Pub Date : 2025-02-06DOI: 10.1016/j.amjsurg.2025.116238
Jose E. Barrera , Shuyan Wei , Chioma G. Obinero , Catherine Tang , Emily Cao , Charles Osamor III , Jessica R. Nye , Gabrielle E. Hatton , Mohin Bhadkamkar , Yuewei Wu-Fienberg , Lillian S. Kao , Matthew R. Greives
Introduction
Morel-Lavallee lesions (MLL) are closed degloving injuries, often requiring complex management when infected. We evaluated if early debridement reduces infection risk compared to observation.
Methods
We conducted a single-center retrospective study of MLL in adults from 2012 to 2022, analyzing diagnoses, infection, demographics, and hospital outcomes. Patients undergoing debridement within 48 h were compared to those initially observed.
Results
Of 219 patients, 79 (36 %) underwent initial surgical debridement, and 140 (64 %) were initially observed. The overall infection rate was 9 %. The surgery group had longer hospital stays (14vs7 days, p < 0.001) and more debridements (2vs0, p < 0.001). While infection rate was higher in the surgery group (13.9%vs6.4 %, p = 0.064), this difference was not statistically significant. Multivariate analysis identified higher BMI, hip location, and RBC transfusions as significant infection predictors.
Conclusion
No significant differences in infection rates were found, but several risk factors were identified. Greater awareness and better study designs are needed for improved MLL management guidelines.
{"title":"Is more better? Evaluating the impact of early surgical debridement on Morel-Lavallee lesions","authors":"Jose E. Barrera , Shuyan Wei , Chioma G. Obinero , Catherine Tang , Emily Cao , Charles Osamor III , Jessica R. Nye , Gabrielle E. Hatton , Mohin Bhadkamkar , Yuewei Wu-Fienberg , Lillian S. Kao , Matthew R. Greives","doi":"10.1016/j.amjsurg.2025.116238","DOIUrl":"10.1016/j.amjsurg.2025.116238","url":null,"abstract":"<div><h3>Introduction</h3><div>Morel-Lavallee lesions (MLL) are closed degloving injuries, often requiring complex management when infected. We evaluated if early debridement reduces infection risk compared to observation.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of MLL in adults from 2012 to 2022, analyzing diagnoses, infection, demographics, and hospital outcomes. Patients undergoing debridement within 48 h were compared to those initially observed.</div></div><div><h3>Results</h3><div>Of 219 patients, 79 (36 %) underwent initial surgical debridement, and 140 (64 %) were initially observed. The overall infection rate was 9 %. The surgery group had longer hospital stays (14vs7 days, p < 0.001) and more debridements (2vs0, p < 0.001). While infection rate was higher in the surgery group (13.9%vs6.4 %, <em>p</em> = 0.064), this difference was not statistically significant. Multivariate analysis identified higher BMI, hip location, and RBC transfusions as significant infection predictors.</div></div><div><h3>Conclusion</h3><div>No significant differences in infection rates were found, but several risk factors were identified. Greater awareness and better study designs are needed for improved MLL management guidelines.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"Article 116238"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350842","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 : 2025-02-06DOI: 10.1016/j.amjsurg.2025.116209
Evan Thomas , Salsabeal Al Saedy , Steven Green , Mahedi Hasan , Clair Chavez , Jacob Glaser
Background
Geriatric patients manifest pain and physical findings differently and are associated with higher mortality and complications. We hypothesized that physical exam (PE) is unreliable versus computed tomography (CT) for comprehensive injury identification in geriatric patients. Additionally, we quantified significant incidental radiologic findings.
Study design
Our institution adopted a policy of Pan Scan (PS) CT for trauma activations of patients ≥65 years. PS included CT of head/neck and chest/abdomen/pelvis. PE and imaging findings were extracted from physician reports.
Results
50 % of patients had clinically significant CT traumatic findings. Of these, 75 % had PE correlating to significant CT findings, while 25 % had significant PS findings not identifiable on PE (p < 0.001). The NPV was 0.80 for the PE. 57.7 % had clinically significant incidental findings.
Conclusion
Physical exam alone is not sensitive enough to detect all traumatic injuries in elderly patients. As an added benefit to PS, important incidental findings are identified. These data support use of PS in geriatric trauma to optimize care.
{"title":"Pan scan for geriatric trauma patients: Overkill or necessary?","authors":"Evan Thomas , Salsabeal Al Saedy , Steven Green , Mahedi Hasan , Clair Chavez , Jacob Glaser","doi":"10.1016/j.amjsurg.2025.116209","DOIUrl":"10.1016/j.amjsurg.2025.116209","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients manifest pain and physical findings differently and are associated with higher mortality and complications. We hypothesized that physical exam (PE) is unreliable versus computed tomography (CT) for comprehensive injury identification in geriatric patients. Additionally, we quantified significant incidental radiologic findings.</div></div><div><h3>Study design</h3><div>Our institution adopted a policy of Pan Scan (PS) CT for trauma activations of patients ≥65 years. PS included CT of head/neck and chest/abdomen/pelvis. PE and imaging findings were extracted from physician reports.</div></div><div><h3>Results</h3><div>50 % of patients had clinically significant CT traumatic findings. Of these, 75 % had PE correlating to significant CT findings, while 25 % had significant PS findings not identifiable on PE (p < 0.001). The NPV was 0.80 for the PE. 57.7 % had clinically significant incidental findings.</div></div><div><h3>Conclusion</h3><div>Physical exam alone is not sensitive enough to detect all traumatic injuries in elderly patients. As an added benefit to PS, important incidental findings are identified. These data support use of PS in geriatric trauma to optimize care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116209"},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387677","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 : 2025-02-05DOI: 10.1016/j.amjsurg.2025.116239
Nader Zamani , Sherene E. Sharath , Panos Kougias
Introduction
The objective was to characterize the interactive effects of cardiovascular disease (CVD) and chronic kidney disease (CKD) on long-term mortality following major operations.
Methods
We performed a national, retrospective cohort study of patients undergoing high-risk operations from 1991 through 2018 using the VA Corporate Data Warehouse and Surgical Quality Improvement Program. Preoperative exposures included CVD (history of angina, CHF, MI, stroke, peripheral arterial disease, and related procedures) and CKD Stages III-V. The primary outcome was long-term mortality.
Results
514,057 operations were included. After adjustment, the interaction between CVD and CKD Stage III (HR 1.38, 95% CI: 1.35–1.42), Stage IV (HR 1.91, 95% CI: 1.83–2.01), and Stage V (HR 2.70, 95% CI: 2.59–2.81) progressively conferred increasing risk of mortality.
Conclusions
In the setting of major operations, it is more accurate to interpret CVD and CKD in context of one another while accounting for the degree of baseline renal dysfunction.
{"title":"Combined influence of cardiovascular disease and chronic kidney disease on long-term mortality following major operations","authors":"Nader Zamani , Sherene E. Sharath , Panos Kougias","doi":"10.1016/j.amjsurg.2025.116239","DOIUrl":"10.1016/j.amjsurg.2025.116239","url":null,"abstract":"<div><h3>Introduction</h3><div>The objective was to characterize the interactive effects of cardiovascular disease (CVD) and chronic kidney disease (CKD) on long-term mortality following major operations.</div></div><div><h3>Methods</h3><div>We performed a national, retrospective cohort study of patients undergoing high-risk operations from 1991 through 2018 using the VA Corporate Data Warehouse and Surgical Quality Improvement Program. Preoperative exposures included CVD (history of angina, CHF, MI, stroke, peripheral arterial disease, and related procedures) and CKD Stages III-V. The primary outcome was long-term mortality.</div></div><div><h3>Results</h3><div>514,057 operations were included. After adjustment, the interaction between CVD and CKD Stage III (HR 1.38, 95% CI: 1.35–1.42), Stage IV (HR 1.91, 95% CI: 1.83–2.01), and Stage V (HR 2.70, 95% CI: 2.59–2.81) progressively conferred increasing risk of mortality.</div></div><div><h3>Conclusions</h3><div>In the setting of major operations, it is more accurate to interpret CVD and CKD in context of one another while accounting for the degree of baseline renal dysfunction.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116239"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429161","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 : 2025-02-05DOI: 10.1016/j.amjsurg.2025.116240
Eric Bao, Sarah Nathaniel, Nargiz Seyidova, Olachi Oleru, Abigail Tirrell, Peter W Henderson
{"title":"My thoughts: Development of a database selection tool for large database research.","authors":"Eric Bao, Sarah Nathaniel, Nargiz Seyidova, Olachi Oleru, Abigail Tirrell, Peter W Henderson","doi":"10.1016/j.amjsurg.2025.116240","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116240","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116240"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397917","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}
The prognostic factors for overall survival (OS) in perihilar cholangiocarcinoma (pCCA) included resection margin (RM) and lymph node metastases (LNM). Nevertheless, the advantage associated with a negative RM in patients with LNM remains unresolved.
Methods
The study retrospectively analyzed patients with pCCA underwent curative-intent resection between October 2013 and December 2018. The evaluation of the OS was conducted based on the presence of LNM and the status of RM.
Results
Of the 167 resected pCCA patients, 87 (52.1 %) were LNM negative, and 80 (47.9 %) were LNM positive. Of the 87 LNM-negative patients, 68 (78.2 %) were R0 resections, and 19 (21.8 %) were R1 resections. In LNM-negative patients, the OS was longer in the R0 resection than the R1 resection group (median survival time (MST) of 32.1 vs 15.7 months, respectively; p < 0.001). Of the 80 LNM-positive patients, 35 were R0 resections and 45 were R1 resections. Among patients with LNM positivity, the OS rates were similar between the groups who underwent R1 resection and R0 resection (MST of 8.4 vs 8.0 months, respectively; p = 0.109).
Conclusion
In patients with pCCA, the RM status was the most important prognostic factor for LNM-negative patients. However, there was no impact in LNM-positive patients.
{"title":"The impact of resection margin status according to lymph node metastasis on the survival outcome of perihilar cholangiocarcinoma","authors":"Poowanai Sarkhampee, Weeris Ouransatien, Satsawat Chansitthichok, Nithi Lertsawatvicha, Paiwan Wattanarath","doi":"10.1016/j.amjsurg.2025.116236","DOIUrl":"10.1016/j.amjsurg.2025.116236","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic factors for overall survival (OS) in perihilar cholangiocarcinoma (pCCA) included resection margin (RM) and lymph node metastases (LNM). Nevertheless, the advantage associated with a negative RM in patients with LNM remains unresolved.</div></div><div><h3>Methods</h3><div>The study retrospectively analyzed patients with pCCA underwent curative-intent resection between October 2013 and December 2018. The evaluation of the OS was conducted based on the presence of LNM and the status of RM.</div></div><div><h3>Results</h3><div>Of the 167 resected pCCA patients, 87 (52.1 %) were LNM negative, and 80 (47.9 %) were LNM positive. Of the 87 LNM-negative patients, 68 (78.2 %) were R0 resections, and 19 (21.8 %) were R1 resections. In LNM-negative patients, the OS was longer in the R0 resection than the R1 resection group (median survival time (MST) of 32.1 vs 15.7 months, respectively; p < 0.001). Of the 80 LNM-positive patients, 35 were R0 resections and 45 were R1 resections. Among patients with LNM positivity, the OS rates were similar between the groups who underwent R1 resection and R0 resection (MST of 8.4 vs 8.0 months, respectively; p = 0.109).</div></div><div><h3>Conclusion</h3><div>In patients with pCCA, the RM status was the most important prognostic factor for LNM-negative patients. However, there was no impact in LNM-positive patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116236"},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387347","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 : 2025-02-03DOI: 10.1016/j.amjsurg.2025.116233
Erin M White, Peter S Yoo
{"title":"The pandemic hit surgery - But ACGME case logs were immune.","authors":"Erin M White, Peter S Yoo","doi":"10.1016/j.amjsurg.2025.116233","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116233","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116233"},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456639","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 : 2025-02-03DOI: 10.1016/j.amjsurg.2025.116231
Mustafa Abid , Mark Holmes , Anthony Charles
Background
General Surgeon Workforce Density (WFD) is used to approximate surgical access. Treatment-incidence ratios (TIR) provide a novel measure of care access. TIR's association with General Surgeon WFD has not been evaluated.
Study design
Retrospective cohort study of North Carolina inpatient discharges (2016–2019). The association between county and Hospital Service Area (HSA) TIRs for general surgical diseases was analyzed using adjusted linear and logistic regression.
Results
When adjusting for pertinent covariates, county General Surgeon WFD and TIR (−0.0009, 95 % CI -0.028,0.026; p 0.95) and HSA General Surgeon WFD and TIR (0.008, 95 % CI -0.021,0.037; p 0.58) were not statistically significantly associated. The odds of a county 0.91 (95 % CI 0.42,1.97; p 0.82) or HSA (OR 0.93, 95 % CI 0.43,2.04; p 0.86) having a high TIR was not associated with WFD.
Conclusion
General Surgeon WFD is not associated with disease-specific procedural rates of common surgical conditions at the county or HSA level.
{"title":"General surgeon workforce density is not associated with treatment-incidence ratios at the county or hospital service area level in North Carolina","authors":"Mustafa Abid , Mark Holmes , Anthony Charles","doi":"10.1016/j.amjsurg.2025.116231","DOIUrl":"10.1016/j.amjsurg.2025.116231","url":null,"abstract":"<div><h3>Background</h3><div>General Surgeon Workforce Density (WFD) is used to approximate surgical access. Treatment-incidence ratios (TIR) provide a novel measure of care access. TIR's association with General Surgeon WFD has not been evaluated.</div></div><div><h3>Study design</h3><div>Retrospective cohort study of North Carolina inpatient discharges (2016–2019). The association between county and Hospital Service Area (HSA) TIRs for general surgical diseases was analyzed using adjusted linear and logistic regression.</div></div><div><h3>Results</h3><div>When adjusting for pertinent covariates, county General Surgeon WFD and TIR (−0.0009, 95 % CI -0.028,0.026; p 0.95) and HSA General Surgeon WFD and TIR (0.008, 95 % CI -0.021,0.037; p 0.58) were not statistically significantly associated. The odds of a county 0.91 (95 % CI 0.42,1.97; p 0.82) or HSA (OR 0.93, 95 % CI 0.43,2.04; p 0.86) having a high TIR was not associated with WFD.</div></div><div><h3>Conclusion</h3><div>General Surgeon WFD is not associated with disease-specific procedural rates of common surgical conditions at the county or HSA level.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116231"},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419134","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 : 2025-02-03DOI: 10.1016/j.amjsurg.2025.116234
Yasmin Arda, John O Hwabejire
{"title":"Housing, health, and harm: Gentrification's impact on firearm violence and access to care.","authors":"Yasmin Arda, John O Hwabejire","doi":"10.1016/j.amjsurg.2025.116234","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116234","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116234"},"PeriodicalIF":2.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373648","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 : 2025-02-02DOI: 10.1016/j.amjsurg.2025.116229
Sarah Lu , Katrina Nietsch , Akiro Duey , Bashar Zaidat , Laura C. Mazudie Ndjonko , Nancy Shrestha , Jun Kim , Samuel K. Cho
Background
High-energy lower extremity injury presents with difficult clinical decisions because successful limb salvage is the best scenario for complex traumas, but early amputation may be necessary to limit complications. Artificial Intelligence is a tool rising in popularity to help make clinical judgements.
Purpose/questions
The aim of this study is to determine whether ChatGPT-4 can produce accurate recommendations for limb salvage or amputation given various patient scenarios.
Methods
Various lower leg trauma scenarios were given to the appropriate use criteria for limb salvage made by AAOS or ChatGPT-4. A recommendation score for limb salvage and early amputation were collected. Tests to determine statistical significance between AAOS and ChatGPT-4 were performed.
Results
A total of 196 patient scenario combinations were utilized. The mean error for limb salvage and early amputation were −0.3 and −0.2 respectively. AAOS and ChatGPT had significant positive correlations when predicting limb salvage and early amputation scores. The effect size of limb salvage and early amputation was −0.094 and −0.14, respectively.
Conclusion
ChatGPT-4 generally under-estimates appropriateness scores for both limb salvage and early amputation treatment options, but produces similar scores. ChatGPT-4 may be used to aid physicians in choosing between limb salvage and early amputation, though with caution.
{"title":"Management of lower extremity traumas: Comparing appropriate use criteria ChatGPT recommendations","authors":"Sarah Lu , Katrina Nietsch , Akiro Duey , Bashar Zaidat , Laura C. Mazudie Ndjonko , Nancy Shrestha , Jun Kim , Samuel K. Cho","doi":"10.1016/j.amjsurg.2025.116229","DOIUrl":"10.1016/j.amjsurg.2025.116229","url":null,"abstract":"<div><h3>Background</h3><div>High-energy lower extremity injury presents with difficult clinical decisions because successful limb salvage is the best scenario for complex traumas, but early amputation may be necessary to limit complications. Artificial Intelligence is a tool rising in popularity to help make clinical judgements.</div></div><div><h3>Purpose/questions</h3><div>The aim of this study is to determine whether ChatGPT-4 can produce accurate recommendations for limb salvage or amputation given various patient scenarios.</div></div><div><h3>Methods</h3><div>Various lower leg trauma scenarios were given to the appropriate use criteria for limb salvage made by AAOS or ChatGPT-4. A recommendation score for limb salvage and early amputation were collected. Tests to determine statistical significance between AAOS and ChatGPT-4 were performed.</div></div><div><h3>Results</h3><div>A total of 196 patient scenario combinations were utilized. The mean error for limb salvage and early amputation were −0.3 and −0.2 respectively. AAOS and ChatGPT had significant positive correlations when predicting limb salvage and early amputation scores. The effect size of limb salvage and early amputation was −0.094 and −0.14, respectively.</div></div><div><h3>Conclusion</h3><div>ChatGPT-4 generally under-estimates appropriateness scores for both limb salvage and early amputation treatment options, but produces similar scores. ChatGPT-4 may be used to aid physicians in choosing between limb salvage and early amputation, though with caution.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116229"},"PeriodicalIF":2.7,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405392","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}
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