American journal of surgery最新文献

英文中文

See one, do one, teach one - Trends in resident autonomy and teaching assistant cases during general surgery residency in the United States: A nationwide retrospective analysis 看一个，做一个，教一个--美国普外科住院医师培训期间住院医师自主权和助教病例的趋势：全国范围内的回顾性分析。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.amjsurg.2024.115952

Introduction

Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce.

Methods

A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume.

Results

Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 % increase; τ = 0.610, p = 0.001). There was a concurrent 72.7 % increase in TA cases from a median of 22–38 (τ = 0.574, p = 0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017.

The uptrend in TA cases was associated with the significant increase in colorectal (τ = 0.559, p = 0.001), general surgery-other (τ = 0.404, p = 0.018), and hepatopancreaticobiliary (HPB) (τ = 0.596, p = 0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ = 0.956, p=<0.001), HPB (τ = 0.713, p=<0.001) and colorectal (τ = 0.522, p = 0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ = −0.485, p = 0.006) and vascular surgery (τ = 0.603, p = 0.001) dropped significantly.

The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 %) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023.

Conclusions

Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.

导言：住院医师培训期间的自主性对于培养合格的外科医生至关重要。教学助手（TA）"病例是这一过程的重要组成部分，是住院医师获得信心和磨练术中技能不可或缺的机会。然而，有关毕业生所完成病例的数量和多样性的高质量数据却很少：我们从公开收集的 2006 年至 2023 年 ACGME 认可项目毕业的普外科住院医师的手术病例日志数据中进行了回顾性分析。检索了外科医生主任病例和助教病例总数的中位数数据。收集的数据根据亚专科进行整理。采用Mann-Kendall趋势检验法研究TA病例和外科医生主任手术量的趋势：2007年至2023年期间，外科医生主刀病例从229例逐渐增加到274例（增加19.6%；τ = 0.610，p = 0.001）。同时，助产士病例也从中位数的 22-38 例增加了 72.7%（τ = 0.574，p = 0.001）。外科医生主任（每位住院医师 283 例）和 TA 病例（每位住院医师 43 例）在 2018-2019 年和 2016-2017 年达到高峰。TA病例的上升趋势与结直肠（τ = 0.559，p = 0.001）、普通外科-其他（τ = 0.404，p = 0.018）和肝胆胰（HPB）（τ = 0.596，p = 0.001）亚专科的显著增加有关。创伤和血管外科没有明显变化。就主治病例总数而言，普外科-其他（τ = 0.956，p=结论：在过去的十七年中，外科医生主治病例和TA病例的数量呈逐渐上升趋势。虽然这是自主性提高的一个积极指标，但进一步的研究必须侧重于提高住院医师自主性的策略，以安全地培养全面发展的外科医生。

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引用次数: 0

Table of Contents (3 pgs) 目录（3 页）

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-10 DOI: 10.1016/S0002-9610(24)00472-0

引用次数: 0

From the Editor – In – Chief: Featured papers in the November 2024 issue 主编的话2024 年 11 月刊的特色论文。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.amjsurg.2024.115957

引用次数: 0

Evaluating patient experience with a surgical navigation program for under-resourced patients 评估为资源不足的患者提供手术导航计划的患者体验

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.amjsurg.2024.115955

Background

This study aimed to characterize patient satisfaction with navigators and surgical care accessed through a novel navigation program for under-resourced communities.

Methods

PSN-I and PSQ-18 questionnaires assessed satisfaction with navigators and care, respectively. Primary outcomes were PSN-I and PSQ-18 scores. Secondary analyses tested associations between satisfaction and patient factors and between PSN-I and PSQ-18 scores.

Results

Of 294 patients contacted, 88 (29.9 %) responded. Most were Hispanic/Latinx (76.1 %), Spanish-speaking (71.5 %), and uninsured (85.2 %). Participants were highly satisfied with navigators (mean 38.5, SD 7.6; max. 45) and most care domains except Financial Aspects (mean 3.2, SD 1.0; max. 5) and Accessibility/Convenience (mean 3.5, SD 0.6; max. 5). Higher navigator satisfaction was associated with post-consultation need for surgery (coeff. 5.6, 95 % CI[0.9, 10.3]) and increased the odds of care satisfaction (OR 1.1, 95 % CI[1.0, 1.2]).

Conclusions

Patients are satisfied with navigation services—a previously unstudied aspect of this unique surgical equity program.

背景本研究旨在了解患者对导航员的满意度，以及通过一项针对资源匮乏社区的新型导航计划获得的手术护理的特点。方法PSN-I 和 PSQ-18 问卷分别评估患者对导航员和护理的满意度。主要结果为 PSN-I 和 PSQ-18 分数。二次分析检验了满意度与患者因素之间以及 PSN-I 和 PSQ-18 分数之间的关联。大多数患者为西班牙/拉美裔（76.1%）、讲西班牙语（71.5%）、无保险（85.2%）。参与者对导航员（平均值 38.5，标准差 7.6；最高值 45）以及除财务方面（平均值 3.2，标准差 1.0；最高值 5）和可及性/便利性（平均值 3.5，标准差 0.6；最高值 5）以外的大多数护理领域都非常满意。较高的导航员满意度与会诊后的手术需求相关（系数为 5.6，95 % CI[0.9，10.3]），并增加了护理满意度的几率（OR 1.1，95 % CI[1.0，1.2]）。

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引用次数: 0

Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study 权衡利弊：在一项回顾性队列研究中探讨轻型和重型聚丙烯网在腹股沟疝修补术中的不同效果

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-07 DOI: 10.1016/j.amjsurg.2024.115950

Background

Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34–36 g/m2) and heavy-weight polypropylene (HW-PP, 95 g/m2) meshes.

Methods

Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications.

Results

Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 % and 39.5 %. According to EHS, 31.5 %, 22.3 % and 46.2 % were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities.

Conclusion

1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.

背景咽喉疝修补术是一种常见的外科手术，每年有 2000 多万病例。在临床实践中，对不同类型网片的选择各不相同。比较轻型聚丙烯网片（LW-PP，34-36 克/平方米）和重型聚丙烯网片（HW-PP，95 克/平方米）。选择标准确保同质性。终点是使用简表 36（SF-36）评估不同网片重量对总体健康相关生活质量（HRQoL）的影响，并监测术后并发症。发生侧疝和直疝的比例分别为 60.5% 和 39.5%。根据 EHS，31.5%、22.3% 和 46.2% 的疝气分为 1、2 和 3 级。随访结果显示，30 天后的 HRQoL 相似，12 个月后，LW-PP 网片有减少限制、提高舒适度和改善总体健康的良好趋势。结论术后1年的HRQoL评估显示，LW-PP网片无劣势。网片的选择应量体裁衣，以提高疗效和术后舒适度为目标。

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引用次数: 0

Analyzing X and LinkedIn usage among society of asian academic surgeons officers. 分析亚洲学术外科医生协会官员对 X 和 LinkedIn 的使用情况。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-05 DOI: 10.1016/j.amjsurg.2024.115954

Sanjana Balachandra, Kaavya Jaichandar, Ramsha Akhund, Ashba Allahwasaya, Zhixing Song, Daniel Chu, Kristen Wong, Herbert Chen

引用次数: 0

Surgeon as teacher Scott Warner Woods Memorial Lecture Midwest Surgical Association Mackinac Island, Michigan. 作为教师的外科医生斯科特-华纳-伍兹纪念讲座中西部外科协会，密歇根州麦基那克岛。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-04 DOI: 10.1016/j.amjsurg.2024.115946

Grace J Kim

Though a key component of the surgical training paradigm envisioned by Halstead and critical for the generation of future surgeons, teaching surgery is increasingly challenging. The qualities and practices of effective educators have been published and can be acquired through practice. Teaching allows us to connect with our learners and the larger surgical community.

虽然外科教学是 Halstead 构想的外科培训模式的关键组成部分，对培养未来的外科医生至关重要，但其挑战性与日俱增。有效教育者的素质和做法已经公布，可以通过实践获得。教学可以让我们与学员和更广泛的外科界建立联系。

引用次数: 0

Clinician perspectives on the perioperative roles and responsibilities of anesthesia, surgery, and primary care. 临床医生对麻醉、手术和基础护理在围手术期的作用和责任的看法。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-01 DOI: 10.1016/j.amjsurg.2024.115948

Donna Ron, Madison M Ballacchino, Alexandra Briggs, Stacie G Deiner

Background: Although high-risk older patients benefit from a multidisciplinary approach to perioperative care, the specific roles and responsibilities of the clinicians involved have yet to be adequately characterized.

Methods: Qualitative analysis of semi-structured interviews with four anesthesia preoperative clinic providers, seven surgeons, and nine primary care providers in northern New England.

Results: The analysis revealed both distinct and overlapping roles and responsibilities. Anesthesia providers were described as a "safety net" and surgeons as "captain of the ship", in charge of getting "all the ducks in a row" to avoid surgery delays and cancellations. Primary care providers saw themselves as the "quarterback", ensuring care continuity and consideration of patient psychosocial factors.

Conclusions: While all have a shared responsibility for facilitating patient-centered decision-making and a safe perioperative course, each discipline has different areas of focus and expertise. Role clarification can help optimize the distribution of responsibilities and enhance perioperative communication and collaboration.

背景：尽管高风险老年患者可从多学科围手术期护理中获益，但相关临床医生的具体角色和责任仍有待充分确定：尽管高风险老年患者受益于围术期护理的多学科方法，但相关临床医生的具体角色和责任尚未得到充分描述：方法：对新英格兰北部地区的四名麻醉术前诊所提供者、七名外科医生和九名初级保健提供者进行的半结构化访谈进行定性分析：结果：分析结果表明，他们的角色和职责既有区别又有重叠。麻醉提供者被描述为 "安全网"，而外科医生被描述为 "船长"，负责 "万无一失"，以避免手术延误和取消。初级医疗服务提供者将自己视为 "四分卫"，确保医疗服务的连续性并考虑患者的社会心理因素：虽然各学科都有责任促进以患者为中心的决策和安全的围手术期，但每个学科都有不同的重点领域和专长。明确角色有助于优化责任分配，加强围手术期的沟通与合作。

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引用次数: 0

Temporal research trends in parathyroid surgery 甲状旁腺手术的时间研究趋势

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-30 DOI: 10.1016/j.amjsurg.2024.115941

Background

Progress has been observed in the pathophysiology of calcium homeostasis, localization studies, and intraoperative adjuncts in parathyroid surgery. The aim of this study is to gain a comprehensive perspective on the research landscape of parathyroid surgery over time.

Methods

A search of the Web of Science Core Collection was conducted to identify publications on parathyroid surgery from 1985 to 2024. Keywords were manually curated, and their frequencies were calculated based on the publication year.

Results

Publications on secondary hyperparathyroidism have decreased in recent years, but those on calcimimetics, tertiary hyperparathyroidism, and parathyroid cancer have increased. Publications related to sestamibi scans have decreased, while research on four-dimensional computed tomography and positron emission tomography has increased. Research on fluorescence and ablation treatment has recently been on the rise. The citation count per publication was positively correlated with the number of contributing institutions.

Conclusion

We provide an overview of contemporary research themes and emerging topics related to parathyroid surgery. The endocrine surgery community could benefit from more inter-institutional partnerships to foster scientific progress.

背景甲状旁腺手术在钙稳态的病理生理学、定位研究和术中辅助治疗方面取得了进展。本研究旨在全面透视甲状旁腺手术的长期研究状况。方法通过检索科学网核心文献集，找出1985年至2024年间有关甲状旁腺手术的论文。结果近年来，有关继发性甲状旁腺功能亢进症的文献有所减少，但有关钙亚胺类药物、三级甲状旁腺功能亢进症和甲状旁腺癌的文献有所增加。与西他嘧啶扫描有关的论文有所减少，而与四维计算机断层扫描和正电子发射断层扫描有关的研究则有所增加。有关荧光和消融治疗的研究最近有所增加。每篇论文的引用次数与投稿机构的数量呈正相关。内分泌外科界可以从更多的机构间合作中获益，从而促进科学进步。

{"title":"Temporal research trends in parathyroid surgery","authors":"","doi":"10.1016/j.amjsurg.2024.115941","DOIUrl":"10.1016/j.amjsurg.2024.115941","url":null,"abstract":"<div><h3>Background</h3><p>Progress has been observed in the pathophysiology of calcium homeostasis, localization studies, and intraoperative adjuncts in parathyroid surgery. The aim of this study is to gain a comprehensive perspective on the research landscape of parathyroid surgery over time.</p></div><div><h3>Methods</h3><p>A search of the Web of Science Core Collection was conducted to identify publications on parathyroid surgery from 1985 to 2024. Keywords were manually curated, and their frequencies were calculated based on the publication year.</p></div><div><h3>Results</h3><p>Publications on secondary hyperparathyroidism have decreased in recent years, but those on calcimimetics, tertiary hyperparathyroidism, and parathyroid cancer have increased. Publications related to sestamibi scans have decreased, while research on four-dimensional computed tomography and positron emission tomography has increased. Research on fluorescence and ablation treatment has recently been on the rise. The citation count per publication was positively correlated with the number of contributing institutions.</p></div><div><h3>Conclusion</h3><p>We provide an overview of contemporary research themes and emerging topics related to parathyroid surgery. The endocrine surgery community could benefit from more inter-institutional partnerships to foster scientific progress.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136175","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 optimal management of blunt aortic injury in the young 年轻人主动脉钝挫伤的最佳治疗方法

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-30 DOI: 10.1016/j.amjsurg.2024.115943

Background

Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset.

Methods

Patients (1–19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1–9] and adolescents [ages 10–19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI.

Results

Adolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 %, p = 0.057) and significantly reduced mortality (2.1 vs 14.4 %, p < 0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059–0.324, p < 0.0001).

Conclusions

BAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.

背景钝性主动脉损伤（BAI）在儿科人群中相对少见。本研究的目的是利用一个大型全国性数据集，对儿童和青少年的 BAI 处理情况进行研究。方法从创伤质量改进计划 (TQIP) 数据库中找出 14 年来的 BAI 患者（1-19 岁）。按年龄组（儿童[1-9 岁]和青少年[10-19 岁]）对患者进行分层并进行比较。结果与接受非手术治疗的青少年相比，接受TEVAR治疗的青少年发病率相似（16.8% vs 12.6%，p = 0.057），死亡率显著降低（2.1% vs 14.4%，p < 0.0001）。MLR发现，使用TEVAR是唯一与死亡率降低显著相关的可调整风险因素（OR 0.138; 95%CI 0.059-0.324, p < 0.0001）。对于患有 BAI 的儿童患者，非手术治疗可以安全地控制病情，而血管内修复术可以改善青少年的预后。

{"title":"The optimal management of blunt aortic injury in the young","authors":"","doi":"10.1016/j.amjsurg.2024.115943","DOIUrl":"10.1016/j.amjsurg.2024.115943","url":null,"abstract":"<div><h3>Background</h3><p>Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset.</p></div><div><h3>Methods</h3><p>Patients (1–19 years of age) with BAI were identified from the Trauma Quality Improvement Program (TQIP) database over 14-years. Patients were stratified by age group (children [ages 1–9] and adolescents [ages 10–19]) and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality in adolescents with BAI.</p></div><div><h3>Results</h3><p>Adolescents undergoing TEVAR had similar morbidity (16.8 vs 12.6 %, p = 0.057) and significantly reduced mortality (2.1 vs 14.4 %, p < 0.0001) compared to those adolescents managed non-operatively. MLR identified use of TEVAR as the only modifiable risk factor significantly associated with reduced mortality (OR 0.138; 95%CI 0.059–0.324, p < 0.0001).</p></div><div><h3>Conclusions</h3><p>BAI leads to significant morbidity and mortality for both children and adolescents. For pediatric patients with BAI, children may be safely managed non-operatively, while an endovascular repair may improve outcomes for adolescents.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136073","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

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