American journal of surgery最新文献

英文中文

Analysis of ERAS protocol adherence and postoperative outcomes after major colorectal surgery in a community hospital 一家社区医院结直肠大手术后ERAS方案遵守情况和术后效果分析。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.amjsurg.2024.116022

Ashlyn B. White, Steven D. Scarcliff, Tyler J. Stoneman, Dylan S. Schindele, Blake A. Lyon, Charlton T. Nguyen, Sarah E. Thompson, Amy E. Hudson

Despite widespread adoption, the efficacy of Enhanced Recovery After Surgery (ERAS) protocols in community hospital settings remains understudied. This retrospective analysis conducted at a high-volume community hospital aimed to evaluate adherence to ERAS protocols and analyze postoperative outcomes following colorectal surgery. A total of 278 adult patients undergoing elective colorectal surgery between January 2022 and January 2024 were included. Data analysis revealed time to first mobilization proved to be satisfactory in accordance with ERAS hospital guidelines (mean 1.0 ± 0.05 days, range 0.1–13.8 days), and furthermore demonstrated a strong positive correlation with both time to first bowel function (r = 0.69, p < 0.0001) and length of stay (r = 0.25, p < 0.0001). Time to urinary catheter removal occurred slightly after guideline-directed removal (mean 1.1 ± 0.05 days, range 0.5–12.9 days), however did exhibit a significant positive correlation with length of stay (r = 0.33, p < 0.0001). 10.9 % of patients experienced a postoperative complication, while the average length of stay across all procedures was 3.1 ± 0.17 days (range 0.9–23.3 days), and the overall 30-day readmission rate stood at 10.43 %. This study underscores the need for ongoing evaluation and refinement of ERAS protocols in community hospital settings to enhance surgical care and patient satisfaction.

尽管 "术后恢复强化方案"（ERAS）已被广泛采用，但其在社区医院环境中的疗效仍未得到充分研究。这项回顾性分析在一家高流量社区医院进行，旨在评估ERAS方案的遵守情况，并分析结直肠手术的术后效果。共纳入了 2022 年 1 月至 2024 年 1 月间接受择期结直肠手术的 278 名成人患者。数据分析显示，根据ERAS医院指南，患者首次活动时间令人满意（平均为1.0±0.05天，范围为0.1-13.8天），并且与首次排便功能时间呈强正相关（r = 0.69，p＜0.05）。

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引用次数: 0

Unveiling the disparities within: Why we need to disaggregate data for Asian women with breast cancer. 揭示内部差异：为什么我们需要对亚洲女性乳腺癌患者的数据进行分类？

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.amjsurg.2024.116013

Angelena Crown, Amanda L Kong

引用次数: 0

National trends and costs of same day discharge in patients undergoing elective minimally invasive colectomy 接受择期微创结肠切除术的患者当天出院的全国趋势和费用。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-16 DOI: 10.1016/j.amjsurg.2024.116021

Wardah Rafaqat , Mahin Janjua , Omar Mahmud , Bradford James , Baryalay Khan , Hanjo Lee , Aimal Khan

Background

Enhanced Recovery Pathways (ERPs) have enabled safe same day discharge (SDD) of select patients after elective minimally invasive colectomy. We aimed to analyse the financial impact of SDD in these cases.

Methods

We queried the Nationwide Readmission Database (2016–2019) and included patients with a hospital length of stay ≤2 days after minimally invasive elective colectomy. Propensity score matched pairs of patients discharged on the day of the operation and those discharged on post operative day 1 or 2 were compared. Our primary outcome was the combined cost of hospitalization and readmission.

Results

SDD patients had lower comorbidity (33 % vs 21 %) and illness severity (79 % vs 63 %), more Medicare insurance (44 % vs 38 %), and more benign neoplasms (52 % vs 17 %). Most SDD patients underwent right colectomy (89 %). Across 647 matched pairs, total cost was significantly lower in SDD patients ($8000 vs. $12,900; p < 0.001) due to cheaper index hospitalizations. No difference in readmission rates or costs emerged.

Conclusion

SDD reduced costs of index hospitalization and may be cost-effective in a select cohort of healthier patients.

背景：强化康复路径（ERP）使部分择期微创结肠切除术后的患者能够在当天安全出院（SDD）。我们旨在分析 SDD 对这些病例的财务影响：我们查询了全国再入院数据库（2016-2019 年），纳入了微创择期结肠切除术后住院时间≤2 天的患者。对手术当天出院的患者和术后第 1 天或第 2 天出院的患者进行倾向评分配对比较。我们的主要结果是住院和再入院的综合费用：SDD患者的合并症（33% 对 21%）和疾病严重程度（79% 对 63%）较低，医疗保险（44% 对 38%）较多，良性肿瘤（52% 对 17%）较多。大多数 SDD 患者接受了右结肠切除术（89%）。在 647 对配对患者中，SDD 患者的总费用明显较低（8000 美元对 12900 美元；P 结论：SDD 降低了患者的住院费用：SDD 降低了指数住院的费用，对特定的健康患者群体而言可能具有成本效益。

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引用次数: 0

Cognitive conservation in surgery: More than efficiency, efficiency, efficiency. 手术中的认知保护：不仅仅是效率、效率、效率。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-15 DOI: 10.1016/j.amjsurg.2024.116024

Mina Sarofim

引用次数: 0

Histologic parameters driving completion thyroidectomy for papillary thyroid carcinoma in a high-volume institution: A retrospective observational study 在一家高容量医疗机构中，甲状腺乳头状癌组织学参数是完成甲状腺切除术的驱动力：一项回顾性观察研究。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-15 DOI: 10.1016/j.amjsurg.2024.116016

Leonardo Rossi , Andrea De Palma , Carlo Enrico Ambrosini , Lorenzo Fregoli , Antonio Matrone , Rossella Elisei , Gabriele Materazzi

Background

When the histological examination indicates papillary thyroid carcinoma (PTC), there is no unanimity on the need to proceed with completion thyroidectomy (CT). This study aims to assess the histologic parameters that influenced the decision to perform CT.

Materials and methods

This study included PTC patients who underwent thyroid lobectomy between 2019 and 2022. Group A included patients who underwent thyroid lobectomy without further treatments, whereas Group B included those who underwent CT based on histological findings. Differences in terms of histologic parameters were analyzed.

Results

Group A included 291 patients (68.3 %), whereas Group B 135 patients (31.7 %). Multivariate analysis identified associations between CT and tumor size (p < 0.001), aggressive variant (p = 0.009), and vascular invasion (p < 0.001). ROC curve analysis established a tumor size cut-off of 21 mm for CT. At ROC curve analysis, the cut-off number of aggressive factors required for CT was 2.

Conclusion

A thorough comprehensive assessment encompassing all pathological characteristics might be necessary in case of PTC with aggressive histologic features after thyroid lobectomy.

背景：当组织学检查显示为甲状腺乳头状癌（PTC）时，对于是否需要进行完整甲状腺切除术（CT）的意见并不一致。本研究旨在评估影响CT手术决定的组织学参数：本研究纳入了2019年至2022年期间接受甲状腺叶切除术的PTC患者。A组包括未接受进一步治疗而接受甲状腺叶切除术的患者，而B组包括根据组织学结果接受CT检查的患者。分析了组织学参数方面的差异：结果：A组包括291名患者（68.3%），B组包括135名患者（31.7%）。多变量分析确定了 CT 与肿瘤大小之间的关系（P对于甲状腺腺叶切除术后具有侵袭性组织学特征的PTC患者，可能有必要进行包括所有病理特征在内的全面综合评估。

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引用次数: 0

Assessing students' perception of gender as a barrier in Orthopedic residency matching: A pilot survey study 评估学生对性别是骨科住院医师配对障碍的看法：一项试点调查研究。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-12 DOI: 10.1016/j.amjsurg.2024.116015

Reem Sarsour , Monica Guirgus , Mina Balen , Katie Kyan , Van Le , Bradley Carlson , Rina Jain

Background

Gender disparity in orthopedic residency programs is evident. Limited research investigates if gender attitudes deter women from applying to orthopedic surgery residency programs.

Methods

A questionnaire was distributed to a single medical school which explored medical students' perceptions regarding their gender's influence on matching into orthopedic surgery residency, alongside motivators and barriers for applying. Descriptive statistics and chi-square tests analyzed potential association and trends using SPSS computation with alpha set at 0.05.

Results

202 medical students completed the questionnaire. Women respondents were found to be 10.6 times more likely to report their own gender as a barrier to matching to orthopedic surgery residency compared to men.

Conclusion

A significant proportion of women perceive their gender as a barrier to matching. Dismantling gender stereotypes may increase consideration of women medical students of orthopedic surgery as a career option.

背景：骨科住院医师项目中的性别差异是显而易见的。有关性别态度是否会阻碍女性申请骨科住院医师项目的研究十分有限：方法：我们向一所医学院发放了一份问卷，调查医学生对其性别对申请骨科住院医师项目的影响的看法，以及申请的动机和障碍。描述性统计和卡方检验使用 SPSS 计算法分析了潜在的关联和趋势，阿尔法值设定为 0.05。与男性相比，女性受访者认为自己的性别是阻碍她们进入骨科住院医师培训的因素的可能性是男性的 10.6 倍：结论：很大一部分女性认为自己的性别是匹配的障碍。消除性别刻板印象可能会让更多女医科学生考虑将骨科手术作为一种职业选择。

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引用次数: 0

Time is money: The return on investment of research in surgical training 时间就是金钱：外科培训研究的投资回报

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-10 DOI: 10.1016/j.amjsurg.2024.116011

Terry P. Gao, Rebecca L. Green, Kristen M. HoSang, Eric S. Kopelson, Lindsay E. Kuo

Introduction

Future income potential can impact surgical trainees’ career choices, particularly when deciding to subspecialize, which often requires additional training and research time. This study quantifies the effects of added time on career value for eight surgical subspecialties.

Methods

The Net present value(NPV) was calculated for eight subspecialties and general surgery over a 35-year career, factoring in salary, educational debt, tax, inflation, and practice setting. NPV for each was compared over a number of research years (0, 1, 2) using data from the MGMA, AAMC, and US government records.

Results

After a 35-year career, six subspecialties in private practice increased career NPV(>$14,000) with 0 research years. One additional research year yielded negative career values for transplant, trauma, and vascular; with two, only cardiovascular and pediatric retained a positive NPV. In academia, 1–2 research years resulted in negative NPV for all but cardiovascular and thoracic surgery.

Conclusions

The financial return of additional training years is highly variable.

导言未来的收入潜力会影响外科学员的职业选择，尤其是在决定从事亚专科时，这通常需要额外的培训和研究时间。本研究量化了八个外科亚专科增加时间对职业价值的影响。方法计算了八个亚专科和普通外科 35 年职业生涯的净现值（NPV），其中考虑了工资、教育债务、税收、通货膨胀和执业环境等因素。使用来自 MGMA、AAMC 和美国政府记录的数据，比较了每个亚专科在不同研究年限（0、1、2）下的净现值。在移植、创伤和血管领域，多一个研究年会产生负的职业净现值；多两个研究年，只有心血管和儿科保留了正的净现值。在学术界，除心血管和胸外科外，1-2 个研究年的净现值均为负值。

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引用次数: 0

Women in surgical innovation: A guide to breaking down barriers and developing solutions from bench to bedside (Part I). 外科创新中的女性：从工作台到床边打破障碍和制定解决方案指南（第一部分）。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-10 DOI: 10.1016/j.amjsurg.2024.116012

Tandis Soltani, Asanthi Ratnasekera, Mecker G Möller, Pauline K Park, Rachel M Russo

引用次数: 0

AJS virtual research mentor: Tips on writing an abstract for a conference. AJS 虚拟研究导师：撰写会议摘要的技巧。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-10 DOI: 10.1016/j.amjsurg.2024.116009

Nicole M Mott, Madhushree Zope, Ian S Reynolds, Yanick Tadé, Guillermo Polcano Serra, Jane J Long, Wendelyn M Oslock

引用次数: 0

Variation in PTH levels and kinetics after parathyroidectomy 甲状旁腺切除术后 PTH 水平和动力学的变化

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-10-10 DOI: 10.1016/j.amjsurg.2024.116010

Claire E. Graves MD, Michael J. Campbell MD

Intraoperative parathyroid hormone (IOPTH) is a surgical adjunct used to assess function of remaining parathyroid glands in “real-time” during parathyroidectomy. Parathyroid degradation kinetics are affected by timing of blood draws, patient characteristics, and disease phenotype. A nuanced understanding of these multiple factors can help parathyroid surgeons interpret IOPTH results. This article summarizes recent literature on PTH kinetics with a focus on how to apply this knowledge clinically during parathyroid surgery.

术中甲状旁腺激素（IOPTH）是一种外科辅助手段，用于在甲状旁腺切除术中 "实时 "评估剩余甲状旁腺的功能。甲状旁腺降解动力学受抽血时间、患者特征和疾病表型的影响。对这些多重因素的细致了解有助于甲状旁腺外科医生解释 IOPTH 结果。本文总结了有关 PTH 动力学的最新文献，重点介绍了如何在甲状旁腺手术中将这些知识应用于临床。

引用次数: 0

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American journal of surgery

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