American journal of surgery最新文献

Background

We examined whether hospital resources mediated the association between race/ethnicity and postoperative VTE, in a national cohort.

Methods

National Inpatient Sample data were restricted to major abdominal surgeries (1993–2020) performed for malignancies. Hospital resource index was as a summary measure of hospital size, teaching status, and private payor proportions. The composite VTE outcome included postoperative deep vein thrombosis and pulmonary embolism. Adjusted logistic regression with 4-way decomposition described joint and mediating effects.

Results

Among 1,169,862 surgeries, unadjusted VTE rate was 1.0 ​% (14,789). VTE risk was 28 ​% higher for Black/African Americans (adjusted Odds Ratio ​= ​1.28, 95 ​% CI: 1.21, 1.37) relative to White/Caucasians. VTE risk was lower among Black individuals as hospital resource index increased (excess risk ​= ​−0.005, p ​< ​0.001), with an effect size of likely minimal clinical impact.

Conclusion

Cohorts that are more vulnerable to postoperative VTE did not meaningfully benefit from improving hospital resources. It is likely that lifestyle modifying behaviors, environmental factors, and comorbidity management are more influential in reducing risks.

Background

As there is limited literature evaluating food insecurity status (FI) and surgical outcomes, we sought to assess the association between county-level FI and outcomes following cardiac surgery.

Methods

In a retrospective cohort, patients who underwent coronary artery bypass grafting between 2016 and 2020 were identified utilizing the Medicare Standard Analytic Files. Using County-level FI, patients were stratified into low, moderate, and high cohorts. The primary outcome was textbook outcomes, a measure of “optimal” post-operative outcomes. Adjusted multiple logistic regression and Cox regression models were utilized to evaluate outcomes and survival.

Results

Among 267,914 patients, patients residing in high FI regions were less likely to achieve textbook outcomes (OR: 0.94, 95 ​% CI: 0.90–0.99). When evaluating individual post-operative outcomes of interest, patients residing in high FI regions also had a greater odd of 90-day mortality (OR: 1.24, 95 ​% CI: 1.12–1.36) and extended LOS (OR: 1.07, 95 ​% CI: 1.01–1.14) (all p ​< ​0.0001). Moreover, this population was also at greater risk of 5-year mortality (HR: 1.11, 95 ​% CI: 1.06–1.17) compared with their counterparts from low food insecurity regions. Racial disparities persisted in high FI counties as Black patients had a greater risk of 5-year mortality (HR: 1.27, 95 ​% CI: 1.17–1.38, p ​< ​0.0001) compared with White patients within the same FI level.

Conclusions

County-level FI was associated with worse outcomes following cardiac surgery.

Introduction

Methods

Results

Conclusion

Background

The ideal duration of neonatal antibiotic prophylaxis is not determined with wide variance in practice. This study aims to evaluate the association between duration of antibiotics and surgical site infection (SSI) in neonatal surgery.

Methods

A retrospective review regarding antibiotic prophylaxis was performed on <30-day-old surgical patients at a children's hospital from 2014 to 2019. The patients were analyzed based on demographics, presence of SSI, and antibiotic duration. The primary outcome was the development of SSI with ANOVA, chi-square, and recursive partitioning used for statistical analysis.

Results

19/155 patients developed an SSI (12.26 ​%). Those with an SSI had a lower weight at surgery (p ​= ​0.03). Additionally, wound classification (p ​= ​0.17) and antibiotic duration >48hrs (p ​= ​0.94) made no statistical difference in SSI rate. The two variables most closely linked to SSI development were gestational age (100 ​%) and weight at time of procedure (80.76 ​%).

Conclusions

Antibiotic prophylaxis >48 ​h did not decrease the incidence of SSI. Risk factors for SSI development in neonatal surgery were lower gestational age, decreased weight at time of procedure and total length of procedure.

Background

The aim of this study is to quantify the relative contribution of comorbidities and pre-operative functional status on outcomes in geriatric emergency general surgery (EGS) patients.

Methods

This is a retrospective study of older-adult EGS patients at an academic medical center between 2017 and 2018. Patients ≥65 years were included. The primary outcomes examined were 30-day mortality, 30-day morbidity, and length of stay (LOS).

Results

734 patients were included. The mean age was 76, and 48.9 ​% received non-operative management. The median LOS was 6.8 days; 11.8 ​% of patients died within 30 days, and 40.6 ​% developed morbidities. Lacking capacity to consent on admission was independently associated with 30-day mortality (OR: 2.63, [1.32–5.25], p ​= ​0.006). Comorbidities associated with developing morbidity were CVA with neurologic deficit (OR: 2.29, [1.20–4.36], p ​= ​0.012), CHF (OR: 2.60, [1.64–4.11], p ​< ​0.001), in addition to pre-operative delirium (OR: 3.42, [1.43–8.14], p ​= ​0.006).

Conclusions

A significant contribution to outcomes is determined by pre-admission comorbidities and cognitive and functional status. Opportunities exist for collaboration between Acute Care Surgery and geriatric medicine teams for the optimization of comorbidities.

Background

Sentinel lymph node status is critical for melanoma staging and treatment. However, the factors influencing SLNB and its oncologic benefits in elderly patients are unclear.

Methods

We conducted a retrospective analysis of patients aged ≥65 with clinically node-negative melanoma and Breslow depth ≥1 ​mm, using Surveillance, Epidemiology, and End Results Medicare database (2010–2018). Multivariable logistic regression assessed SLNB likelihood by demographic and clinical factors, and Cox-proportional hazard models evaluated overall and melanoma-specific mortality (MSM) for SLNB recipients versus non-recipients.

Results

Of 13,160 melanoma patients, 62.29 ​% underwent SLNB. SLNB was linked to reduced all-cause mortality (HR: 0.65 [95%CI 0.61–0.70]) and MSM (HR: 0.76 [95%CI 0.67–0.85]). Older age, non-White race, male sex, and unmarried status was associated with decreased SLNB likelihood, while cardiopulmonary, neurologic, and secondary cancer comorbidities were associated with increased SLNB likelihood.

Conclusions

Though less frequently performed, SLNB is associated with lower mortality in elderly melanoma patients. Advanced age alone should not contraindicate SLNB.

Background

Pancreatic adenocarcinoma of distal pancreas is hard to treat due to late presentation. While open distal pancreatectomy with splenectomy has had favourable outcomes, it has also had many complications which were low among Minimally invasive procedures. This retrospective cohort analysis compares minimally invasive and open distal pancreatectomy (MIDP) outcomes using a national inpatient database.

Methods

The study used 2016–2020 NIS data. The study included 1577 distal pancreatic malignant tumor surgery patients. There were 530 Minimally Invasive and 1047 Open groups. Propensity matched analysis was performed on surgical groups to reduce confounding variables.

Results

In comparison to open procedures, minimally invasive techniques reduced hospital stays by 10 ​% (OR ​= ​0.90, 95 ​% CI 0.86–0.93). While not statistically significant, the unmatched analysis linked MIDP to lower in-hospital mortality. African Americans were 37 ​% less likely to undergo MIDP than Caucasians (OR ​= ​0.63, 95 ​% CI ​= ​0.40–0.96).

Conclusion

Nationwide analysis suggests MIDP may be a safe and effective surgical treatment for distal pancreatic adenocarcinoma. It may reduce hospital stays and mortality over open surgery. The study also suggests race may affect minimally invasive procedure rates.