American journal of surgery最新文献

英文中文

Body image and psychosocial effects in women after treatment of breast cancer: A prospective study 乳腺癌治疗后妇女的身体形象和社会心理影响：前瞻性研究

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-14 DOI: 10.1016/j.amjsurg.2024.115895

Purpose

To explore treatment-related, socio-economic, and psychological factors influencing body image and return to work.

Materials and methods

137 patients participated in the study. A questionnaire was completed before surgery and at 1-year follow-up, where patients were also interviewed in person with questions modified from the Body Image Scale and the sexual adjustment scale as well as questions about their work status.

Results

There was a significant decline in body image score from baseline to 1-year follow-up related to younger age, more extensive surgery and post-surgery treatments. Treatment with adjuvant chemotherapy was associated with a lower rating on ability to work in relation to mental requirements and later return to work. Higher anxiety scores at baseline were associated with both a decline in body image and a delay in return to work.

Conclusion

Breast cancer surgery can affect body image and especially adjuvant chemotherapy seems to affect work ability. However, personal characteristics are also involved and thus should be considered when planning for treatment of breast cancer.

目的探讨影响身体形象和重返工作岗位的治疗相关因素、社会经济因素和心理因素。结果从基线到1年随访期间，身体形象评分显著下降，这与年龄较小、手术范围较大和术后治疗有关。辅助化疗治疗与心理要求和日后重返工作岗位相关的工作能力评分较低有关。结论：乳腺癌手术会影响身体形象，尤其是辅助化疗似乎会影响工作能力。乳腺癌手术会影响身体形象，尤其是辅助化疗似乎会影响工作能力，但这也与个人特征有关，因此在制定乳腺癌治疗计划时应加以考虑。

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引用次数: 0

Unleashing surgical skills: Ultra-high fidelity trauma thoracotomy training on knowledge donor platform 释放手术技能：知识捐献平台上的超高仿真创伤胸廓切开术培训。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-13 DOI: 10.1016/j.amjsurg.2024.115899

Background

Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure.

Methods

General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence.

Results

Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 ± 1.7), followed by Live Patient only (4.3 ± 2.5), and KD only (2.6 ± 1.3). The mean confidence rating for residents with neither training opportunity was 1.4 ± 1.0.

Conclusions

The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.

背景：抢救性开胸手术是一种时间敏感的急诊外科手术，具有直接的死亡风险。我们假设一个高保真全身供体模拟模型（称为 "知识供体"，Knowledge Donor (KD)），该模型具有机械肺通气和人体血液灌注功能，可增强学习者对实施这一关键手术的信心：方法：邀请普外科住院医师和教师参加 KD 培训。方法：邀请普外科住院医师和教师参加 KD 培训，并收集调查问卷以跟踪参与情况和信心情况：模拟复苏胸廓切开术由第一至第四年级的住院医师参与。同时拥有 KD 和 "真实病人 "经验的住院医师的平均信心指数最高（5.6 ± 1.7），其次是仅有 "真实病人 "经验的住院医师（4.3 ± 2.5）和仅有 KD 经验的住院医师（2.6 ± 1.3）。没有参加过任何培训机会的住院医师的平均信心评级为 1.4 ± 1.0：KD 平台是一种超逼真的培训模式，可近似复制现场手术。该平台可让住院医师在安全的环境中练习复杂的外科手术，而不会危及患者安全。该试点项目在提高住院医师对高风险外科手术（尤其是胸廓切开术）的手术信心方面取得了初步成效。

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引用次数: 0

An assessment of nationwide trends in emergency department (ED) resuscitative endovascular balloon occlusion of the aorta (REBOA) use – A trauma quality improvement program registry analysis 全国急诊科（ED）主动脉血管内球囊闭塞复苏术（REBOA）使用趋势评估--创伤质量改进计划登记分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-13 DOI: 10.1016/j.amjsurg.2024.115898

Background

Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemorrhage control in severe non-compressible torso trauma remains controversial, with limited data on patient selection and outcomes. This study aims to analyze the nationwide trends of its use in the emergency department (EDs).

Methods

A retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) from 2017 to 2022 was performed, focusing on REBOA placements in EDs.

Results

The analysis included 3398 REBOA procedures. Majority patients were male (76 %) with a median age of 40 years (27–58) and injury severity score of 20 (20–41). The most common mechanism was collision (64 %), with emergency surgeries most frequently performed for pelvic trauma (14 %). Level 1 trauma centers performed 82 % of these procedures, with consistent low annual utilization (<200 facilities). Survival rates were 85 % at 1-h post-placement, decreasing significantly to 42 % by discharge.

Conclusions

REBOA usage in remains limited but steady, primarily occurring at level 1 trauma center EDs. While short-term survival rates are favorable, they drop significantly by the time of discharge.

背景在严重的不可压缩躯干创伤中使用复苏性血管内球囊主动脉闭塞术（REBOA）进行暂时性出血控制仍存在争议，有关患者选择和预后的数据有限。本研究旨在分析全国范围内急诊科（ED）使用该方法的趋势。方法对2017年至2022年美国外科学院创伤质量改进计划（ACS-TQIP）进行了回顾性分析，重点关注急诊科的REBOA置入情况。大多数患者为男性（76%），中位年龄为40岁（27-58岁），受伤严重程度为20分（20-41分）。最常见的受伤机制是碰撞（64%），最常见的急诊手术是骨盆创伤（14%）。一级创伤中心完成了其中 82% 的手术，年利用率一直很低（200 家机构）。置入后 1 小时的存活率为 85%，出院时显著下降至 42%。虽然短期存活率较高，但到出院时存活率明显下降。

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引用次数: 0

An analysis of the effect of low titer O whole blood (LTOWB) proportions for resuscitation after trauma on 6-hour and 24-hour survival 分析创伤后低滴度 O 型全血（LTOWB）复苏比例对 6 小时和 24 小时存活率的影响

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-13 DOI: 10.1016/j.amjsurg.2024.115900

引用次数: 0

Utility of ligamentum teres hepatis flap reinforcement to prevent postoperative pancreatic fistulas in robotic distal pancreatectomy 在机器人远端胰腺切除术中，肝韧带皮瓣加固对预防术后胰瘘的作用。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-13 DOI: 10.1016/j.amjsurg.2024.115894

Background

Postoperative pancreatic fistula (POPF) is a significant contributor to morbidity and mortality after robotic distal pancreatectomy (RDP). Ligamentum teres hepatis (LTH) reinforcement of the pancreatic remnant may reduce the incidence of POPF.

Methods

Patients ≥18 years old, who underwent RDP at the University of Massachusetts Memorial Medical Center from 01/01/2018-08/31/2022. Primary endpoint was POPF incidence. Secondary outcomes included peri- and postoperative variables.

Results

Thirty-three patients underwent RDP, of which LTH reinforcement was used in 21 (64 %) cases. Six (18 %) patients developed a POPF. No association was identified between LTH flap reinforcement and POPF (OR 1.18, 95 % CI 0.18 to 7.85, p = 0.87). There were no peri- or postoperative complications related to ligamentum teres flap creation.

Conclusions

LTH reinforcement of the pancreatic remnant can be safely performed during RDP. Further studies are needed to assess the utility of this intervention to mitigate the risk of pancreatic fistula formation following RDP.

背景：术后胰瘘（POPF）是机器人远端胰腺切除术（RDP）后发病率和死亡率的重要因素。肝韧带（LTH）加固胰腺残余可降低 POPF 的发生率：方法：2018 年 1 月 1 日至 2022 年 8 月 31 日期间在马萨诸塞大学纪念医学中心接受 RDP 的年龄≥18 岁的患者。主要终点为 POPF 发生率。次要结果包括围手术期和术后变量：33 名患者接受了 RDP，其中 21 例（64%）使用了 LTH 加固术。6例（18%）患者出现了POPF。未发现 LTH 皮瓣加固与 POPF 之间存在关联（OR 1.18，95 % CI 0.18 至 7.85，p = 0.87）。术前和术后均未出现与韧带瓣创建相关的并发症：结论：胰腺残余的LTH加固可以在RDP手术中安全进行。结论：胰腺残端 LTH 加固术可以在 RDP 期间安全地进行，还需要进一步的研究来评估这种干预对降低 RDP 后胰瘘形成风险的作用。

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引用次数: 0

Axillary de-escalation after neoadjuvant chemotherapy for advanced lymph node involvement in breast cancer 乳腺癌晚期淋巴结受累新辅助化疗后的腋窝去势疗法

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-09 DOI: 10.1016/j.amjsurg.2024.115893

Introduction

Sentinel lymph node biopsy reduces morbidity in patients with clinically node-positive breast cancer who achieve axillary pathologic complete response following neoadjuvant therapy (NACT). De-escalation trials primarily addressed cN1 disease, with underrepresentation of cN2 disease. This study evaluates the role of de-escalation in patients with cN2 breast cancer.

Methods

A retrospective analysis of the National Cancer Database (2013–2020) included women over 18 with T1-2 invasive breast cancer and clinical N2 disease who received NACT followed by ALND or SLNB then ALND. The primary outcome was pathologic nodal status post-NACT.

Results

Of 5852 cN2 patients treated, 18.15 % achieved ypN0, 0.97 % had isolated tumor cells, 19.14 % were ypN1, 49.64 % were ypN2, and 12.20 % were ypN3 following NACT. Achieving ypN0 was associated with pCR in the breast, HER2-positive and triple-negative receptor status, cT2 tumors, and younger age.

Conclusion

Despite some patients with cN2 disease achieving ypN0, most exhibited residual axillary disease post-NACT. These findings indicate that axillary de-escalation may not be feasible for most patients with cN2 disease, underscoring the importance of meticulous patient selection and assessment.

导言前哨淋巴结活检可降低临床结节阳性乳腺癌患者在新辅助治疗（NACT）后获得腋窝病理完全反应的发病率。降级试验主要针对cN1疾病，而cN2疾病的代表性不足。本研究评估了降级疗法在cN2乳腺癌患者中的作用。方法对美国国家癌症数据库（2013-2020年）进行回顾性分析，纳入了18岁以上患有T1-2浸润性乳腺癌和临床N2疾病的女性患者，她们接受了NACT后进行ALND或SLNB后进行ALND。结果在接受 NACT 治疗的 5852 例 cN2 患者中，18.15% 达到 ypN0，0.97% 有孤立肿瘤细胞，19.14% 为 ypN1，49.64% 为 ypN2，12.20% 为 ypN3。结论尽管一些患有cN2疾病的患者实现了ypN0，但大多数患者在NACT后表现出残留的腋窝疾病。这些研究结果表明，腋窝去势对于大多数cN2患者来说可能并不可行，因此强调了对患者进行精心选择和评估的重要性。

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引用次数: 0

Association between clinical factors and mortality in older adult trauma patients: A systematic review and meta-analysis 老年创伤患者的临床因素与死亡率之间的关系：系统回顾和荟萃分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-08 DOI: 10.1016/j.amjsurg.2024.115890

Background

This study reviews and meta-analysis factors affecting mortality in older adult trauma patients, addressing previously unidentified heterogeneity and risk burden.

Methods

Databases (PubMed, Embase, Cochrane and Scopus) were searched for studies from January 1, 2000, to April 30, 2024. Inclusion criteria were patients aged ≥65 years with trauma, assessing survival or death outcomes. Two authors independently screened and extracted data using the PRISMA checklist; disagreements were resolved by a third author.

Results

Eighteen retrospective studies were included (425,355 patients), showing an overall mortality rate of 9.6 %. Falls were the predominant cause of injury. Demographic mortality risk factors included advanced age, frailty, male sex, and comorbidities (blood/bleeding disorders, liver disease, cancer, kidney disease, and lung disease). Injury risk factors were identified as contributing to the outcome, including low systolic blood pressure, Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score, and surgical intervention.

Conclusion

Trauma significantly elevates the mortality rate in older adults, with advanced age, gender, comorbidities, injury severity, frailty, and surgical intervention being key factors.

背景本研究对影响老年创伤患者死亡率的因素进行了回顾和荟萃分析，解决了之前未发现的异质性和风险负担问题。方法检索数据库（PubMed、Embase、Cochrane 和 Scopus）中 2000 年 1 月 1 日至 2024 年 4 月 30 日的研究。纳入标准为年龄≥65岁的外伤患者，评估生存或死亡结果。两位作者使用 PRISMA 核对表独立筛选和提取数据；出现分歧时由第三位作者解决。结果共纳入 18 项回顾性研究（425,355 名患者），显示总死亡率为 9.6%。跌倒是主要的受伤原因。人口统计学死亡风险因素包括高龄、体弱、男性和合并症（血液/出血性疾病、肝病、癌症、肾病和肺病）。损伤风险因素包括低收缩压、格拉斯哥昏迷量表、损伤严重程度评分、修订创伤评分和手术干预。

{"title":"Association between clinical factors and mortality in older adult trauma patients: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.amjsurg.2024.115890","DOIUrl":"10.1016/j.amjsurg.2024.115890","url":null,"abstract":"<div><h3>Background</h3><p>This study reviews and meta-analysis factors affecting mortality in older adult trauma patients, addressing previously unidentified heterogeneity and risk burden.</p></div><div><h3>Methods</h3><p>Databases (PubMed, Embase, Cochrane and Scopus) were searched for studies from January 1, 2000, to April 30, 2024. Inclusion criteria were patients aged ≥65 years with trauma, assessing survival or death outcomes. Two authors independently screened and extracted data using the PRISMA checklist; disagreements were resolved by a third author.</p></div><div><h3>Results</h3><p>Eighteen retrospective studies were included (425,355 patients), showing an overall mortality rate of 9.6 %. Falls were the predominant cause of injury. Demographic mortality risk factors included advanced age, frailty, male sex, and comorbidities (blood/bleeding disorders, liver disease, cancer, kidney disease, and lung disease). Injury risk factors were identified as contributing to the outcome, including low systolic blood pressure, Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score, and surgical intervention.</p></div><div><h3>Conclusion</h3><p>Trauma significantly elevates the mortality rate in older adults, with advanced age, gender, comorbidities, injury severity, frailty, and surgical intervention being key factors.</p></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141993665","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

Not so sweet victory: Diabetes associated with increased unplanned healthcare utilization following ostomy creation. 并不甜蜜的胜利糖尿病与造口术后非计划医疗使用增加有关。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-08 DOI: 10.1016/j.amjsurg.2024.115889

Tabitha E Norton, Pasithorn A Suwanabol, Samantha L Savitch

引用次数: 0

ALL-SAFE: A novel approach to global surgery collaboration. ALL-SAFE：全球外科协作的新方法。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-08 DOI: 10.1016/j.amjsurg.2024.115884

Serena S Bidwell, Grace J Kim

引用次数: 0

Representation of online LGBTQ+ support in general surgery residency programs. 在线 LGBTQ+ 支持在普外科住院医师培训项目中的代表性。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-08-06 DOI: 10.1016/j.amjsurg.2024.115891

Chandler A Annesi, Andrada Diaconescu, Adam Lucy, Kristen Wong, Herbert Chen

Background: Lesbian, Gay, Bisexual, Transgender, Queer, and more(LGBTQ+) trainees are underrepresented in medicine, and their experiences in surgery have not been well studied. We sought to examine the practices of general surgery residency programs by region regarding representation of LGBTQ+ support online.

Methods: Retrospective, two-person review of 100 general surgery residency programs stratified by Electronic Residency Application Service(ERAS) region comparing data on Diversity, Equity, and Inclusion(DEI) and LGBTQ+ -specific webpages.

Results: The Middle Atlantic and South Atlantic regions had 20% of programs each, with fewer programs found in other regions. Of the 100 institutions, 92% had DEI webpages, and 43% had LGBTQ+ -specific webpages. There was a significant difference in the likelihood of a program being an Human Rights Campaign(HRC) LGBTQ+ leader when compared by region(p < 0.01).

Conclusions: Few general surgery residency programs share LGBTQ+-specific DEI content online with no regional difference observed. Recommendations such as updating websites to highlight LGBTQ+ inclusion should aid recruitment of a diverse, surgical residency as well as create a welcoming environment for prospective residents.

背景：女同性恋、男同性恋、双性恋、变性人、同性恋及更多（LGBTQ+）受训者在医学界的代表性不足，而他们在外科的经历尚未得到充分研究。我们试图研究各地区普外科住院医师培训项目在LGBTQ+在线支持方面的做法：方法：对100个普外科住院医师培训项目进行回顾性双人审查，按住院医师电子申请服务（ERAS）地区进行分层，比较多元化、平等与包容（DEI）和LGBTQ+特定网页的数据：结果：中大西洋和南大西洋地区各有20%的项目，其他地区的项目较少。在 100 所院校中，92% 的院校拥有 DEI 网页，43% 的院校拥有 LGBTQ+ 专属网页。如果按地区进行比较，项目成为 "人权运动（HRC）LGBTQ+领导者 "的可能性存在明显差异（P结论）：很少有普外科住院医师培训项目在网上分享针对LGBTQ+的DEI内容，且没有地区差异。更新网站以突出 LGBTQ+ 的包容性等建议应有助于招聘多样化的外科住院医师，并为未来的住院医师创造一个受欢迎的环境。

{"title":"Representation of online LGBTQ+ support in general surgery residency programs.","authors":"Chandler A Annesi, Andrada Diaconescu, Adam Lucy, Kristen Wong, Herbert Chen","doi":"10.1016/j.amjsurg.2024.115891","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2024.115891","url":null,"abstract":"<p><strong>Background: </strong>Lesbian, Gay, Bisexual, Transgender, Queer, and more(LGBTQ+) trainees are underrepresented in medicine, and their experiences in surgery have not been well studied. We sought to examine the practices of general surgery residency programs by region regarding representation of LGBTQ+ support online.</p><p><strong>Methods: </strong>Retrospective, two-person review of 100 general surgery residency programs stratified by Electronic Residency Application Service(ERAS) region comparing data on Diversity, Equity, and Inclusion(DEI) and LGBTQ+ -specific webpages.</p><p><strong>Results: </strong>The Middle Atlantic and South Atlantic regions had 20% of programs each, with fewer programs found in other regions. Of the 100 institutions, 92% had DEI webpages, and 43% had LGBTQ+ -specific webpages. There was a significant difference in the likelihood of a program being an Human Rights Campaign(HRC) LGBTQ+ leader when compared by region(p < 0.01).</p><p><strong>Conclusions: </strong>Few general surgery residency programs share LGBTQ+-specific DEI content online with no regional difference observed. Recommendations such as updating websites to highlight LGBTQ+ inclusion should aid recruitment of a diverse, surgical residency as well as create a welcoming environment for prospective residents.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981530","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

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