treatable cause of nephrolithiasis. However, PHPT is not consistently evaluated in nephrolithiasis patients. Symptoms of parathyroid disease were explored in relation to evaluation of PHPT in nephrolithiasis patients.
Methods
Patients with nephrolithiasis on imaging between 2017 and 2021 were identified. Measurement of serum calcium levels after nephrolithiasis diagnosis was determined. Patients with hypercalcemia ( 10.2 mg/dL) were identified. Characteristics associated with parathyroid hormone (PTH) evaluation and specialist referral were assessed.
Results
Of 2264 nephrolithiasis patients with calcium levels measured, 383 (17.1 %) had hypercalcemia. Of those, 107 (27.9 %) had PTH levels drawn. PTH was more often assessed in patients with higher median calcium levels, recurrent nephrolithiasis, depression, and osteopenia/osteoporosis. PTH was elevated (>64 pg/mL) or non-suppressed (40–64 pg/mL) in 68 (63.6 %) patients. Of those, 31 (45.6 %) were referred to a parathyroid specialist. Referred patients had higher PTH and calcium levels than those without referral, and higher rates of osteopenia/osteoporosis.
Conclusions
PTH evaluation in hypercalcemic nephrolithiasis patients was low. The majority of patients evaluated had elevated or non-suppressed PTH levels, but only a fraction were referred to a specialist.
{"title":"A thorough evaluation for primary hyperparathyroidism: More than a stone's throw away","authors":"","doi":"10.1016/j.amjsurg.2024.115978","DOIUrl":"10.1016/j.amjsurg.2024.115978","url":null,"abstract":"<div><h3>Background</h3><div>Primary hyperparathyroidism (PHPT) is a treatable cause of nephrolithiasis. However, PHPT is not consistently evaluated in nephrolithiasis patients. Symptoms of parathyroid disease were explored in relation to evaluation of PHPT in nephrolithiasis patients.</div></div><div><h3>Methods</h3><div>Patients with nephrolithiasis on imaging between 2017 and 2021 were identified. Measurement of serum calcium levels after nephrolithiasis diagnosis was determined. Patients with hypercalcemia (<span><math><mrow><mo>≥</mo></mrow></math></span> 10.2 mg/dL) were identified. Characteristics associated with parathyroid hormone (PTH) evaluation and specialist referral were assessed.</div></div><div><h3>Results</h3><div>Of 2264 nephrolithiasis patients with calcium levels measured, 383 (17.1 %) had hypercalcemia. Of those, 107 (27.9 %) had PTH levels drawn. PTH was more often assessed in patients with higher median calcium levels, recurrent nephrolithiasis, depression, and osteopenia/osteoporosis. PTH was elevated (>64 pg/mL) or non-suppressed (40–64 pg/mL) in 68 (63.6 %) patients. Of those, 31 (45.6 %) were referred to a parathyroid specialist. Referred patients had higher PTH and calcium levels than those without referral, and higher rates of osteopenia/osteoporosis.</div></div><div><h3>Conclusions</h3><div>PTH evaluation in hypercalcemic nephrolithiasis patients was low. The majority of patients evaluated had elevated or non-suppressed PTH levels, but only a fraction were referred to a specialist.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315926","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 : 2024-09-17DOI: 10.1016/j.amjsurg.2024.115973
Background
Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.
Methods
A retrospective analysis was performed on trauma patients with iTSAH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and pre-injury antiplatelet/anticoagulant use.
Results
276 patients were identified over the 8-year study period. The median number of head CT scans was 2. Neurosurgery consultation was obtained in 80.4 % of patients. A total of 19 (8.6 %) patients had radiographic progression. Six (2.2 %) patients had neurologic deterioration. No patients required operative intervention or readmission. No deaths were related to iTSAH.
Conclusions
There were no patients with iTSAH that required neurosurgical consultation despite a subset of patients having radiographic or neurologic progression. These patients may not require repeat head CT scan or neurosurgical consult, necessitating a change of SAH definitions in the mBIG.
{"title":"Less is more: Streamlining management of isolated traumatic subarachnoid hemorrhage in the modified brain injury guidelines","authors":"","doi":"10.1016/j.amjsurg.2024.115973","DOIUrl":"10.1016/j.amjsurg.2024.115973","url":null,"abstract":"<div><h3>Background</h3><div>Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on trauma patients with iTSAH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and pre-injury antiplatelet/anticoagulant use.</div></div><div><h3>Results</h3><div>276 patients were identified over the 8-year study period. The median number of head CT scans was 2. Neurosurgery consultation was obtained in 80.4 % of patients. A total of 19 (8.6 %) patients had radiographic progression. Six (2.2 %) patients had neurologic deterioration. No patients required operative intervention or readmission. No deaths were related to iTSAH.</div></div><div><h3>Conclusions</h3><div>There were no patients with iTSAH that required neurosurgical consultation despite a subset of patients having radiographic or neurologic progression. These patients may not require repeat head CT scan or neurosurgical consult, necessitating a change of SAH definitions in the mBIG.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322588","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}
Background: In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions.
Methods: We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology.
Results: Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle.
Conclusions: We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.
{"title":"Gender bias in surgery: A systematic review of qualitative studies.","authors":"Gabriele Eckerdt Lech, Lincólin Bardini Goulart, Carolina Hack Alves, Carolina Polidori Aguiar, Luiza Bertolli Lucchese Moraes, Gabriela Rangel Brandão","doi":"10.1016/j.amjsurg.2024.115974","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115974","url":null,"abstract":"<p><strong>Background: </strong>In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology.</p><p><strong>Results: </strong>Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle.</p><p><strong>Conclusions: </strong>We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279242","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 : 2024-09-14DOI: 10.1016/j.amjsurg.2024.115972
Background
Textbook outcome (TO) is a single composite score representing ideal care for a procedure or medical condition. Short bowel syndrome (SBS) patients are at high risk for complications and death. Our aim was to determine the incidence of and predictive factors for a TO in SBS patients.
Methods
515 adults with SBS were followed for 12 months after initial hospital discharge for SBS. TO was defined based on eight outcome parameters. Demographic data, intestinal anatomy, and nutritional outcome were compared in patients with and without TO.
Results
78 (15 %) patients had a TO. The frequency of the different components of TO were: PN < 1 year (39 %), BMI >18.5 kg/m2 (89 %), no stoma (59 %), no surgical intervention (71 %), no hospital readmission (56 %), no vascular access infection (62 %), absence of end stage liver disease (96 %), and survival (97 %). Intestinal remnant length and anatomy type were predictive of a TO.
Conclusions
A TO is achieved in 15 % SBS patients using the selected criteria. This is largely attributable to continued need for PN. Intestinal length and anatomy were independent predictors of TO.
背景手册结果（TO）是一个单一的综合评分，代表了手术或医疗条件的理想护理效果。短肠综合征（SBS）患者是并发症和死亡的高危人群。我们的目的是确定SBS患者TO的发生率和预测因素。TO的定义基于八个结果参数。结果78例（15%）患者出现了TO。78例（15%）患者出现了TO，TO的不同组成部分的频率分别为PN<1年（39%）、BMI>18.5 kg/m2（89%）、无造口（59%）、无手术干预（71%）、无再入院（56%）、无血管通路感染（62%）、无终末期肝病（96%）和存活（97%）。结论 根据所选标准，15% 的 SBS 患者可获得 TO。这主要归因于继续需要 PN。肠道长度和解剖类型是预测 TO 的独立因素。
{"title":"Textbook outcome in short bowel syndrome","authors":"","doi":"10.1016/j.amjsurg.2024.115972","DOIUrl":"10.1016/j.amjsurg.2024.115972","url":null,"abstract":"<div><h3>Background</h3><p>Textbook outcome (TO) is a single composite score representing ideal care for a procedure or medical condition. Short bowel syndrome (SBS) patients are at high risk for complications and death. Our aim was to determine the incidence of and predictive factors for a TO in SBS patients.</p></div><div><h3>Methods</h3><p>515 adults with SBS were followed for 12 months after initial hospital discharge for SBS. TO was defined based on eight outcome parameters. Demographic data, intestinal anatomy, and nutritional outcome were compared in patients with and without TO.</p></div><div><h3>Results</h3><p>78 (15 %) patients had a TO. The frequency of the different components of TO were: PN < 1 year (39 %), BMI >18.5 kg/m<sup>2</sup> (89 %), no stoma (59 %), no surgical intervention (71 %), no hospital readmission (56 %), no vascular access infection (62 %), absence of end stage liver disease (96 %), and survival (97 %). Intestinal remnant length and anatomy type were predictive of a TO.</p></div><div><h3>Conclusions</h3><p>A TO is achieved in 15 % SBS patients using the selected criteria. This is largely attributable to continued need for PN. Intestinal length and anatomy were independent predictors of TO.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270464","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 : 2024-09-12DOI: 10.1016/j.amjsurg.2024.115944
Background
Anaplastic thyroid cancer (ATC) is highly aggressive with a poor prognosis. Adjuvant systemic therapy and radiation post-surgery are endorsed by NCCN and ATA guidelines. Our study aimed to identify those at risk of forgoing postoperative adjuvant treatment and to determine survival predictors.
Methods
We used the National Cancer Database (NCDB) to identify ATC patients who underwent upfront thyroidectomy from 2010 to 2017, excluding those opting for palliative care. We compared demographics, characteristics, treatments, and outcomes between those who received adjuvant therapy and those who did not. Predictors of receiving adjuvant therapy were identified using logistic regression, while Cox regression identified survival factors.
Results
Of 563 patients, 160 received no adjuvant treatment, 82 received radiation only, 16 received systemic therapy only, and 305 received combination therapy. Notably, over 75 % of patients who did not receive adjuvant treatment had it excluded from their treatment plan, not due to refusal. Older age (OR 0.92) and non-white race/ethnicity (OR 0.33) were significant predictors of not receiving adjuvant therapy. Undergoing a total thyroidectomy, an R0 or R1 resection, and radiation or combination therapy were associated with better survival, while non-metropolitan location, primary tumor size >7.5 cm, and stage IVC disease were negative factors.
Conclusion
Total thyroidectomy, R0/R1 resection, and adjuvant therapy reduce mortality in ATC patients. However, older patients and minorities are less likely to receive adjuvant therapy, underscoring disparities in treatment adherence.
{"title":"Disparities in postoperative adjuvant therapy utilization and factors impacting survival among anaplastic thyroid cancer patients","authors":"","doi":"10.1016/j.amjsurg.2024.115944","DOIUrl":"10.1016/j.amjsurg.2024.115944","url":null,"abstract":"<div><h3>Background</h3><div>Anaplastic thyroid cancer (ATC) is highly aggressive with a poor prognosis. Adjuvant systemic therapy and radiation post-surgery are endorsed by NCCN and ATA guidelines. Our study aimed to identify those at risk of forgoing postoperative adjuvant treatment and to determine survival predictors.</div></div><div><h3>Methods</h3><div>We used the National Cancer Database (NCDB) to identify ATC patients who underwent upfront thyroidectomy from 2010 to 2017, excluding those opting for palliative care. We compared demographics, characteristics, treatments, and outcomes between those who received adjuvant therapy and those who did not. Predictors of receiving adjuvant therapy were identified using logistic regression, while Cox regression identified survival factors.</div></div><div><h3>Results</h3><div>Of 563 patients, 160 received no adjuvant treatment, 82 received radiation only, 16 received systemic therapy only, and 305 received combination therapy. Notably, over 75 % of patients who did not receive adjuvant treatment had it excluded from their treatment plan, not due to refusal. Older age (OR 0.92) and non-white race/ethnicity (OR 0.33) were significant predictors of not receiving adjuvant therapy. Undergoing a total thyroidectomy, an R0 or R1 resection, and radiation or combination therapy were associated with better survival, while non-metropolitan location, primary tumor size >7.5 cm, and stage IVC disease were negative factors.</div></div><div><h3>Conclusion</h3><div>Total thyroidectomy, R0/R1 resection, and adjuvant therapy reduce mortality in ATC patients. However, older patients and minorities are less likely to receive adjuvant therapy, underscoring disparities in treatment adherence.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322700","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 : 2024-09-11DOI: 10.1016/j.amjsurg.2024.115949
Taylor Carter, M Libby Weaver, Brigitte K Smith
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