American journal of surgery最新文献

Background: The benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy.

Method: This is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016-2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)-primary outcome, and length-of-stay (LOS)-secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses.

Results: Of 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91-3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51-10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05).

Conclusion: Drain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR.

Background: The Gender Equity Initiative in Global Surgery organization launched a mentorship program to address the limited opportunities available in low-and-middle-income countries (LMICs). We aimed to evaluate the utility of the virtual program in bridging this critical gap.

Methods: A retrospective review of program surveys containing quantitative and qualitative questions from 2022 to 2023 was performed.

Results: Of n ​= ​193 applicants, 81.3 ​% (157/193) identified as women, and 69.4 ​% (134/193) reported no prior mentorship. Applicants were from 41 countries (35 LMICs). The most requested specialties were general surgery (27.9 ​%, 54/193), neurosurgery (18.1 ​%, 35/193), and cardiothoracic surgery (11.4 ​%, 22/193). 55.9 ​% (108/193) preferred mentors from other countries (United States, United Kingdom, Canada), while 13.9 ​% (27/193) preferred mentors from their country. Ultimately, 48 applicants were matched with 13 mentors.

Conclusions: Demand for the program surpassed capacity, highlighting a need for mentorship opportunities for women overall, particularly in LMICs.

Introduction: Racial disparities in surgical outcomes are well described, but a paucity of literature exists examining trends in outcomes of thyroid cancer. We performed a systematic review of studies on thyroid cancer outcomes to better delineate the impact of race.

Methods: A comprehensive search strategy was performed in several academic databases for articles on thyroid cancer and surgical outcomes in accordance with PRISMA guidelines. A total of 1771 abstracts were reviewed. Abstracts were screened by two independent reviewers with disagreements resolved by a third. Studies that were based in the United States, included single center, unique data, focused on outcomes of differentiated thyroid cancer, were performed on adults >18 years old, and reported race in their results were included. Chi square statistics with Yates correction were calculated on the compiled data. The protocol was registered on PROSPERO (CRD42022300021).

Results: Twelve studies met inclusion criteria with data on 7,221patients. Among the included studies, our study consists of 67 ​% White patients, 22 ​% Black patients, 7 ​% Hispanic patients, and 3 ​% Asian patients. Extrathyroidal extension was observed in 8.4 ​% (n ​= ​13) of White patients. In comparison to White patients, Black (18.4 ​%, n ​= ​21, p ​= ​0.024) and Hispanic patients (28.3 ​%, n ​= ​30, p ​< ​0.001) had a higher incidence of extrathyroidal extension, while a similar incidence was observed in Asian patients (14.0 ​%, n ​= ​8, p ​= ​0.336). Compared to White patients (22.2 ​%, n ​= ​34), Black (12.4 ​%, n ​= ​13, p ​= ​0.065), Hispanic (16.0 ​%, n ​= ​15, p ​= ​0.301), and Asian (18.4 ​%, n ​= ​9, p ​= ​0.709) patients had a similar incidence of T1a stage. White patients had 10.1 ​% (n ​= ​54) recurrence rates, and Black (13.5 ​%, n ​= ​7, p ​= ​0.595), Hispanic (10.5 ​%, n ​= ​2, p ​= ​1.000), and Asian (11.1 ​%, n ​= ​3, p ​= ​1.000) patients had similar recurrence rates.

Conclusions: Race is seldom reported in outcomes on studies of thyroid cancer. From our analysis we conclude that non-White patients may have a higher risk of more advanced local disease at presentation. More data with granular detail on race is necessary to better understand racial disparities in thyroid cancer outcomes and how to alleviate them.

Background: Breast atypia increases overall breast cancer risk, potentially necessitating future interventions. This study examines the frequency and outcomes of additional percutaneous biopsies after an atypia diagnosis.

Methods: Adult patients with breast atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ) at a single institution were reviewed for subsequent core needle biopsies (CNBs) and corresponding malignant outcomes.

Results: Among 432 patients, median age at diagnosis was 54.8 ​y. Seventy-one (71/432, 16.4 ​%) patients developed a breast malignancy. During a median follow-up of 7.4 ​y, 113 patients underwent 149 additional CNBs. Twenty-six patients (26/113, 23.0 ​%) had >2 additional CNBs. Approximately half (79/149, 53.0 ​%) of all additional CNBs occurred within 5 years after breast atypia diagnosis.

Conclusion: A considerable number of patients with breast atypia undergo additional percutaneous biopsies, especially within 5 years post-atypia diagnosis. Our study highlights the significant burden of surveillance and the need for tailored follow-up strategies.