American Surgeon最新文献

IntroductionVerification by the American College of Surgeons and state designation of trauma centers improve outcomes in trauma care. In regions where participation in trauma systems is optional, legislation requiring inclusion may need evidence of outcome differences. Given the distinct populations treated at trauma centers vs non-trauma centers, validated risk adjustment is essential for fair comparison. The International Classification of Diseases, 10th Revision injury severity score (ICISS) has been validated for such assessments.MethodsWith institutional review board approval, data from the state Healthcare Cost and Utilization Project from 2018 to 2020 was analyzed. Using ICISS for risk adjustment, outcomes were compared across overall, age-specific, and diagnosis-specific groups.ResultsAmong 3,316,016 discharges, 245,404 (7.4 percent) included at least one injury diagnosis. After excluding transfers out, 151,855 cases remained. Patients at trauma centers had lower risk-adjusted mortality and fewer occurrences of acute kidney injury and pulmonary embolism but higher rates of ventilator-associated pneumonia and surgical site infections. Subgroup analyses revealed that pediatric patients and those with traumatic brain injuries or shock were predominantly treated at trauma centers. Increased age, higher injury severity, male gender, and non-trauma center treatment were associated with lower survival rates. Among geriatric patients with proximal femur fractures, 63 percent were treated at non-trauma centers, with no observed mortality benefit from trauma center care.ConclusionsTrauma center care is associated with improved outcomes supporting the development of more inclusive trauma systems.

Nasal bone fractures represent the most common facial skeletal injury, challenging both function and aesthetics. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-based review analyzed 23 studies published within the past 5 years, selected from 998 records retrieved from PubMed, Embase, and Web of Science. Data from 1780 participants were extracted, focusing on diagnostic methods, surgical techniques, anesthesia protocols, and long-term outcomes. Ultrasound and artificial intelligence-based algorithms improved diagnostic accuracy, while telephone triage streamlined necessary encounters. Navigation-assisted reduction, ballooning, and septal reduction with polydioxanone plates improved outcomes. Anesthetic approaches ranged from local nerve blocks to general anesthesia with intraoperative administration of lidocaine, alongside techniques to manage pain from nasal pack removal postoperatively. Long-term follow-up demonstrated improved quality of life, breathing function, and aesthetic satisfaction with timely and individualized treatment. This review highlights the trend toward personalized, technology-assisted approaches in nasal fracture management, highlighting areas for future research.

BackgroundSurgical society membership and meeting attendance are critical for academic success. Studies demonstrate an association between society membership and greater publication numbers, NIH grants, and departmental leadership positions. Despite this, another study revealed a 68% lapse in membership status by faculty respondents due to costs. Understanding these costs is essential to structuring institutional investments in faculty development.MethodsMembership dues, meeting registration fees, and meeting attendance costs for 23 national, regional, and subspecialty societies from 2022 to 2024 were analyzed. Meeting costs were estimated assuming a 3-day attendance model. Membership dues and meeting registration fees were trended over a 3-year period.ResultsSubspecialty and national societies had the highest meeting attendance cost ($2638 and $2492, respectively). Regional societies had the lowest cost ($2252). Overall average membership dues were the highest for subspecialty societies ($474) and lowest for regional societies ($327). National societies' average membership dues were $431 and had the highest average increase over the 3-year period ($47). Subspecialty societies had the highest average meeting registration fees ($684) and the highest increases in fees over the study ($61). National societies' meeting registration averaged $581 with an average increase of $49. Regional societies had the lowest registration fees ($445) with no increases.DiscussionSubspecialty societies have the highest overall costs and had the greatest increases in meeting registration fees. National societies had the greatest increases in membership dues. Regional society costs are lowest and remained unchanged. An understanding of how faculty and departments finance these costs is needed.

BackgroundThe study of poorly differentiated adenocarcinoma of the rectosigmoid junction (RSJ) remains underexplored. This study aims to develop a postoperative nomogram to accurately predict cancer-specific survival (CSS) in patients afflicted with this form of cancer.MethodsThe study utilized data from the Surveillance, Epidemiology, and End Results database, focusing on patients diagnosed with RSJ cancer between 2004 and 2017. Participants were divided into a training cohort and a validation cohort at a 7:3 ratio. Initially, the training cohort was analyzed using Cox univariate analysis to identify significantly impactful factors. These factors were then examined through Cox multivariate analysis to isolate the best predictors for CSS, which were used to construct the nomogram. The validity of this nomogram was subsequently tested using the validation cohort.ResultsThe study enrolled a total of 2668 patients, with 1867 in the training cohort and 801 in the validation cohort. The 1-, 3-, and 5-year CSS rates were 86.5%, 67.9%, and 57.8%, respectively. Significant predictors identified included race, age, and stage. The constructed nomogram was validated through receiver operating characteristic analysis, calibration, and decision curve analysis, confirming its reliability and accuracy in predicting CSS.ConclusionRace, age, and staging have been affirmed as significant prognostic indicators for CSS. This study has successfully developed a postoperative nomogram that effectively predicts the 1-, 3-, and 5-year CSS for these patients. This predictive model holds substantial clinical value, providing essential guidance for therapeutic decision-making and patient counseling.

BackgroundCholedocholithiasis is a common biliary tract disease that requires effective intervention. This study aimed to evaluate the effectiveness of transduodenal choledochoscopy stone extraction and analyze its impact on postoperative complications in a prospective cohort of patients.MethodsA prospective study was conducted on 186 patients with choledocholithiasis who underwent transduodenal choledochoscopy stone extraction between January 2022 and December 2023. Patients were evaluated for operative success rate, stone clearance rate, and postoperative complications. Stone characteristics, technical aspects, quality of life outcomes, and cost-effectiveness were assessed. Follow-up was conducted for 6 months post-procedure.ResultsThe overall stone clearance rate was 94.6% (176/186), with complete stone removal achieved in a single session in 82.8% of cases (154/186). Mean operation time was 45.3 ± 15.7 min. Basket extraction was the primary method (52.7%), followed by balloon extraction (24.2%) and mechanical lithotripsy (23.1%). Postoperative complications occurred in 11.8% of patients, including pancreatitis (3.2%), cholangitis (2.7%), bleeding (1.6%), and minor complications (4.3%). The stone recurrence rate during the 6-month follow-up period was 4.3%, with a mean time to recurrence of 4.2 ± 1.3 months. Multivariate analysis revealed that stone size >15 mm (OR: 2.34, 95% CI: 1.45-3.78, P < 0.001), multiple stones (OR: 1.89, 95% CI: 1.23-2.91, P = 0.003), and intrahepatic location (OR: 1.76, 95% CI: 1.12-2.77, P = 0.014) were independent risk factors for procedural failure. Quality of life scores showed significant improvement across all SF-36 domains (P < 0.001). Mean procedure-related costs were $2845 ± 625, with additional costs of $986 ± 423 for managing complications.ConclusionsTransduodenal choledochoscopy stone extraction demonstrates high effectiveness with acceptable complication rates. The technique proves particularly suitable for patients with stones smaller than 15 mm and shows advantages in terms of single-session success rates and long-term stone clearance. While initial costs and operator experience may pose challenges, reduced radiation exposure and lower need for re-intervention highlight its clinical value. While associated with higher initial costs, the procedure may be cost-effective due to reduced need for repeat interventions and improved quality of life outcomes. Careful patient selection based on stone characteristics and anatomical factors is crucial for optimal outcomes.

BackgroundEarly-career surgeons can have challenges in establishing and growing their careers. Many mentoring programs lack concrete data and have nebulous outcomes to evaluate success. We sought to develop and evaluate the long-term benefits of a goal-oriented, ACS-based surgical mentoring program. We hypothesize that a goal-oriented, individualized, ACS-based 1-year mentoring program to match senior surgeons ("mentors") with early-career surgeons ("mentees") would have long-term measurable benefits.Study DesignThis is a prospective longitudinal cohort study. A 1-year pilot mentoring program was developed through the ACS in 2011, evaluated, and then recreated in 2013. Mentors and mentees were paired based on numerous factors and were required to conceive a goal. Exit surveys were conducted at the end of each program. A long-term follow-up phone interview and survey were completed 8 years post-mentorship completion. Success was based on the ability of the pair to identify a goal and accomplish that goal in part or full.ResultsThere was a considerable and diverse interest in the program judging by the number of applications submitted based on a single invitation. Successful pairs are more likely to keep in touch and assist the mentoring program in the future.ConclusionMentors and mentees benefit from participation in a goal-oriented surgical mentoring program. The benefits include increased knowledge, participation and promotion in professional societies, career changes, and the formation of both professional relationships and personal friendships. Such results showcase a direct connection between a positive mentor-mentee relationship and increased success and satisfaction in the medical community.

ObjectiveTraumatic pseudoaneurysms are a serious complication following blunt and penetrating trauma, carrying a significant risk of morbidity and mortality if ruptured. However, there is a lack of specific guidelines for their detection and surveillance. This study aimed to evaluate the detection and management of posttraumatic solid organ pseudoaneurysms.Materials and MethodsA prospectively maintained database was created at a Level 1 trauma center from January 2023 to June 2024. All patients aged 15 years and older who presented with a high-grade liver, kidney, or spleen injury were included in the study. Univariate data analyses was utilized with P < 0.05 considered statistically significant.ResultsTwo hundred and five patients were included in the study. Pseudoaneurysms were identified in 10.7% of patients (n = 22/205). Gunshot wounds (n = 8/22, 36.4%) and motor vehicle collisions (n = 7/22, 31.8%) were the most common mechanisms of injury. Pseudoaneurysms were identified in the liver (n = 10/22, 45.5%), spleen (n = 9/22, 40.9%), and kidney (n = 3/22, 13.6%). 90.9% (n = 20/22) of pseudoaneurysms were identified within 5 days of initial injury. Seventeen (n = 17/22, 77.3%) patients underwent endovascular embolization for pseudoaneurysm repair with an 88.2% success rate. Five (n = 5/22, 22.7%) patients with pseudoaneurysms were managed by observation alone with no intervention. Overall, 48.3% (n = 99/205) of patients had a follow-up abdominal CTA prior to discharge.ConclusionAbdominal CTAs provide adequate surveillance for post-traumatic abdominal pseudoaneurysms, allowing for timely repair to decrease the risk of mortality from pseudoaneurysm rupture. Future prospective multi-center studies are needed to establish evidence-based guidelines for pseudoaneurysm detection and management.

Hilar cholangiocarcinoma (HCCA) is a rare, aggressive cancer often diagnosed at an unresectable stage. Patients commonly require systemic therapy and biliary stenting to manage symptoms and maintain liver function. Histotripsy is a novel, non-invasive, mechanical ablation technique recently FDA-approved for liver tumors. We report the case of a 77-year-old woman with recurrent HCCA who experienced progressive biliary obstruction despite chemotherapy and irreversible electroporation. She underwent 2 staged histotripsy treatments targeting tumors in the left and right biliary systems. Procedures were well-tolerated, with no complications, and led to normalization of bilirubin within 72 hours. Imaging at 6 months showed stable disease and sustained biliary patency, with only 1 stent exchange needed. This case highlights the potential role of histotripsy in relieving biliary obstruction and controlling local disease in patients with HCCA.

The care of patients with necrotizing pancreatitis is a complex problem for the general, acute care, minimally invasive, and hepatopancreatobiliary surgeon. In this brief report, we present a case series of 2 patients with fulminant retroperitoneal necrosis recently treated at our center using a novel robotic-assisted retroperitoneal necrosectomy and debridement (RAND) following failure of the step-up approach. This approach maximizes access to the retroperitoneum and allows improved visualization and dexterity in the challenging retroperitoneal space while maintaining minimally invasive surgical principles. Using the robotic platform permits instrument maneuvering, reduces instrument exchanges, and facilitates definitive debridement without the need for repeated surgical interventions.