American Surgeon最新文献

Frailty is a key predictor of postoperative outcomes in older adults. The Modified 5-Factor Frailty Index (mFI-5) is a tool to assess frailty and predict complications. This study investigates the mFI-5's ability to predict postoperative delirium in geriatric patients undergoing colectomy.

BackgroundAs robotic surgery has grown in prevalence, robotic residency curricula have evolved. University of North Dakota (UND) instituted a formal curriculum in robotics in 2018. We sought to investigate trends in robotic exposure for residents and subsequent use of robotic surgical systems in practice.MethodsA survey of recent graduates was conducted regarding robotic experience during residency, training or certification outside of residency, current use of robotics in practice, and practice type and setting. Graduate years 2014-2018 and years 2019-2023 were pooled into "pre-curriculum" and "post-curriculum" groups respectively. Mann-Whitney U test was used to compare quantitative data, and categorical data was analyzed using Fisher's exact test.ResultsWe observed a significant increase in robotic cases completed during residency (0 vs 25, p=0.004), an increase in the number of residents who received training in robotic surgery during residency (38% vs 100%, p=0.009), and a significant decrease in number of days missed from practice to obtain robotic surgery training or certification (3.5 vs 0, p=0.02). There was no significant association between training during residency and use of robotic surgery system in practice, or between rural practice setting and use of robotic surgery system in practice.DiscussionAmong UND graduates, robotic exposure during training is likely not the determining factor leading surgeons to incorporate this technology into their practices. Our findings echo national data showing increasing use of robotics in general surgery. Robotic surgery has a significant and growing presence in rural general surgery.

BackgroundClimate change is the most significant threat to human health. Despite growing efforts to reduce health care's contribution to climate change, there is limited data on patient opinions of these initiatives. This study aimed to evaluate patient perceptions of environmental sustainability in health care.MethodsWe surveyed adult patients in an outpatient general surgery clinic at a single tertiary academic institution. Participants had the option to be contacted for a follow-up interview. Survey and interview questions measured patient concerns about climate change and health, perceptions of the intersectionality of health care and climate change, and preferences for improving environmental sustainability in health care. Quantitative and qualitative analysis of results was performed.ResultsThere were 97 patients who completed the survey. Many were concerned about the impact of the environment on their health (75.3%, n = 73) and agreed that health care contributes to climate change (51.5%, n = 50). Most patients were more likely to choose a health care system that promoted environmental stewardship (87.6%, n = 85) and cared if their hospital worked to reduce its environmental impact (84.5%, n = 82). Most patients believed that hospital systems should publicize environmental sustainability efforts (86.6%, n = 84), and some patients were interested in learning about the environmental impact of their surgical options (37.1%, n = 36). Five patients completed a follow-up interview and expressed interest in sustainable health care if the quality of care is maintained.DiscussionSurgical patients are concerned about the environment's impact on their health and recognize that health care contributes to climate change. Patients, like the public, value increased environmental sustainability efforts in health care.

Background: Surgeons experience high levels of burnout, impacting both their personal and professional lives in negative ways. Purpose: This review discusses individual and organizational level interventions affecting surgeons' relationships at home and work. The authors use Maslow's Hierarchy of Needs to explore the importance of psychological needs that impact surgeons' well-being and performance. Research Design: A thorough search of the literature was conducted to assess interventions that are likely to affect surgeons' personal and professional relationships. Analysis: The literature review included papers focused on research on surgeons' burnout, stress, well-being, personal partner, workplace team dynamics, and workplace culture/environment. Results: The review underscores the importance of relationships at home and work, a sense of belonging, and self-esteem as they relate to surgeons' well-being. Highlighted are individual and organizational strategies to enhance well-being. Conclusions: Strong personal and professional relationships positively impact surgeons' flourishing and should be taken into consideration at the individual and organizational level.

Pancreatic pseudocysts in children are uncommon, and while most resolve spontaneously, a subset requires intervention. Endoscopic ultrasound-guided drainage has become the preferred modality in adults; however, its use in pediatrics is limited by patient size, anatomy, and availability of appropriately sized equipment. This manuscript reviews operative management strategies for pediatric pancreatic pseudocysts when endoscopic drainage is not feasible. Surgical alternatives include laparoscopic cystogastrostomy, which offers minimally invasive access for cyst drainage; open cystogastrostomy, which remains a reliable option when exposure, anatomy, or safety concerns preclude laparoscopy; and stapler-assisted techniques that facilitate creation of a wide, secure cystogastrostomy to reduce recurrence. Within this framework, we present an illustrative case of an eight-year-old patient with a large retrogastric pseudocyst who was not a candidate for endoscopic drainage and underwent successful open, stapler-assisted transgastric cystogastrostomy. The outcome highlights the continued relevance of surgical drainage as a safe and effective treatment pathway when endoscopic intervention cannot be performed.

Background: Food insecurity is defined as having limited availability of food and/or being unable to acquire food. In patients with obesity, the relationship between food insecurity and eating-related (ER) experiences is poorly described. We hypothesized that patients who are considering metabolic and bariatric surgery (MBS) and are experiencing food insecurity would report worse ER behavior, distress, and symptoms. Methods: All patients who presented for evaluation for MBS were given the food insecurity screen and BODY-Q ER modules. The validated two-question food insecurity screen was used to dichotomize the presence or absence of food insecurity over the prior 12 months. The BODY-Q module is a validated questionnaire to assess ER behavior (eg, feeling out of control), distress (eg, feeling embarrassed), and symptoms (eg, feeling pain or bloating) on a scale of 0-100 with 100 being optimal health. Average BODY-Q scores were compared using independent sample t-tests with a P < 0.05 considered significant. Results: Overall, 818 surveys were completed with an 80% compliance rate (818 completed/1022 total). A total of 174 surveys (21.3%) were positive for food insecurity. ER behavior did not differ, but patients with food insecurity reported significantly worse ER distress and ER symptoms (P < 0.01, respectively). Discussion: In patients considering MBS, 21% suffer from food insecurity which is associated with worse ER distress and ER symptoms. These findings suggest that food insecurity screening is a valuable tool for identifying patients with a high risk of ER emotional distress and negative symptoms. Pre-emptive diet-related and psychological interventions may benefit high-risk patients.

Prepectoral breast reconstruction offers esthetic and recovery advantages but may be more vulnerable to complications due to the absence of muscular coverage. This study examined the clinical course of patients with failed prepectoral implant reconstruction. All consecutive prepectoral reconstructions performed between March 2017 and July 2022 at a single tertiary center were reviewed. Of 239 reconstructions, 42 (17.5%) ultimately failed, most commonly due to infection (50%). Sixteen patients (38%) underwent definitive reconstruction with a median interval of 379 days (IQR 249) from initial surgery to final reconstruction. The most common secondary reconstruction modalities were implant-based reconstruction (31%) and free-tissue transfer (31%). On multivariate analysis, increasing age, higher body mass index (BMI), and prior radiation were independently associated with implant loss. Failure of salvage after prepectoral reconstruction remains a major challenge and often results in delayed or abandoned reconstruction, highlighting the need for careful patient selection.

Artificial intelligence (AI) and machine learning (ML) are rapidly transforming surgery, moving beyond traditional risk prediction to real-time clinical support and intraoperative assistance. However, successful integration requires clinicians to understand key methodological challenges, including overfitting, data bias, and the "black box" nature of many models, which can obscure interpretability and limit generalizability. Recent advances demonstrate AI's growing ability to process text and audiovisual data to streamline documentation, enhance intraoperative decision-making, and even perform basic operative tasks through robotic automation. This review outlines core ML principles relevant to surgical applications, discusses data modalities and evaluation metrics, and highlights emerging models that exemplify the evolving role of AI in the operating room. As these systems progress from experimental to practical use, understanding both their potential and limitations will be essential to ensure safe, effective, and ethically sound adoption in surgical practice.

BackgroundEarly identification of low-risk patients after curative gastric or colorectal surgery can enable safe, timely discharge. We evaluated two routinely available postoperative markers-serum prealbumin (PA) and lymphocyte percentage (L%)-as a simple rule-out strategy.MethodsThis is a single-center retrospective cohort study with a temporal external validation set. Prealbumin (mg/dL) and L% (%) were measured on postoperative day (POD)1/3/5. We prespecified a high-sensitivity threshold (sensitivity ≥90%) in the training cohort and assessed its performance in the validation cohort. Multivariable logistic models were fitted at POD3 and POD5.ResultsPostoperative day 1 L% showed limited discrimination; analyses focused on POD3/5. At both time points, PA and L% were independent protective predictors, with no effect modification by tumor site. Slim (PA + L%) and Full models had similar discrimination; both were well calibrated, and decision-curve analysis indicated clear net benefit over default strategies. Under the fixed high-sensitivity approach, the POD3 Slim model maintained high sensitivity and NPV with moderate specificity.ConclusionsBy POD3, combining PA and L% provides a low-cost, readily deployable, rule-out-oriented approach that supports safe early discharge within structured postoperative pathways. Multicenter prospective validation and impact studies are warranted.