American journal of surgery最新文献

英文中文

Exploring consent for animal-derived products in surgery 探讨手术中动物源性产品的同意问题。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.amjsurg.2024.115989

Tega Ebeye , Chantal R. Valiquette , Natalia Ziolkowski

引用次数: 0

Unveiling the impact of trauma during pregnancy 揭示怀孕期间创伤的影响。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.amjsurg.2024.116124

Anna Mary Jose, Aryan Rafieezadeh, Jordan Kirsch, Mikaiel Ebanks, Ilya Shnaydman, Gabriel Froula, Kartik Prabhakaran, Bardiya Zangbar

Background

Pregnant trauma patients present unique challenges in terms of assessment and management. This study assesses the impact of traumatic injuries on pregnant patients using a national trauma database.

Methods

ACS-TQIP (2020–2021) identified traumatically injured females aged ≥15 and ≤ 55. Propensity score matching compared pregnant and not-pregnant patients. Primary outcome was mortality, with secondary outcomes including length of stay (LOS), emergency department and discharge disposition, interventions, and complications.

Results

Of 947,000 traumatically injured females, 8421 (0.9 %) were pregnant. Pregnant patients (6.0 %) sustained firearm injuries more than not-pregnant patients (5.4 %) (p = 0.02). Pregnant patients had more severe thoracic (47.2%vs.9.4 %) and abdominal injuries (7.1%vs.4.8 %) compared to not-pregnant patients (p < 0.001). Among pregnant patients, 5.6 % had preterm labor, 2.6 % had cesarean sections, and 1.9 % had abortions. After matching, there was no significant difference in mortality between both groups (p = 0.40). Pregnant patients had longer ICU LOS (p < 0.05) and higher rates of unplanned return to ICU (p < 0.05).

Conclusions

Pregnant patients are more often victims of firearm violence, sustaining critical thoracic and abdominal injuries. These injuries demand increased interventions, introduce complications, and can be fatal.

背景：怀孕创伤患者在评估和管理方面面临着独特的挑战。本研究利用国家创伤数据库评估创伤性损伤对怀孕患者的影响。方法：ACS-TQIP（2020-2021）对年龄≥15岁、≤55岁的女性外伤患者进行鉴定。倾向评分匹配比较怀孕和未怀孕的患者。主要结局是死亡率，次要结局包括住院时间（LOS）、急诊科和出院处理、干预措施和并发症。结果：947,000名女性外伤患者中，有8421人（0.9%）怀孕。孕妇火器伤发生率（6.0%）高于非孕妇火器伤发生率（5.4%）（p = 0.02）。与未怀孕患者相比，怀孕患者有更严重的胸部（47.2%vs. 9.4%）和腹部损伤（7.1%vs. 4.8%） (p结论：怀孕患者更容易成为枪支暴力的受害者，持续严重的胸部和腹部损伤。这些伤害需要更多的干预措施，引起并发症，并可能致命。

{"title":"Unveiling the impact of trauma during pregnancy","authors":"Anna Mary Jose, Aryan Rafieezadeh, Jordan Kirsch, Mikaiel Ebanks, Ilya Shnaydman, Gabriel Froula, Kartik Prabhakaran, Bardiya Zangbar","doi":"10.1016/j.amjsurg.2024.116124","DOIUrl":"10.1016/j.amjsurg.2024.116124","url":null,"abstract":"<div><h3>Background</h3><div>Pregnant trauma patients present unique challenges in terms of assessment and management. This study assesses the impact of traumatic injuries on pregnant patients using a national trauma database.</div></div><div><h3>Methods</h3><div>ACS-TQIP (2020–2021) identified traumatically injured females aged ≥15 and ≤ 55. Propensity score matching compared pregnant and not-pregnant patients. Primary outcome was mortality, with secondary outcomes including length of stay (LOS), emergency department and discharge disposition, interventions, and complications.</div></div><div><h3>Results</h3><div>Of 947,000 traumatically injured females, 8421 (0.9 %) were pregnant. Pregnant patients (6.0 %) sustained firearm injuries more than not-pregnant patients (5.4 %) (p = 0.02). Pregnant patients had more severe thoracic (47.2%vs.9.4 %) and abdominal injuries (7.1%vs.4.8 %) compared to not-pregnant patients (p < 0.001). Among pregnant patients, 5.6 % had preterm labor, 2.6 % had cesarean sections, and 1.9 % had abortions. After matching, there was no significant difference in mortality between both groups (p = 0.40). Pregnant patients had longer ICU LOS (p < 0.05) and higher rates of unplanned return to ICU (p < 0.05).</div></div><div><h3>Conclusions</h3><div>Pregnant patients are more often victims of firearm violence, sustaining critical thoracic and abdominal injuries. These injuries demand increased interventions, introduce complications, and can be fatal.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116124"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783611","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

Table of Contents (4 pgs)

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.amjsurg.2025.116183

引用次数: 0

Damage control packing: How long can it stay?

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-31 DOI: 10.1016/j.amjsurg.2025.116232

Jihun Cha, Thomas W Clements, Chad G Ball, Andrew W Kirkpatrick, Timothy Bax, John Mayberry

Damage control (DC) packing is used selectively in patients in shock with extensive abdominal, thoracic, perineal/genital/perirectal, neck/axillae/groin (junctional), and extremity injury to stop bleeding. In multiple casualty scenarios, DC packing may be used to facilitate an abbreviated surgery and thus "buy time". The packing is by guideline or military doctrine removed or exchanged 1-3 days later in a planned reoperation. In remote environments, however, where timely evacuation cannot occur and resources are limited, it may be necessary for packing to be left in place longer than 3 days. Also, in Large Scale Combat Operations, Multi-Domain Operations, and Distributed Maritime Operations, evacuation will be accomplished by nonsurgeons and may last several days. Prolonged retention of packing is associated with complications, but significant rebleeding may occur upon removal. This article reviews the benefits and hazards of DC packing removal to inform decision making by both surgeons and nonsurgeons. We conclude that except for Dismounted Complex Blast Injury most DC gauze packing does not mandatorily need to be removed or exchanged within a three-day window.

{"title":"Damage control packing: How long can it stay?","authors":"Jihun Cha, Thomas W Clements, Chad G Ball, Andrew W Kirkpatrick, Timothy Bax, John Mayberry","doi":"10.1016/j.amjsurg.2025.116232","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116232","url":null,"abstract":"<p><p>Damage control (DC) packing is used selectively in patients in shock with extensive abdominal, thoracic, perineal/genital/perirectal, neck/axillae/groin (junctional), and extremity injury to stop bleeding. In multiple casualty scenarios, DC packing may be used to facilitate an abbreviated surgery and thus \"buy time\". The packing is by guideline or military doctrine removed or exchanged 1-3 days later in a planned reoperation. In remote environments, however, where timely evacuation cannot occur and resources are limited, it may be necessary for packing to be left in place longer than 3 days. Also, in Large Scale Combat Operations, Multi-Domain Operations, and Distributed Maritime Operations, evacuation will be accomplished by nonsurgeons and may last several days. Prolonged retention of packing is associated with complications, but significant rebleeding may occur upon removal. This article reviews the benefits and hazards of DC packing removal to inform decision making by both surgeons and nonsurgeons. We conclude that except for Dismounted Complex Blast Injury most DC gauze packing does not mandatorily need to be removed or exchanged within a three-day window.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116232"},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370143","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

Overcoming inertia: Provider perspectives on de-implementation strategies in preoperative testing

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.amjsurg.2025.116228

Erin Kim , Alexis G. Antunez , Devak Nanua , Valerie Gavrila , Anthony Cuttitta , Lesly A. Dossett

Background

Routine preoperative testing for low-risk surgeries is often unnecessary and may result in preventable harm. While de-implementation strategies have reduced the frequency and proportion of unnecessary preoperative tests, the reach of the strategies and the provider-level adoption remain unclear. Understanding stakeholders’ perspective on these strategies is essential for widespread de-implementation.

Methods

Interviews were conducted with 18 anesthesiologists, surgeons, and physician assistants at a single academic institution. Thematic analysis was guided by the RE-AIM framework, and persistent barriers were assessed using the Consolidated Framework for Implementation Research.

Results

De-implementation strategies achieved high reach, with educational meetings emerging as the most effective strategy. Workflow variations significantly influenced adoption and implementation, with regular meetings and data sharing identified as facilitators for maintenance. Barriers were identified in the individual characteristics, inner setting, and outer setting levels.

Conclusions

Tailored de-implementation strategies are essential to overcoming provider- and institution-level barriers and to sustain guideline-concordant care.

{"title":"Overcoming inertia: Provider perspectives on de-implementation strategies in preoperative testing","authors":"Erin Kim , Alexis G. Antunez , Devak Nanua , Valerie Gavrila , Anthony Cuttitta , Lesly A. Dossett","doi":"10.1016/j.amjsurg.2025.116228","DOIUrl":"10.1016/j.amjsurg.2025.116228","url":null,"abstract":"<div><h3>Background</h3><div>Routine preoperative testing for low-risk surgeries is often unnecessary and may result in preventable harm. While de-implementation strategies have reduced the frequency and proportion of unnecessary preoperative tests, the reach of the strategies and the provider-level adoption remain unclear. Understanding stakeholders’ perspective on these strategies is essential for widespread de-implementation.</div></div><div><h3>Methods</h3><div>Interviews were conducted with 18 anesthesiologists, surgeons, and physician assistants at a single academic institution. Thematic analysis was guided by the RE-AIM framework, and persistent barriers were assessed using the Consolidated Framework for Implementation Research.</div></div><div><h3>Results</h3><div>De-implementation strategies achieved high reach, with educational meetings emerging as the most effective strategy. Workflow variations significantly influenced adoption and implementation, with regular meetings and data sharing identified as facilitators for maintenance. Barriers were identified in the individual characteristics, inner setting, and outer setting levels.</div></div><div><h3>Conclusions</h3><div>Tailored de-implementation strategies are essential to overcoming provider- and institution-level barriers and to sustain guideline-concordant care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116228"},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147488","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

Colon injuries in the presence of complete spinal cord injury: Primary repair or colostomy?

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.amjsurg.2025.116225

Wei Huang , Caitlyn Braschi , Natalie Hodges , Yu Cheng Chiu , Demetrios Demetriades

Background

Complete spinal cord injury (SCI) is associated with severe colon dysmotility and therefore may be associated with higher risk of leak following primary repair or anastomosis for concomitant colon injury.

Methods

TQIP database study, patients with complete SCI and associated colon injuries who underwent primary repair (PR) or resection with primary anastomosis (RPA) were compared to those who underwent ostomy alone using propensity score matching.

Results

Ninety-nine patients treated with a colostomy were matched with 215 treated with PR or RPA. Patients treated with colostomy were more likely to develop severe sepsis post-operatively (13.1 % vs 4.2 %, p = 0.004). Subgroup analysis, comparing colostomy versus PR or colostomy versus RPA, showed again a higher incidence of postoperative severe sepsis in the colostomy group.

Conclusions

Primary repair and/or RPA are associated with a lower incidence of postoperative severe sepsis than colostomy and should be considered in patients with combined SCI and colon injury.

{"title":"Colon injuries in the presence of complete spinal cord injury: Primary repair or colostomy?","authors":"Wei Huang , Caitlyn Braschi , Natalie Hodges , Yu Cheng Chiu , Demetrios Demetriades","doi":"10.1016/j.amjsurg.2025.116225","DOIUrl":"10.1016/j.amjsurg.2025.116225","url":null,"abstract":"<div><h3>Background</h3><div>Complete spinal cord injury (SCI) is associated with severe colon dysmotility and therefore may be associated with higher risk of leak following primary repair or anastomosis for concomitant colon injury.</div></div><div><h3>Methods</h3><div>TQIP database study, patients with complete SCI and associated colon injuries who underwent primary repair (PR) or resection with primary anastomosis (RPA) were compared to those who underwent ostomy alone using propensity score matching.</div></div><div><h3>Results</h3><div>Ninety-nine patients treated with a colostomy were matched with 215 treated with PR or RPA. Patients treated with colostomy were more likely to develop severe sepsis post-operatively (13.1 % vs 4.2 %, p = 0.004). Subgroup analysis, comparing colostomy versus PR or colostomy versus RPA, showed again a higher incidence of postoperative severe sepsis in the colostomy group.</div></div><div><h3>Conclusions</h3><div>Primary repair and/or RPA are associated with a lower incidence of postoperative severe sepsis than colostomy and should be considered in patients with combined SCI and colon injury.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116225"},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147329","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

Interventions to support caregivers of older adults undergoing surgery: A systematic review

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.amjsurg.2025.116226

Elham Navab , Nicholas Legacy , Kristen R. Haase , Laura Freeman , Ainslee Smith , Amir Hossein Goudarzian , Ana Patricia Ayala , Valentina Donison , Ailsa Sirois , Farshad Sharifi , Tyler R. Chesney , Camilla Wong , Joanne Callow , Dominque Boswell , Shabbir Alibhai , Martine Puts

Introduction

Increasing numbers of caregivers provide support to older adults after surgery, which is associated with stress and negative impacts on their health. Our review questions were:

Methods

The databases searched included PubMed, OVID MEDLINE, OVID PsycINFO, EBSCO CINAHL, OVID EMBASE, Web of Science Core Collection, Wiley Cochrane CENTRAL on February 14, 2024. Studies eligible for inclusion were randomized controlled trial (RCT) or quasi-experimental design with control groups, published in English, Dutch, German, French and Persian, included any unpaid caregiver, and the intervention must include a component specifically designed to meet the caregivers’ needs.

Results

in total 27,845 were screened and 45 full texts were reviewed. Seven RCTs, two pilot RCTS, and four quasi RCTs were included. Only five interventions had any positive impact and included self-management, telehealth, education and a family-centered care model.

Conclusion

Few effective interventions were identified and more engagement with caregivers may identify interventions that better target the caregivers’ needs.

Prospero registration number

CRD42024519637.

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引用次数: 0

Hospital experience with geriatric trauma impacts long-term survival

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-29 DOI: 10.1016/j.amjsurg.2025.116227

Manuel Castillo-Angeles , Cheryl K. Zogg , Molly P. Jarman , Stephanie Nitzschke , Reza Askari , Zara Cooper , Ali Salim , Joaquim M. Havens

Background

Hospital experience measured by geriatric trauma proportion (GTP) is associated with in-hospital mortality among geriatric patients. Our goal was to determine the impact of GTP on long-term survival among older trauma patients.

Methods

This was a retrospective analysis of Medicare inpatient claims (2014–2015) of geriatric trauma patients admitted in Florida. GTP was calculated by dividing the number of geriatric trauma patients by the overall adult trauma volume in each hospital. Hospitals were then categorized into tertiles of GTP. Our main outcome was mortality at 30, 90, 180, and 365 days. Multivariable regression was performed to identify the association between GTP and long-term survival.

Results

We included 65,763 geriatric trauma patients. As compared with hospitals in the lowest tertile, patients treated at the highest tertile were associated with lower mortality at 90 days (OR 0.90, 95%CI 0.82–0.98), 180 days (OR 0.90, 95%CI 0.83–0.97), and 365 days (OR 0.91, 95%CI 0.85–0.98).

Conclusions

Higher GTP is associated with improved long-term outcomes. However, mortality following trauma among geriatric patients continues to increase for 12 months.

{"title":"Hospital experience with geriatric trauma impacts long-term survival","authors":"Manuel Castillo-Angeles , Cheryl K. Zogg , Molly P. Jarman , Stephanie Nitzschke , Reza Askari , Zara Cooper , Ali Salim , Joaquim M. Havens","doi":"10.1016/j.amjsurg.2025.116227","DOIUrl":"10.1016/j.amjsurg.2025.116227","url":null,"abstract":"<div><h3>Background</h3><div>Hospital experience measured by geriatric trauma proportion (GTP) is associated with in-hospital mortality among geriatric patients. Our goal was to determine the impact of GTP on long-term survival among older trauma patients.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of Medicare inpatient claims (2014–2015) of geriatric trauma patients admitted in Florida. GTP was calculated by dividing the number of geriatric trauma patients by the overall adult trauma volume in each hospital. Hospitals were then categorized into tertiles of GTP. Our main outcome was mortality at 30, 90, 180, and 365 days. Multivariable regression was performed to identify the association between GTP and long-term survival.</div></div><div><h3>Results</h3><div>We included 65,763 geriatric trauma patients. As compared with hospitals in the lowest tertile, patients treated at the highest tertile were associated with lower mortality at 90 days (OR 0.90, 95%CI 0.82–0.98), 180 days (OR 0.90, 95%CI 0.83–0.97), and 365 days (OR 0.91, 95%CI 0.85–0.98).</div></div><div><h3>Conclusions</h3><div>Higher GTP is associated with improved long-term outcomes. However, mortality following trauma among geriatric patients continues to increase for 12 months.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116227"},"PeriodicalIF":2.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078404","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

Navigating the challenges of surgical research in low-and-middle income settings.

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-29 DOI: 10.1016/j.amjsurg.2025.116230

Chandler Hinson, Jenna Alkhatib, Lamario Williams, Madhushree Zope, Emmanuel A Ameh, Peter Nthumba

引用次数: 0

How to deploy a study: Key building blocks for maximum impact in surgical health services research.

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2025-01-28 DOI: 10.1016/j.amjsurg.2025.116204

Sherene E Sharath, Marie-Claire R Roberts, Ernest J Barthélemy, Danylo Orlov, Panos Kougias

引用次数: 0

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