American journal of surgery最新文献

英文中文

Outcomes of non-obstructed gastric volvulus: Repair during the index hospitalization vs early elective setting 非梗阻性胃扭转的结局：指数住院期间的修复与早期选择设置。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-27 DOI: 10.1016/j.amjsurg.2025.116758

A. Laykova , D. Scheeres , G. Zambito , A. Banks-Venegoni

Introduction

There is a current gap in literature regarding the appropriate timing of non-emergent repair for a resolved obstructing gastric volvulus. This study aims to evaluate outcomes related to hiatal hernia repair (HHR) during the index hospitalization versus early outpatient repair, with the assumption that outpatient repair will result in better outcomes.

Methods

This study included HHR data from 2017 to 2022. The primary outcome assessed overall morbidity using the Clavien-Dindo classification among various secondary outcomes.

Results

A total of 25 patients were included. There was no difference in morbidity between groups (p = 0.66). In the outpatient group, 3 patients re-volvulized prior to repair and the LOS post repair was statistically longer in the inpatient group (2.5 days vs 1 day, p = 0.0172).

Conclusion

Our findings demonstrate that definitive HHR following resolved obstructing gastric volvulus can be safely performed during the index hospitalization, without increase in morbidity, which may be preferred for this patient population.

导读：目前关于解决梗阻胃扭转的非紧急修复时机的文献存在空白。本研究旨在评估住院期间裂孔疝修复（HHR）与早期门诊修复的相关结果，并假设门诊修复会产生更好的结果。方法：本研究纳入2017 - 2022年HHR数据。主要结局采用Clavien-Dindo分级在各种次要结局中评估总体发病率。结果：共纳入25例患者。两组间发病率差异无统计学意义（p = 0.66）。门诊组修复前再容积3例，住院组修复后LOS更长（2.5天vs 1天，p = 0.0172）。结论：我们的研究结果表明，在指数住院期间，解决梗阻性胃扭转后的最终HHR可以安全地进行，而不会增加发病率，这可能是该患者群体的首选。

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引用次数: 0

Risk factors for lymph node metastasis in p/ypT1-2 rectal cancer p/ypT1-2直肠癌淋巴结转移的危险因素

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.amjsurg.2025.116782

Young Hae Choi, Jung Wook Huh, Woo Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Yoonah Park, Jung Kyong Shin

Background

This study aimed to identify and compare risk factors for lymph node metastasis in rectal cancer patients with and without neoadjuvant chemoradiotherapy.

Methods

We retrospectively analyzed 1354 patients who underwent curative surgery, categorized into a Non-CRT group (pT1–2, n = 921) and a CRT group (ypT1–2, n = 433).

Results

Lymph node metastasis occurred in 20.4 % of Non-CRT and 17.6 % of CRT patients. Independent predictors were lymphatic invasion (p < 0.001), tumor budding (p < 0.001), and pT2 stage (p = 0.002) in Non-CRT, and lymphatic invasion (p = 0.001) and venous invasion (p < 0.001) in CRT. Venous invasion showed a markedly stronger association in the CRT group (OR 12.102). Lymph node metastasis rates increased up to 64.3 % and 87.5 % with all risk factors, respectively.

Conclusion

Risk factors for lymph node metastasis differed by CRT status, with venous invasion emerging as the key determinant in the CRT group.

背景：本研究旨在确定和比较接受和未接受新辅助放化疗的直肠癌患者淋巴结转移的危险因素。方法：回顾性分析1354例根治性手术患者，分为非CRT组（pT1-2, n = 921）和CRT组（ypT1-2, n = 433）。结果：非CRT患者发生淋巴结转移20.4%，CRT患者发生淋巴结转移17.6%。非CRT的独立预测因子为淋巴浸润（p < 0.001）、肿瘤出芽（p < 0.001）和pT2分期（p = 0.002）， CRT的独立预测因子为淋巴浸润（p = 0.001）和静脉浸润（p < 0.001）。静脉侵犯与CRT组的相关性更强（OR 12.102）。在所有危险因素的影响下，淋巴结转移率分别增加了64.3%和87.5%。结论：淋巴结转移的危险因素因CRT状态而异，其中静脉浸润是CRT组的关键决定因素。

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引用次数: 0

Misunderstandings in robotic surgical instruction: An exploratory discourse analysis 机器人手术指导中的误解：探索性语篇分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI: 10.1016/j.amjsurg.2025.116783

Riley Brian , Alyssa Murillo , Ivori White , Laura Sterponi , Hueylan Chern , Daniel Oh , Patricia S. O'Sullivan

Introduction

When communication breaks down, misunderstandings ensue and may result in a communication process called repair. We aimed to characterize misunderstandings in robotic surgical instruction by appraising repairs.

Methods

We recorded learners and instructors working through simulated robotic surgical procedures. Using tools from discourse analysis, we categorized different aspects of repair: the trouble source (cause of confusion), initiation of repair (marker of the trouble source as confusing), repair proper (attempted resolution of confusion), and response to repair (signal of repair proper as adequate or inadequate).

Results

We reviewed 2596 min of video and audio data from 33 simulated cases. Using transcripts, we defined categories of trouble source, initiation of repair, repair proper, and response to repair.

Conclusions

Our findings suggest methods by which instructors can avoid common trouble sources to reduce reasons for misunderstanding and through which both learners and instructors can more effectively address misunderstandings when they do occur.

当沟通中断时，误解随之而来，并可能导致一个被称为修复的沟通过程。我们旨在通过评估修复来描述机器人手术指导中的误解。方法我们记录了学习者和教师在模拟机器人手术过程中的工作情况。使用话语分析的工具，我们对修复的不同方面进行了分类：故障来源（混淆的原因）、修复的开始（将故障来源标记为混淆）、适当的修复（试图解决混淆）和对修复的反应（适当的修复信号为充分或不充分）。结果回顾了33例模拟病例2596 min的视频和音频资料。使用转录本，我们定义了故障源、修复启动、适当修复和修复响应的类别。结论我们的研究结果提出了一些方法，教师可以通过这些方法避免常见的麻烦来源，减少误解的原因，学习者和教师都可以通过这些方法在误解发生时更有效地解决误解。

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引用次数: 0

Not safe for work: Preventing violence against healthcare workers 工作不安全：防止暴力侵害卫生保健工作者。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-08 DOI: 10.1016/j.amjsurg.2025.116607

Jessica L. Weaver MD PhD , Oviya A. Giri MBBS , Patricia Martinez Quinones MD PhD , Sruti Cheruvu MD , Lindsay Bryant , Lisa K. Cannada MD , the Association of Women Surgeons Publications Committee

引用次数: 0

Beyond the OR: Building your niche and brand as a path to career growth in academic surgery 超越手术室：建立你的利基和品牌，作为学术外科职业发展的道路。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-03 DOI: 10.1016/j.amjsurg.2025.116652

Isabella Faria MD , Lisa K. Cannada MD

引用次数: 0

Emeritus Editorial Board 名誉编辑委员会

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/S0002-9610(26)00022-X

引用次数: 0

Short-term outcomes in radiofrequency ablation for the primary treatment of T1N0M0 papillary thyroid carcinomas 射频消融初级治疗T1N0M0甲状腺乳头状癌的短期疗效

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-31 DOI: 10.1016/j.amjsurg.2025.116702

Rachel Liou , Lauren Slattery , Yinin Hu , Eric J. Kuo , Catherine McManus , James A. Lee , Jennifer H. Kuo

Radiofrequency ablation (RFA) has been gaining traction for treating benign thyroid nodules, but its use for papillary thyroid carcinomas (PTCs) remains uncommon. We conducted a single institution prospective cohort study of patients who underwent RFA for biopsy-proven PTC(s) 1.5 cm in greatest diameter. Primary outcomes included volume reduction ratio (VRR) at 1, 3, 6, and 12 months and rate of complications. We performed RFA on 46 PTCs in 41 patients. With a median follow-up of 8 months (IQR:6–12.3), we achieved complete sonographic disappearance of 85 % of tumors. Median VRR was −107.5 % (IQR: 322.3 - 6.0), 18.8 % (IQR: 75 - 54.12), and 100 % (IQR:70.7–100) at 1, 3, and 12- months follow-up. Four patients (9.8 %) experienced minor complications. Preliminary findings suggest that RFA is a safe and effective treatment modality for patients with PTCs. Additional enrollment and further surveillance are necessary to assess the long-term efficacy of RFA for PTCs.

射频消融术（RFA）在治疗良性甲状腺结节方面越来越受到关注，但其在甲状腺乳头状癌（ptc）中的应用仍不常见。我们对活检证实最大直径为1.5 cm的PTC患者进行了RFA的单机构前瞻性队列研究。主要结局包括1、3、6和12个月的体积缩小比（VRR）和并发症发生率。我们对41例患者的46例ptc进行了RFA。中位随访8个月（IQR:6-12.3）， 85%的肿瘤超声完全消失。随访1、3和12个月时，中位VRR分别为- 107.5% （IQR: 322.3 - 6.0）、18.8% （IQR: 75 - 54.12）和100% （IQR:70.7-100）。4例患者（9.8%）出现轻微并发症。初步发现RFA是一种安全有效的PTCs治疗方式。为了评估RFA治疗ptc的长期疗效，需要额外的登记和进一步的监测。

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引用次数: 0

The accidental storm surfer 意外的风暴冲浪者。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-17 DOI: 10.1016/j.amjsurg.2025.116673

Zhaohui Su Ph.D.

引用次数: 0

Hyperphosphatemia as a biomarker for early renal failure after trauma and development of the risk-for-renal-replacement-after-trauma (R3T) score 高磷血症作为创伤后早期肾衰竭的生物标志物和创伤后肾替代风险（R3T）评分的发展。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-23 DOI: 10.1016/j.amjsurg.2025.116796

Ryan D. Rosen , Meredith Hazelrigg , Amanda B. Dooley-Romero , Mitchell Rits , Samantha L. Tarras , Heather Dolman

Background

Hyperphosphatemia occurs after trauma due to severe tissue injury. As the kidneys excrete phosphate, we investigate the relationship between hyperphosphatemia and renal failure after trauma, while developing a tool to predict the need for renal replacement therapy (RRT).

Methods

A retrospective study evaluated trauma admissions to the ICU. The primary outcome was RRT initiation within 14 days. Independent predictors of RRT were derived to create the Risk-for-Renal-Replacement-after-Trauma (R3T) Score. The R3T was validated with receiver-operating-characteristic (ROC) curves.

Results

1619 patients were included; 54 (3.3 %) required RRT. Elevated serum phosphate was associated with increased risk for RRT. Seven independent predictors were included in the R3T, yielding an area under the ROC curve of 0.947.

Conclusions

Hyperphosphatemia was associated with increased risk for RRT, suggesting phosphate levels are an inexpensive biomarker for renal failure after trauma. The R3T Score shows promise in identifying those at highest risk for RRT.

背景：高磷血症发生在严重组织损伤后。由于肾脏分泌磷酸盐，我们研究了创伤后高磷血症与肾功能衰竭之间的关系，同时开发了一种预测肾脏替代治疗（RRT）需求的工具。方法：回顾性研究评估创伤入院ICU。主要终点是在14天内启动RRT。导出RRT的独立预测因子以创建创伤后肾置换风险（R3T）评分。采用受试者工作特征（ROC）曲线对R3T进行验证。结果：共纳入1619例患者；54例（3.3%）需要RRT。血清磷酸盐升高与RRT风险增加相关。R3T中包含7个独立预测因子，ROC曲线下面积为0.947。结论：高磷血症与RRT风险增加相关，表明磷酸盐水平是创伤后肾衰竭的廉价生物标志物。R3T评分在识别RRT风险最高的人群方面显示出希望。

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引用次数: 0

Statewide trends in routine pre-operative testing before low-risk surgery 低风险手术前常规术前检查的全州趋势

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI: 10.1016/j.amjsurg.2025.116815

Nicole M. Mott , Erin Kim , Faelan Jacobson-Davies , Michael J. Englesbe , Hari Nathan , Lesly A. Dossett

Background

Routine pre-operative testing before low-risk surgery remains common despite guidelines against it.

Methods

We conducted a retrospective cohort study of adults undergoing low-risk surgery (cholecystectomy, hernia repair, lumpectomy, thyroidectomy, mastectomy) in Michigan from 2015 to 2024. The primary outcome was testing performed within 30 days of surgery. Linear mixed models identified predictors of testing, and the results of a pilot quality improvement (QI) initiative to reduce testing at 31 hospitals were examined.

Results

Among 99,501 patients, testing rates declined from 44 % to 39 % from 2019 to 2024. Older age, comorbidity burden, and undergoing a pre-operative history and physical were associated with testing. Hospital testing rates varied from 13 % to 93 %. In the QI-participating hospitals, testing declined from 38 % to 33 % in the measurement period compared to the baseline period (p = 0.035).

Conclusions

Pre-operative testing remains common and variable. QI initiatives help reduce testing, but broader de-implementation strategies may promote sustained improvement.

背景：尽管指南反对在低风险手术前进行常规术前检查，但这种做法仍然很普遍。方法对2015年至2024年在密歇根州接受低风险手术（胆囊切除术、疝修补术、乳房肿瘤切除术、甲状腺切除术、乳房切除术）的成年人进行回顾性队列研究。主要结果是手术后30天内进行的测试。线性混合模型确定了检测的预测因素，并检查了31家医院减少检测的试点质量改进（QI）倡议的结果。结果在99501例患者中，检测率从2019年的44%下降到2024年的39%。年龄较大、合并症负担、术前病史和体格检查与检测有关。医院检测率从13%到93%不等。在参与qi的医院中，与基线期相比，检测率从38%下降到33% （p = 0.035）。结论术前检测普遍存在，且存在差异。QI计划有助于减少测试，但是更广泛的去实现策略可能促进持续的改进。

{"title":"Statewide trends in routine pre-operative testing before low-risk surgery","authors":"Nicole M. Mott , Erin Kim , Faelan Jacobson-Davies , Michael J. Englesbe , Hari Nathan , Lesly A. Dossett","doi":"10.1016/j.amjsurg.2025.116815","DOIUrl":"10.1016/j.amjsurg.2025.116815","url":null,"abstract":"<div><h3>Background</h3><div>Routine pre-operative testing before low-risk surgery remains common despite guidelines against it.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults undergoing low-risk surgery (cholecystectomy, hernia repair, lumpectomy, thyroidectomy, mastectomy) in Michigan from 2015 to 2024. The primary outcome was testing performed within 30 days of surgery. Linear mixed models identified predictors of testing, and the results of a pilot quality improvement (QI) initiative to reduce testing at 31 hospitals were examined.</div></div><div><h3>Results</h3><div>Among 99,501 patients, testing rates declined from 44 % to 39 % from 2019 to 2024. Older age, comorbidity burden, and undergoing a pre-operative history and physical were associated with testing. Hospital testing rates varied from 13 % to 93 %. In the QI-participating hospitals, testing declined from 38 % to 33 % in the measurement period compared to the baseline period (p = 0.035).</div></div><div><h3>Conclusions</h3><div>Pre-operative testing remains common and variable. QI initiatives help reduce testing, but broader de-implementation strategies may promote sustained improvement.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116815"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922119","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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