Pub Date : 2025-01-27DOI: 10.1016/j.amjsurg.2025.116223
Kimia Ameri, Michelle Kwon, Akie Watanabe, Sam M Wiseman
Background: Thyroid cancer, the most common endocrine malignancy, has highly variable practice patterns. This scoping review aimed to identify quantitative and qualitative quality of care indicators (QIs) essential for providing optimal care in thyroid cancer management.
Methods: A comprehensive search across MEDLINE, EMBASE, PubMed, and Web of Science identified QIs defining structures, processes, and outcomes in five care phases: pre-diagnosis, diagnosis, treatment, post-treatment surveillance, and end-of-life care.
Results: Of the 3,143 articles screened, 36 were included, yielding 135 unique QIs. Key diagnostic QIs were the use of a standardized ultrasound reporting system (n = 4), diagnostic fine needle aspiration biopsy (FNAB) (n = 3), and FNA cytology reporting with the Bethesda System (n = 3). Common treatment QIs included thyroidectomy by high-volume surgeons (≥10-32 cases/year) (n = 7), preoperative voice assessment for high-risk patients (n = 4), and recurrent laryngeal nerve monitoring (n = 3). Serum thyroglobulin (Tg) monitoring was the primary post-treatment QI for recurrence (n = 2).
Conclusions: Developing an evidence-based QI list can identify care gaps, direct targeted interventions, promote care standardization, and improve outcomes for thyroid cancer patients.
{"title":"Thyroid cancer quality of care indicators: A scoping review.","authors":"Kimia Ameri, Michelle Kwon, Akie Watanabe, Sam M Wiseman","doi":"10.1016/j.amjsurg.2025.116223","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116223","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer, the most common endocrine malignancy, has highly variable practice patterns. This scoping review aimed to identify quantitative and qualitative quality of care indicators (QIs) essential for providing optimal care in thyroid cancer management.</p><p><strong>Methods: </strong>A comprehensive search across MEDLINE, EMBASE, PubMed, and Web of Science identified QIs defining structures, processes, and outcomes in five care phases: pre-diagnosis, diagnosis, treatment, post-treatment surveillance, and end-of-life care.</p><p><strong>Results: </strong>Of the 3,143 articles screened, 36 were included, yielding 135 unique QIs. Key diagnostic QIs were the use of a standardized ultrasound reporting system (n = 4), diagnostic fine needle aspiration biopsy (FNAB) (n = 3), and FNA cytology reporting with the Bethesda System (n = 3). Common treatment QIs included thyroidectomy by high-volume surgeons (≥10-32 cases/year) (n = 7), preoperative voice assessment for high-risk patients (n = 4), and recurrent laryngeal nerve monitoring (n = 3). Serum thyroglobulin (Tg) monitoring was the primary post-treatment QI for recurrence (n = 2).</p><p><strong>Conclusions: </strong>Developing an evidence-based QI list can identify care gaps, direct targeted interventions, promote care standardization, and improve outcomes for thyroid cancer patients.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116223"},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073567","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 : 2025-01-26DOI: 10.1016/j.amjsurg.2025.116224
Caroline Given , Melissa Chang , Natassia Dunn , Areg Grigorian , Claudia Alvarez , Sigrid Burruss , Theresa Chin , Catherine Kuza , Jeffry Nahmias
Background
The applicability of spontaneous breathing trial (SBT) factors such as negative inspiratory force (NIF) and rapid shallow breathing index (RSBI) as predictors of reintubation in trauma patients (TPs) is unclear. This study aimed to identify predictors of unplanned reintubation (UR) in TPs.
Methods
A single center, retrospective (1/2017–12/2023) study of TPs ≥18 years-old extubated from endotracheal mechanical ventilation was performed. Patients with UR during admission were compared to patients without UR. A multivariable logistic regression was performed to identify risk factors associated with UR.
Results
39 of 424 TPs (9.2 %) had UR. UR patients were older (median: 55 vs 39 years-old, p = 0.012) and more often had congestive heart failure (10.3 % vs 1.6 %, p < 0.001), cirrhosis (7.7 % vs 1.9 %, p = 0.025), end stage renal disease (7.7 % vs 1.6 %, p = 0.044), and a higher injury severity scores (ISS) (median: 27 vs 18, p < 0.001). UR patients had increased ventilator days (median: 6 vs 2, p < 0.001) prior to extubation, whereas RSBI and NIF were similar (median: 36 vs 32, p = 0.508) and (median: −24.0 vs −27.0 cm H2O, p = 0.190). On multivariable analysis, RSBI <50 or <105 and NIF < -20 were not associated with UR. Age (OR 1.03, CI 1.01–1.05, p = 0.006) and ISS (OR 1.04, CI 1.01–1.08, p = 0.022) were independently associated with increased risk of UR.
Conclusions
SBT parameters (RSBI and NIF) were not associated with UR. Age and ISS were independently associated with UR. This suggests additional patient-specific factors should help guide extubation decisions for TPs.
{"title":"Standard spontaneous breathing trial parameters may not predict unplanned reintubation for trauma patients","authors":"Caroline Given , Melissa Chang , Natassia Dunn , Areg Grigorian , Claudia Alvarez , Sigrid Burruss , Theresa Chin , Catherine Kuza , Jeffry Nahmias","doi":"10.1016/j.amjsurg.2025.116224","DOIUrl":"10.1016/j.amjsurg.2025.116224","url":null,"abstract":"<div><h3>Background</h3><div>The applicability of spontaneous breathing trial (SBT) factors such as negative inspiratory force (NIF) and rapid shallow breathing index (RSBI) as predictors of reintubation in trauma patients (TPs) is unclear. This study aimed to identify predictors of unplanned reintubation (UR) in TPs.</div></div><div><h3>Methods</h3><div>A single center, retrospective (1/2017–12/2023) study of TPs ≥18 years-old extubated from endotracheal mechanical ventilation was performed. Patients with UR during admission were compared to patients without UR. A multivariable logistic regression was performed to identify risk factors associated with UR.</div></div><div><h3>Results</h3><div>39 of 424 TPs (9.2 %) had UR. UR patients were older (median: 55 vs 39 years-old, p = 0.012) and more often had congestive heart failure (10.3 % vs 1.6 %, p < 0.001), cirrhosis (7.7 % vs 1.9 %, p = 0.025), end stage renal disease (7.7 % vs 1.6 %, p = 0.044), and a higher injury severity scores (ISS) (median: 27 vs 18, p < 0.001). UR patients had increased ventilator days (median: 6 vs 2, p < 0.001) prior to extubation, whereas RSBI and NIF were similar (median: 36 vs 32, p = 0.508) and (median: −24.0 vs −27.0 cm H<sub>2</sub>O, p = 0.190). On multivariable analysis, RSBI <50 or <105 and NIF < -20 were not associated with UR. Age (OR 1.03, CI 1.01–1.05, p = 0.006) and ISS (OR 1.04, CI 1.01–1.08, p = 0.022) were independently associated with increased risk of UR.</div></div><div><h3>Conclusions</h3><div>SBT parameters (RSBI and NIF) were not associated with UR. Age and ISS were independently associated with UR. This suggests additional patient-specific factors should help guide extubation decisions for TPs.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116224"},"PeriodicalIF":2.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-24DOI: 10.1016/j.amjsurg.2025.116208
Sophie Carr , Maisa Samiee , Elaine McKevitt , Rebecca Warburton , Jieun Newman-Bremang , Melina Deban , Jin Si Pao , Carol Dingee , Amy Bazzarelli
Background
The diagnosis and treatment of non-palpable breast lesions is a multistep pathway that can involve imaging, tissue biopsy, clip placement, localization, and surgical resection. To minimize the procedural burden on patients, placement of localization seeds at time of initial biopsy has been considered. However, benefit to this patient population remains unclear. This study, therefore, aimed to determine the number of patients within our own institution that may benefit from upfront localization and characterize an appropriate target population.
Methods
A single institution retrospective cross-sectional study was conducted with assessment of all patients who underwent core needle biopsy (CNB) and/or breast cancer surgery at a regional high-volume breast centre between January 1 and December 31, 2018. Patients who underwent CNB with a subsequent radiological localization procedure and breast cancer surgeries that utilized localization were evaluated in order to model seed use.
Results
In total, 314 CNB and 634 breast cancer surgeries were performed. Within the CNB cohort, 60 (19.1 %) required localization. Of the breast cancer surgeries performed, 420 (66.2 %) were breast-conserving surgery and 303 (47.8 %) required localization.
Conclusion
With some localization technologies, the localization procedure can be coupled with biopsy and eliminate the need for a clip as the length of implantation is unrestricted. That said, our institutional data suggests that only a small portion of patients undergoing breast biopsy would benefit from upfront localization and a minority of breast cancer surgeries require localization. Further characterization of this specific patient population is needed to streamline management pathways.
{"title":"Localization procedure for breast lesions at time of biopsy – Which patients would benefit?","authors":"Sophie Carr , Maisa Samiee , Elaine McKevitt , Rebecca Warburton , Jieun Newman-Bremang , Melina Deban , Jin Si Pao , Carol Dingee , Amy Bazzarelli","doi":"10.1016/j.amjsurg.2025.116208","DOIUrl":"10.1016/j.amjsurg.2025.116208","url":null,"abstract":"<div><h3>Background</h3><div>The diagnosis and treatment of non-palpable breast lesions is a multistep pathway that can involve imaging, tissue biopsy, clip placement, localization, and surgical resection. To minimize the procedural burden on patients, placement of localization seeds at time of initial biopsy has been considered. However, benefit to this patient population remains unclear. This study, therefore, aimed to determine the number of patients within our own institution that may benefit from upfront localization and characterize an appropriate target population.</div></div><div><h3>Methods</h3><div>A single institution retrospective cross-sectional study was conducted with assessment of all patients who underwent core needle biopsy (CNB) and/or breast cancer surgery at a regional high-volume breast centre between January 1 and December 31, 2018. Patients who underwent CNB with a subsequent radiological localization procedure and breast cancer surgeries that utilized localization were evaluated in order to model seed use.</div></div><div><h3>Results</h3><div>In total, 314 CNB and 634 breast cancer surgeries were performed. Within the CNB cohort, 60 (19.1 %) required localization. Of the breast cancer surgeries performed, 420 (66.2 %) were breast-conserving surgery and 303 (47.8 %) required localization.</div></div><div><h3>Conclusion</h3><div>With some localization technologies, the localization procedure can be coupled with biopsy and eliminate the need for a clip as the length of implantation is unrestricted. That said, our institutional data suggests that only a small portion of patients undergoing breast biopsy would benefit from upfront localization and a minority of breast cancer surgeries require localization. Further characterization of this specific patient population is needed to streamline management pathways.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116208"},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1016/j.amjsurg.2025.116207
Nathaniel R Wilson, Christina V Angeles, Tarek Haykal
{"title":"Neoadjuvant treatment in advanced resectable melanoma and the need for a predictive biomarker - is pathologic complete response (pCR) the answer?","authors":"Nathaniel R Wilson, Christina V Angeles, Tarek Haykal","doi":"10.1016/j.amjsurg.2025.116207","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116207","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116207"},"PeriodicalIF":2.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035941","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 : 2025-01-19DOI: 10.1016/j.amjsurg.2025.116206
Marie-Claire R Roberts, Sherene E Sharath, Ernest J Barthélemy, Danylo Orlov, Panos Kougias
{"title":"The art and science of interpretation and dissemination | Data without context is meaningless.","authors":"Marie-Claire R Roberts, Sherene E Sharath, Ernest J Barthélemy, Danylo Orlov, Panos Kougias","doi":"10.1016/j.amjsurg.2025.116206","DOIUrl":"10.1016/j.amjsurg.2025.116206","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116206"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035944","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 : 2025-01-19DOI: 10.1016/j.amjsurg.2025.116205
Sherene E Sharath, Marie-Claire R Roberts, Ernest J Barthélemy, Danylo Orlov, Panos Kougias
{"title":"Surgical research in a fast-changing world: The process and benefits of refining a research question.","authors":"Sherene E Sharath, Marie-Claire R Roberts, Ernest J Barthélemy, Danylo Orlov, Panos Kougias","doi":"10.1016/j.amjsurg.2025.116205","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116205","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116205"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057789","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 : 2025-01-19DOI: 10.1016/j.amjsurg.2025.116202
Nebojša Oravec , Lloyd Mack , Dara Hallock , Caitlin McClurg , May Lynn Quan
Introduction
There is a paucity of data to support surveillance protocols for localized, low-grade appendiceal mucinous neoplasms (LAMNs) after resection.
Methods
A search strategy was developed to identify postoperative surveillance strategies for LAMNs, in the context of rates of recurrence and disease-free survival, and applied to four literature databases. Resultant citations were subject to screening in duplicate, in three stages: title, abstract, and full-text. Data was extracted from the final set of included articles and subject to descriptive statistics.
Results
A total of 16 articles, representing 1218 patients, were included. The duration of surveillance ranged from 0.1 to 294 months, and the mode surveillance interval was three months. The most common surveillance method was imaging (n = 610 patients, 48.7 %). Thirty one patients had disease recurrence (2.7 %). Time to recurrence ranged from 2.5 to 68 months, and the range of five-year survival was 93.5–95.2 % among five studies.
Discussion
In the absence of strong evidence to suggest that surveillance confers a survival benefit for patients with localized LAMNs after resection, decisions about surveillance should be patient-oriented.
{"title":"A scoping review of postoperative surveillance strategies for localized, low-grade appendiceal mucinous neoplasms","authors":"Nebojša Oravec , Lloyd Mack , Dara Hallock , Caitlin McClurg , May Lynn Quan","doi":"10.1016/j.amjsurg.2025.116202","DOIUrl":"10.1016/j.amjsurg.2025.116202","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a paucity of data to support surveillance protocols for localized, low-grade appendiceal mucinous neoplasms (LAMNs) after resection.</div></div><div><h3>Methods</h3><div>A search strategy was developed to identify postoperative surveillance strategies for LAMNs, in the context of rates of recurrence and disease-free survival, and applied to four literature databases. Resultant citations were subject to screening in duplicate, in three stages: title, abstract, and full-text. Data was extracted from the final set of included articles and subject to descriptive statistics.</div></div><div><h3>Results</h3><div>A total of 16 articles, representing 1218 patients, were included. The duration of surveillance ranged from 0.1 to 294 months, and the mode surveillance interval was three months. The most common surveillance method was imaging (n = 610 patients, 48.7 %). Thirty one patients had disease recurrence (2.7 %). Time to recurrence ranged from 2.5 to 68 months, and the range of five-year survival was 93.5–95.2 % among five studies.</div></div><div><h3>Discussion</h3><div>In the absence of strong evidence to suggest that surveillance confers a survival benefit for patients with localized LAMNs after resection, decisions about surveillance should be patient-oriented.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116202"},"PeriodicalIF":2.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035867","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 : 2025-01-18DOI: 10.1016/j.amjsurg.2025.116200
Joshua E. Lewis , Amani R. Patterson , Maame A. Effirim , Victoria A. Cuello , Philong Nguyen , Manav Patel , Shawn Lim , Wei-Chen Lee
{"title":"Influences on decision-making for gender-affirming surgery in adolescents: A scoping review of family, religion, and healthcare provider factors","authors":"Joshua E. Lewis , Amani R. Patterson , Maame A. Effirim , Victoria A. Cuello , Philong Nguyen , Manav Patel , Shawn Lim , Wei-Chen Lee","doi":"10.1016/j.amjsurg.2025.116200","DOIUrl":"10.1016/j.amjsurg.2025.116200","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116200"},"PeriodicalIF":2.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057790","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 : 2025-01-17DOI: 10.1016/j.amjsurg.2025.116197
Philipp Seeger , Nikolaos Kaldis , Felix Nickel , Thilo Hackert , Panagis M. Lykoudis , Anastasios D. Giannou
Background
Surgery has evolved from a hands-on discipline where skills were acquired via the “learning by doing” principle to a surgical science with attention to patient safety, health care effectiveness and evidence-based research. A variety of simulation modalities have been developed to meet the need for effective resident training. So far, research regarding surgical training for minimally invasive surgery has been extensive but also heterogenous in grade of evidence.
Methods
A literature search was conducted to summarize current knowledge about simulation training and to guide research towards evidence-based curricula with translational effects. This was conducted using a variety of terms in PubMed for English articles up to October 2024. Results are presented in a structured narrative review.
Results
For virtual reality simulators, there is sound evidence for effective training outcomes. The required instruments for the development of minimally invasive surgery curricula combining different simulation modalities to create a clinical benefit are known and published.
Conclusion
Surgeons are the main creators for minimally invasive surgery training curricula and often follow a hands-on oriented approach that leaves out equally important aspects of assessment, evaluation, and feedback. Further high-quality research that includes available evidence in this field promises to improve patient safety in surgical disciplines.
{"title":"Surgical training simulation modalities in minimally invasive surgery: How to achieve evidence-based curricula by translational research","authors":"Philipp Seeger , Nikolaos Kaldis , Felix Nickel , Thilo Hackert , Panagis M. Lykoudis , Anastasios D. Giannou","doi":"10.1016/j.amjsurg.2025.116197","DOIUrl":"10.1016/j.amjsurg.2025.116197","url":null,"abstract":"<div><h3>Background</h3><div>Surgery has evolved from a hands-on discipline where skills were acquired via the “learning by doing” principle to a surgical science with attention to patient safety, health care effectiveness and evidence-based research. A variety of simulation modalities have been developed to meet the need for effective resident training. So far, research regarding surgical training for minimally invasive surgery has been extensive but also heterogenous in grade of evidence.</div></div><div><h3>Methods</h3><div>A literature search was conducted to summarize current knowledge about simulation training and to guide research towards evidence-based curricula with translational effects. This was conducted using a variety of terms in PubMed for English articles up to October 2024. Results are presented in a structured narrative review.</div></div><div><h3>Results</h3><div>For virtual reality simulators, there is sound evidence for effective training outcomes. The required instruments for the development of minimally invasive surgery curricula combining different simulation modalities to create a clinical benefit are known and published.</div></div><div><h3>Conclusion</h3><div>Surgeons are the main creators for minimally invasive surgery training curricula and often follow a hands-on oriented approach that leaves out equally important aspects of assessment, evaluation, and feedback. Further high-quality research that includes available evidence in this field promises to improve patient safety in surgical disciplines.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116197"},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/j.amjsurg.2025.116201
Catherine G. Williamson , Jordan M. Rook , Joanna Curry , Gerald Gollin , Peyman Benharash , Justin P. Wagner
Necrotizing enterocolitis (NEC) is a devastating illness with mortality rates approaching 26 %, with 4 % of patients with congenital heart disease (CHD) receiving this diagnosis. In this retrospective cohort study, the Pediatric Health Information System database was used to compare outcomes among patients with NEC diagnoses between 2019 and 2021 by CHD. The association of clinical factors with the outcomes of interest were compared using multivariable logistic regression. Of 2415 pediatric patients diagnosed with NEC, 955 (39.5 %) had a diagnosis of CHD. Those with CHD were more frequently White and born at a later gestational age. Antibiotic courses were similar; however, CHD patients had lower rates of post-antibiotic operations (18.0 % vs 32.1 %, p < 0.001) and in-hospital mortality (11.1 % vs 15.5 %, p = 0.001). On adjusted analysis, patients without CHD were twice as likely to undergo an abdominal operation. Compared with patients without CHD, those with CHD had decreased rates of antibiotic failure for NEC diagnosis despite similar treatment courses. Distinct outcomes of bowel ischemia among infants with CHD warrant further study of treatment strategies that may differ from those of classical NEC.
Type of study
Retrospective Cohort Study.
Level of evidence
III.
{"title":"Necrotizing enterocolitis vs bowel ischemia of congenital heart disease: Apples and oranges","authors":"Catherine G. Williamson , Jordan M. Rook , Joanna Curry , Gerald Gollin , Peyman Benharash , Justin P. Wagner","doi":"10.1016/j.amjsurg.2025.116201","DOIUrl":"10.1016/j.amjsurg.2025.116201","url":null,"abstract":"<div><div>Necrotizing enterocolitis (NEC) is a devastating illness with mortality rates approaching 26 %, with 4 % of patients with congenital heart disease (CHD) receiving this diagnosis. In this retrospective cohort study, the Pediatric Health Information System database was used to compare outcomes among patients with NEC diagnoses between 2019 and 2021 by CHD. The association of clinical factors with the outcomes of interest were compared using multivariable logistic regression. Of 2415 pediatric patients diagnosed with NEC, 955 (39.5 %) had a diagnosis of CHD. Those with CHD were more frequently White and born at a later gestational age. Antibiotic courses were similar; however, CHD patients had lower rates of post-antibiotic operations (18.0 % vs 32.1 %, p < 0.001) and in-hospital mortality (11.1 % vs 15.5 %, p = 0.001). On adjusted analysis, patients without CHD were twice as likely to undergo an abdominal operation. Compared with patients without CHD, those with CHD had decreased rates of antibiotic failure for NEC diagnosis despite similar treatment courses. Distinct outcomes of bowel ischemia among infants with CHD warrant further study of treatment strategies that may differ from those of classical NEC.</div></div><div><h3>Type of study</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"242 ","pages":"Article 116201"},"PeriodicalIF":2.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035901","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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