American Surgeon最新文献

BackgroundColorectal cancer is the second leading cause of cancer-related death in the United States, with increasing incidence of new cases in the past few years. Routine screening via colonoscopies is a fundamental aspect of prevention and early detection. Rural patients face greater barriers to accessing colonoscopies given the low penetrance of gastroenterologists in rural counties. Therefore, rural general surgeons are needed to perform colonoscopies to meet the demands of their patient population. In this study, we aim to examine the adenoma detection rates (ADR) for general and colorectal surgeons in a rural setting.Materials and MethodsUsing electronic health record data, we analyzed procedure and pathology results for screening and surveillance colonoscopies performed at a single practice in rural Oregon from January 2020 through June 2024.ResultsA total of 4264 screening and 3663 surveillance colonoscopies were performed over the study period by 4 surgeons (1 colorectal, 3 general). For male patients, the screening ADR was 54% and the surveillance ADR was 62%. For female patients, the screening ADR was 41% and the surveillance ADR was 50%. For all patients, the colorectal surgeon had a screening ADR of 50% and surveillance ADR of 59%, and the general surgeons had screening ADRs ranging between 40 and 50% and surveillance ADRs between 50 and 56%. All surgeons had ADRs well-above the national benchmarks for male, female, and overall populations.DiscussionOur analysis suggests that rural general surgeons can perform high quality colonoscopies, with ADRs well-above national benchmarks and consistent with those of gastroenterologists.

BackgroundColorectal cancer is the third most common malignancy in the U.S., frequently managed with surgical resection. Adhesion-related complications, specifically small bowel obstruction (SBO), are frequent postoperative issues. This study examines whether minimally invasive surgery (MIS) reduces the risk of adhesive SBO compared to open surgery.MethodsThe PubMed, EMBASE/MEDLINE, and Cochrane databases were queried to identify studies comparing open vs MIS colorectal cancer resection. The primary endpoints were the incidence of adhesive SBO, SBO requiring surgery, parastomal hernia, and incisional hernia rate.ResultsTen studies met inclusion criteria, comprising six randomized controlled studies (RCTs) and four non-RCTs, with a total of 23 032 patients-36.5% in the MIS group and 63.5% in the open group. Pooled analysis revealed a significantly lower incidence of adhesive SBO (RR: 0.58; CI: 0.45-0.75; P < .0001), SBO requiring surgery (RR: 0.69; CI: 0.49-0.96; P = .03), and infection rate (RR: 0.67; CI: 0.55-0.82; P < .0001) in the MIS group. No difference was seen in SBO requiring admission, incisional hernia (IH), IH requiring surgery, or length of hospital stay (LOS). The open group had a lower incidence of parastomal hernias (RR: 2.06; CI: 1.31-3.25; P = .002). Sensitivity analysis by using leave-one-out analysis also showed a significant reduction of adhesive SBO in the MIS group.ConclusionsThis study found reduced incidence of SBO, the need for SBO surgery, and infection rate with MIS surgery in colorectal cancer patients.

IntroductionThe incidence of thyroid nodules measuring ≥4 centimeters (cm) has increased over the last decade and is particularly concerning for malignancy. However, the malignancy risk and diagnostic accuracy of fine-needle aspiration biopsy (FNAB) in nodules ≥4 cm remain debated. This study aims to determine the malignancy rate in nodules ≥4 cm and evaluate the diagnostic accuracy of FNAB.MethodsWe retrospectively analyzed patients who underwent partial or total thyroidectomy from January 2015 to December 2024 at a large tertiary care center. Data collected included patient demographics, thyroid nodule size, and final surgical pathology to determine the malignancy rate. Patients with nodules ≥4 cm were identified, and those who underwent FNAB were analyzed for diagnostic concordance between cytology and surgical pathology.ResultsAmong 1049 patients who underwent thyroidectomy, 167 (16%) had nodules ≥4 cm. Of these, 95 (57%) underwent preoperative FNAB and formed the analytic cohort. In this group, 14 patients (14.7%) had malignant final pathology, and 5 of these malignancies (35.7%) were incidentally discovered. Three of the incidental malignancies were papillary thyroid microcarcinomas (<1 cm) and were excluded from diagnostic performance analysis. Fine-needle aspiration biopsy demonstrated a sensitivity of 54.1%, specificity of 91.4%, false-negative rate of 20.99%, and positive predictive value of 81.3%. Concordance between FNAB and final pathology was observed in 79% of benign and 86% of malignant cases.ConclusionFine-needle aspiration biopsy demonstrates limited sensitivity in nodules ≥4 cm, with a 21% false-negative rate and potential for missed incidental malignancies. Based on this, surgical resection should be considered for thyroid nodules ≥4 cm.

Solid pseudopapillary neoplasms (SPNs) of the pancreas primarily affect young women, placing the surgical decision for distal tumors at a clinical crossroads: the oncologic necessity of splenectomy vs the long-term immunologic benefit of spleen preservation. This study synthesizes the current evidence to guide clinical practice. We conducted a systematic review and meta-analysis comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LSDP) for SPN, identifying 3 retrospective studies (n = 96 patients). The evidence base, though limited, showed comparable perioperative morbidity. No significant differences were found in overall complications (OR = 0.73; 95% CI: 0.23 to 2.31; P = 0.60), postoperative pancreatic fistula (OR = 0.51; 95% CI: 0.09 to 2.92; P = 0.45), or severe complications (OR = 0.32; 95% CI: 0.05 to 1.96; P = 0.22). Laparoscopic distal pancreatectomy with splenectomy was associated with a significantly shorter operative time (MD = -63.49 min; 95% CI: -123.79 to -3.18; P = 0.04). A non-significant trend toward a higher lymph node yield was observed in the LSDP group (MD = +4.29; 95% CI: -0.29 to 8.86; P = 0.07). The available evidence suggests LSPDP is a safe and feasible option in selected patients, achieving comparable short-term morbidity to LSDP. Given the low malignant potential of SPNs and the lifelong immunologic benefits of splenic function, especially in the typical young patient demographic, LSPDP should be the preferred approach when oncologically and technically feasible. This review provides a practical framework for surgical decision making in this rare tumor.

BackgroundRenal insufficiency (RI) is highly prevalent among cancer patients and is linked to increased mortality. Comorbid conditions, drug-induced nephrotoxicity, and medication side effects, such as dehydration from vomiting, may affect kidney function. Hence, a better understanding of factors related to postoperative RI in patients undergoing colectomies for colon cancer can help identify strategies to enhance patient outcomes.MethodsWe analyzed the 2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP)-Targeted Colectomy database to identify patients undergoing colectomies for colon cancer. We excluded those with preoperative renal failure, those who received a stoma, or those who experienced postoperative anastomotic leaks to ensure the validity of this study. A total of 535 patients were identified as having postoperative RI (Post-op RI Group), while 11,794 patients were identified as not having postoperative RI (Control Group).ResultsMultivariate logistic regression indicated that preoperative factors such as congestive heart failure (Odds Ratio (OR) = 3.3217; P < .001), hypertension (OR = 2.4416; P < .001), and chemotherapy within 90 days before surgery (OR = 1.7154; P < .001) were independently associated with increased odds of postoperative RI. Postoperative RI was independently associated with increased odds of mortality (OR = 5.3119; P < .001).ConclusionPostoperative RI is associated with morbidity in patients with colon cancer. Identification of patient characteristics, such as preoperative chemotherapy use and comorbidities, that may contribute to RI can be utilized in the management of patients. Closer preoperative monitoring of renal function and urine output, and fluid management in these patients may reduce the risk of kidney injury.

BackgroundCycling has become increasingly popular nationwide, with our region showing a particularly sharp rise. In 2022, 31.6% of residents reported cycling at least 12 days in the past year, compared to 21% nationally. Trail use in the region rose by 36% from 2015 to 2019. As the area's only level II trauma center, we hypothesized a parallel increase in cycling-related trauma admissions.MethodsWe conducted a retrospective cohort study using our institutional trauma registry to identify bicycle-related hospitalizations from 2014 to 2022. Annual trends in injury incidence, demographics, severity, and hospital length of stay were analyzed and compared with existing regional trail usage data (2015-2019) and crash reports from the State Police (2015-2021). Descriptive statistics and unadjusted analyses were performed.ResultsA total of 191 patients were hospitalized for bicycle-related trauma (1.9% of all trauma admissions); over 41% required intensive care unit/operating room admission. The mean Injury Severity Score was 11.9 (SD = 8.3), and head trauma was the most common injury (mean head abbreviated injury scale 2.6; SD = 1.1). The cohort was 82% male, with a mean age of 44.8 (SD = 18.0) years. No significant annual increase in bicycle-related hospitalizations, injury severity, or reported crashes from police data was observed despite greatly increased bicycle usage.ConclusionDespite rising cycling activity, bicycle-related hospitalizations and crashes did not increase. This may reflect the protective impact of expanded cycling infrastructure. As most severe or fatal bicycle injuries occur on urban roadways, the regional emphasis on dedicated cycling infrastructure may play a protective role in reducing trauma incidence.

The American Surgeon, as the official journal of the Southeastern Surgical Congress (SESC), serves as a central component of the society's educational mission to support the development of surgeons, trainees, and clinical educators across the southeastern United States. Historically, manuscripts originating from annual meeting presentations were reviewed by publication committees rather than through formal peer review. As the journal matured and its citation record and Impact Factor grew in importance, The American Surgeon adopted a uniform policy requiring that all submissions-whether meeting-derived or independently submitted-undergo full anonymized peer review. This transition heightened expectations for scholarly rigor and placed new demands on trainees and clinical faculty whose primary responsibilities often center on education and patient care rather than research.To meet this challenge while preserving the society's educational ethos, the journal introduced a structured Pre-Peer Review (Pre-PR) process grounded in four evaluative elements: Suitability Assessment, Editorial Domain Alignment, Readability and Language Assessment, and Positioning, Contextualization, and Currency. Together, these components provide a pedagogically oriented framework that improves manuscript clarity, coherence, and relevance prior to peer review. Authors receive a concrete revision plan and a concise coaching note that identifies actionable steps for strengthening their work. This approach transforms what might otherwise be a discouraging editorial barrier into a formative experience that enhances the quality of submissions and fosters scholarly growth. By integrating structured coaching with transparent editorial standards, The American Surgeon advances both its mission as a peer-reviewed journal and its longstanding commitment to the educational objectives of the SESC.

The incidence of active shooter incidents in the U.S. continues to increase, with 48 incidents reported in 2023, representing a 60% increase from 2019. Such attacks typically occur in soft target forums, defined as having minimal to no defenses. Historically, this has included schools, offices, public areas, but increasingly includes health care facilities, such as hospitals and medical offices. All physicians play critical roles in the response to any mass-casualty incident, including active shooter events. The surgeon plays a particularly special role both in leadership and treatment given the unique medical skillset capable of rendering life-saving aid to victims of a mass-casualty incident.

This article explores the evolving landscape of surgical practice and the potential need for unionization among surgeons. Historically, surgeons were too consumed by their demanding workloads to consider collective bargaining. However, shifts in health care employment structures-where hospitals and health systems increasingly govern surgeons' work conditions-have led to discussions about unionization. Surgeons and labor lawyers argue that as surgeons lose autonomy and face worsening conditions of employment, unionization could provide a means to regain better conditions of employment affecting surgeons and patient outcomes. Though legal barriers exist under the National Labor Relations Act, precedent from resident physician unions suggests feasibility. The article conducts a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of unionization, weighing its advantages (collective bargaining power, improved work-life balance) against potential drawbacks (loss of autonomy, legal complexity). The piece also refers to the Hippocratic Oath, emphasizing how unionization aligns with surgeons' commitment to patient care and professional dignity. The author presents a modified oath advocating fair working conditions and surgeon solidarity. The article concludes that modern surgical practice necessitates a reassessment of labor protections. The author suggests that if Hippocrates were alive today, he would support unionization to safeguard both surgeons' well-being and patient care.

BackgroundMinimizing crystalloid intravenous fluid (IVF) is a core tenet of damage control resuscitation strategies in trauma. However, there is a lingering notion that such fluid-restrictive strategies may cause acute kidney injury (AKI). We hypothesized that perioperative crystalloid administration volume was not associated with the need for renal replacement therapy (RRT) after damage control laparotomy (DCL).MethodsA retrospective analysis was performed at an urban level 1 trauma center from 2019 to 2022. Risk factors for the need for RRT were evaluated using univariate and multiple logistic regression analyses.ResultsAmong 279 included patients, most were male (77%), the median Injury Severity Score (ISS) was 25 (IQR: 17-34), and overall mortality was 7%. 30 (10.7%) received RRT. The volume of perioperative IVF given in the first 24 hours was 5.3 L for patients without RRT vs 7.3 L for patients who received RRT (P = 0.01). Both packed red blood cell (PRBC) transfusion (6 units vs 17 units, P < 0.0001) and ISS (24 vs 32, P < 0.0001) were also significantly different between groups. After multivariable logistic regression (MLR) adjustment, the need for RRT was associated only with ISS (AOR 1.05, 95% CI 1.01-1.08, P = 0.01) and PRBC transfusion volume in the first 24 hours (AOR 1.09, 95% CI 1.05-1.12, P < 0.0001).DiscussionThe need for RRT for critically injured patients undergoing DCL was not associated with perioperative crystalloid administration volume. Only injury severity markers and surrogates were independently associated with the need for RRT. Concern for AKI should not limit the use of contemporary damage control resuscitation strategies.