The American Surgeon[JOURNAL]
Sun
200 papers
Management of Appendiceal Inflammatory Mass: Nonoperative Treatment, Malignancy Risk, and Surveillance.
Kudaş İ, Erdem O, Başak F … +7 more , Aliş ZŞ, Tosun H, Calışkan YK, Acar A, Canbak T, Tolan HK, Tekeşin K
Am Surg · 2026 Apr · PMID 41958008 · Publisher ↗
BackgroundThe management of an appendiceal inflammatory mass (historically termed "plastron") is controversial due to debates over optimal treatment strategies and malignancy risk. This 15-year retrospective study compar...
BackgroundThe management of an appendiceal inflammatory mass (historically termed "plastron") is controversial due to debates over optimal treatment strategies and malignancy risk. This 15-year retrospective study compares medical vs surgical outcomes, provides granular malignancy data, and aims to establish a risk-stratified surveillance protocol.Material and MethodsThis STROBE-compliant retrospective study analyzed 79 consecutive patients (2009-2024) with radiologically confirmed appendiceal inflammatory masses at University of Health Sciences, Ümraniye Training and Research Hospital. We performed propensity score-adjusted comparisons between medical (antibiotics ± percutaneous drainage, n = 32) and surgical (n = 47) groups. Outcomes focused on success rates, complications, hospital stay, malignancy (histopathology), and colonoscopic findings.ResultsMedical management was initially successful (68.7%, 22/32), resulting in significantly shorter hospitalization (mean difference 2.8 days, 95% CI: 0.2-5.4, 4.1 ± 2.7 vs 6.9 ± 4.8 days, = 0.03) and fewer complications (OR 0.35, 95% CI: 0.1-0.9, 9.3% vs 23.4%, = 0.04) vs surgery. Interval appendectomy was required in 31.2% (10/32) of medical patients. Malignancies were identified in 15.1% overall (95% CI: 7.9%-24.9%), including 6.2% diagnosed only at interval appendectomy. Colonoscopy was performed in 31.6% (25/79) and detected significant neoplasia in 20.0% (5/25; 95% CI: 8.9%-39.1%), predominantly among clinically high-risk patients.ConclusionConservative management is effective, but the substantial malignancy risk (15.1%) and high colonoscopy yield (19%) in this high-risk tertiary cohort necessitate vigilant surveillance. Consistent with updated screening guidance, we recommend colonoscopic evaluation for patients aged ≥45 and/or those with elevated tumor markers or suspicious imaging, and a lower threshold for interval appendectomy in high-risk phenotypes, supporting a risk-stratified approach.
Triple Negative and Trouble: Management and Outcomes of Hypotensive Blunt Trauma Patients With Negative Chest X-Ray, Pelvic X-Ray, and FAST.
Forman S, Bloom L, Patel K … +8 more , Gholamrezanezhad A, Weiner Y, Raya J, Kwan P, Siletz A, Martin M, Inaba K, Matsushima K
Am Surg · 2026 Apr · PMID 41958004 · Publisher ↗
BackgroundDuring initial trauma assessment, chest x-ray (CXR), pelvis x-ray (PXR), and Focused Assessments with Sonography for Trauma (FAST) are standard imaging adjuncts in blunt trauma. Hypotensive patients with negati...
BackgroundDuring initial trauma assessment, chest x-ray (CXR), pelvis x-ray (PXR), and Focused Assessments with Sonography for Trauma (FAST) are standard imaging adjuncts in blunt trauma. Hypotensive patients with negative CXR/PXR/FAST results "triple negative" present diagnostic challenges. The aim of this study was to characterize injury patterns, management strategies, and outcomes in this high-risk cohort.MethodsThis is a retrospective cohort study (2015-2024) at an urban Level 1 trauma center. Blunt trauma patients aged ≥16 years presenting with systolic blood pressure<90 mmHg and negative CXR/PXR/FAST results were included. Negative CXR/PXR results were defined by consensus review from two trauma surgeons and a trauma radiologist, who determined whether the imaging results could explain hemodynamic instability. Descriptive analyses evaluated etiologies of hypotension, diagnostic pathways, interventions, and outcomes.ResultsA total of 73 patients met inclusion criteria (median age: 42 years, 69.9% male). Blood products were administered in 65.7%, with massive transfusion protocol activated in 13.7%; 17.8% required vasopressors in the Emergency Department. Following initial evaluation, 93.2% underwent computed tomography, while two proceeded directly to the operating room, and one died following resuscitative thoracotomy. Common injury patterns were hemorrhage from extremity injuries, high spinal cord injuries, abdominal solid organ injuries, and severe traumatic brain injuries. Overall, 21.9% required emergent operative and 11.0% required emergent endovascular intervention. Mortality was 5.5%, with all deaths due to severe neurologic injury.ConclusionDespite negative initial adjunct imaging, hypotensive blunt trauma patients frequently harbor injuries requiring emergent operative or endovascular intervention, with hemorrhagic and neurologic injuries among the most common causes.
The Miracle of Progress: My View of the History of Rectal Cancer Care.
Hull TL
Am Surg · 2026 Apr · PMID 41936099 · Publisher ↗
Rectal cancer treatment has evolved over the past 4 decades. Numerous advances in surgical technique, chemotherapy, and radiation therapy have fueled the changes. The surgeon, oncologist, radiation therapist, radiologist...
Rectal cancer treatment has evolved over the past 4 decades. Numerous advances in surgical technique, chemotherapy, and radiation therapy have fueled the changes. The surgeon, oncologist, radiation therapist, radiologist, and pathologist work as a team toward a multidisciplinary approach. This has led to individualized care for patients. Amazingly, the use of chemoradiotherapy after diagnosis has led to total regression of rectal cancer in about a third of patients. These patients are felt to be cured and are carefully watched and typically do not require surgery. These advancements have been led by inquisitive surgeons and caregivers who have observed a problem, studied ways to improve the situation, and reported on their conclusion. These individuals are dynamic intellectuals, thinking outside the box to discover these miraculous advancements. However, we still have work to do. This discussion will outline what I feel are the advancements during my professional career over the past 4 decades. I will also outline where I feel we now need to focus our inquisitive energy.
Musculoskeletal Disorders in Surgeons: A Systematic Review on Prevalence, Risk Factors, and Mitigation Strategies.
Stewart A, Brown K, Booth K … +1 more , Wu DH
Am Surg · 2026 Apr · PMID 41925023 · Publisher ↗
This review focuses on musculoskeletal disorders (MSDs), which are a frequent occupational hazard among surgeons, with prevalence rates exceeding 70-90% across specialties. Common symptoms include neck, back, and shoulde...
This review focuses on musculoskeletal disorders (MSDs), which are a frequent occupational hazard among surgeons, with prevalence rates exceeding 70-90% across specialties. Common symptoms include neck, back, and shoulder pain, as well as generalized fatigue, particularly among those performing laparoscopic and robotic procedures. Key risk factors include static posture, repetitive motion, and prolonged procedural duration. Female surgeons also were cited to face elevated MSD risk due to equipment design mismatches and physiological factors, while residents report higher pain levels than attendings, often linked to workload and limited ergonomic training. The surgical environment plays a critical role in MSD development. Poor ergonomics in the operating room include issues such as suboptimal table height and instrument design, which exacerbate physical strain. Although robotic surgery improves posture, it does not eliminate discomfort, and endoscopic approaches impose unique demands. Mitigation strategies include ergonomic training, optimized posture and table height, redesigned instruments, and supportive hardware such as ergonomic chairs. Behavioral interventions such as microbreaks, ambidexterity training, and stretching have shown promise in enhancing endurance and reducing fatigue. Importantly, for surgeons, MSDs contribute to early retirement, burnout, and workforce shortages. This paper advocates for a paradigm shift: viewing surgeon fatigue not as a personal failure but because of system design. Based on this review, we suggest that integrating ergonomics into surgical education, operating room design, and health policy could be vital for maintaining surgeon well-being and health care quality.
Optimizing Trauma Team Activation: A Mixed-Method Analysis of De-escalation, Re-consultation, and Clinician Decision-Making at a Level I Trauma Center.
Tang CL, Burkholder TW, Bridge JS … +7 more , Wong MD, Burner ER, Tian JY, Siletz AE, Matsushima K, Inaba K, Martin MJ
Am Surg · 2026 Mar · PMID 41903183 · Publisher ↗
BackgroundTrauma team activation (TTA) optimizes trauma care but is resource-intensive. Secondary triage in-hospital with trauma team release (rTTA) improves resource allocation but may result in under-triage and adverse...
BackgroundTrauma team activation (TTA) optimizes trauma care but is resource-intensive. Secondary triage in-hospital with trauma team release (rTTA) improves resource allocation but may result in under-triage and adverse outcomes. This study aimed to assess the impact of rTTA on clinical outcomes, identify predictors of rTTA and re-consultations, and understand decision-making perspectives of trauma surgeons (TS) and emergency physicians (EPs).MethodsRetrospective analysis of TTA patients from 2023 to 2024, categorizing patients as TTA without release, rTTA without re-consultation, or Rcon (rTTA requiring subsequent re-consultation). Univariate and multivariate analyses evaluated differences in clinical characteristics and predictors of Rcon. A survey on TS and EPs was administered, and responses were analyzed via descriptive statistics and thematic analysis where applicable.ResultsAmong 2091 TTA cases, 617 (29.5%) were released, with 132 patients (21.4%) requiring re-consultation. Re-consultation was most triggered by new imaging findings. Only 3 (2.3%) Rcon patients required hemorrhage control interventions. Mortality was lower among Rcon patients (3.8%) vs rTTA without re-consultation (4.5%) and TTA without release patients (10.9%). Traffic collisions, psychiatric history, and age ≥70 years were independent predictors for re-consultation (ORs = 7.05, 3.77, and 1.89, respectively). Both TS and EPs identified the same leading factors influencing rTTA, but selection frequencies differed. Qualitative thematic analysis identified key themes driving rTTA decisions, including ED evaluation findings, prehospital-emergency department discordance, and limitations of TTA criteria in special populations.DiscussionRcon occurred in one-fifth of rTTA patients, but the low mortality suggests this secondary triage may be safe in selected patients, although variability in decision-making warrants further evaluation.
Teaching the Learner to Teach: An Effective and Reproducible Curriculum to Engage Junior Residents as Educators.
Freedman-Weiss MR, Coppersmith NA, Slade M … +5 more , Dunne D, Encandela J, Ahle SL, Hafler JP, Yoo PS
Am Surg · 2026 Mar · PMID 41887182 · Publisher ↗
BackgroundJunior residents are not uniformly prepared for, trained in, or comfortable with their roles as teachers. There are few feasible and reproducible published curricula to address that gap and no such curriculum t...
BackgroundJunior residents are not uniformly prepared for, trained in, or comfortable with their roles as teachers. There are few feasible and reproducible published curricula to address that gap and no such curriculum that targets the specific needs of junior surgical residents. We designed and implemented a course for junior residents-as-teachers with the aim of studying the impact on residents' comfort, confidence, perceptions, and behaviors as well as proving the feasibility and reproducibility of the curriculum.MethodsUsing Kern's model of curriculum development, we designed and implemented a didactic and workshop-based course. The curriculum content focused on the learning climate, expectation setting, teaching, and giving feedback. The course was offered to PGY-1 and PGY-2 general surgery residents at a university-based program over two separate years. The course was evaluated with a retrospective pre/post-survey assessing change in self-reported comfort, confidence, perceptions, and behaviors. Improvement was analyzed using a student's t-test (1-sided, < 0.05 as significant).ResultsThe course had >90% participation (26 of 30 residents). Statistically significant increases ( < 0.01) were seen in self-reported comfort, confidence, and time spent on expectation setting, teaching, giving feedback, and role-modeling. After the curriculum, participants believed to a greater extent ( = 0.01) that being a skilled teacher as a resident is important. All respondents supported offering the course to future trainees.DiscussionThis junior residents-as-teachers course significantly improved self-reported comfort, confidence, and time spent on teaching activities. The course was feasible even within the constraints of a surgical-training program and was proven reproducible through a second pilot.
Association of Surgical Service Line and Frailty with Outcomes after Major Lower Extremity Amputation.
Karwoski A, Workneh E, Som M … +4 more , Pitsenbarger L, Chao N, Dunlap N, Nagarsheth KH
Am Surg · 2026 Mar · PMID 41886315 · Publisher ↗
BackgroundMajor lower extremity amputations (LEA) are frequently performed by vascular, trauma, and orthopedic surgeons, yet comparative outcomes across services and the role of frailty remain unclear.Materials and Metho...
BackgroundMajor lower extremity amputations (LEA) are frequently performed by vascular, trauma, and orthopedic surgeons, yet comparative outcomes across services and the role of frailty remain unclear.Materials and MethodsWe conducted a single-center retrospective review of adults undergoing major LEA (above-knee, through-knee, and below-knee) from 2015-2022. Frailty was assessed using the 5-factor modified Frailty Index (mFI-5). Outcomes included complications, length of stay (LOS), readmission, re-amputation, mortality, and prosthetic ambulation. We evaluated 30-day return to the operating room (RTOR) overall and separated planned staged open guillotine amputation (OGA)-to-closure returns from unplanned RTOR.ResultsAmong 684 patients (689 LEAs), vascular surgery (VS) performed 44% of procedures, trauma surgery (TS) 37%, and orthopedic surgery (OS) 19%. Median LOS was 14 days and 30-day mortality was 10.8%; 36% achieved prosthetic ambulation. OS had higher ambulation than VS and TS in both non-frail and frail subgroups. Overall, 30-day RTOR differed by service and was highest after TS; however, these differences were largely attributable to planned staged OGA-to-closure returns, while unplanned RTOR did not significantly differ by service. On multivariable analysis, both VS and TS had lower odds of prosthetic ambulation than OS (adjusted OR ≈0.34).DiscussionSurgical service line and frailty are associated with outcomes after major LEA. Differences in ambulation, particularly among non-frail patients, suggest that service-specific pathways and perioperative processes may influence functional recovery and represent targets for standardized LEA pathways.
The Harvest.
Broecker J
Am Surg · 2026 Aug · PMID 41879002 · Publisher ↗
Abstract loading — click title to view on PubMed.
From First Job to Mid-Career: Navigating the Unexpected Turns.
Amini N, Tan S, Sabih Q … +2 more , Benjamin ME, Cannada LK
Am Surg · 2026 Aug · PMID 41873549 · Publisher ↗
Every surgeon will encounter an opportunity to change positions. Ultimately, personal and external environmental factors drive surgeons to leave their jobs. Understanding these motivating factors can help employers modif...
Every surgeon will encounter an opportunity to change positions. Ultimately, personal and external environmental factors drive surgeons to leave their jobs. Understanding these motivating factors can help employers modify the workplace to retain physicians, but most importantly, understanding common motivating factors for job changes can help you identify a position where you can achieve your personal goals.
Is Adjuvant Chemotherapy Necessary for Stage IIB/IIC Appendiceal Adenocarcinoma?
Venkatesh H, Hsieh MC, Lyons J … +2 more , Wu XC, Chu Q
Am Surg · 2026 Mar · PMID 41870327 · Publisher ↗
IntroductionAppendiceal adenocarcinoma is a rare and heterogeneous malignancy with management strategies historically mirroring those of colorectal cancer. The role of adjuvant chemotherapy (AC) in stage II disease remai...
IntroductionAppendiceal adenocarcinoma is a rare and heterogeneous malignancy with management strategies historically mirroring those of colorectal cancer. The role of adjuvant chemotherapy (AC) in stage II disease remains poorly studied, particularly in stage IIB/IIC. We evaluated the impact of AC on overall survival (OS) in stage IIB/IIC appendiceal adenocarcinoma using the National Cancer Database (NCDB).MethodsThe NCDB was queried to identify adults diagnosed with stage IIB/IIC appendiceal adenocarcinoma from 2010 to 2021. Patients with carcinoid, goblet cell, or neuroendocrine histologies were excluded. Patients were stratified into surgery alone (S) or surgery plus adjuvant chemotherapy (S+). Kaplan-Meier and log-rank tests estimated survival distributions, and multivariable Cox proportional hazards regression with Firth's correction assessed independent predictors of OS.Results2082 patients met inclusion criteria. Adequate lymph node evaluation (≥12 nodes) was independently associated with improved survival (aHR: 0.62, < .0001). Adjuvant chemotherapy conferred a significant survival benefit, with a 26% reduction in risk of death (aHR: 0.74, 95% CI: 0.62-0.89, = .0016). Five-year OS was 78.9% for S+ vs 68.7% for S ( < .001). Patients receiving both AC and adequate nodal harvest demonstrated the greatest survival benefit. Non-mucinous histology was associated with superior outcomes compared to mucinous disease (aHR: 0.62, < .0001).ConclusionAdjuvant chemotherapy is independently associated with improved survival in patients with stage IIB/IIC appendiceal adenocarcinoma, particularly when combined with adequate lymph node evaluation. These findings challenge current treatment paradigms that extrapolate from colorectal cancer and support consideration of AC as standard therapy in this high-risk patient subset.
Letter re: "The Number of Revascularization Procedures Is Associated With Final Amputation Level for Chronic Limb-Threatening Ischemia".
Loureiro L, Machado R
Am Surg · 2026 Aug · PMID 41869700 · Publisher ↗
Abstract loading — click title to view on PubMed.
Breaking the Risk-Outcome Dogma in Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative.
Kim I, Towfigh S
Am Surg · 2026 Mar · PMID 41863460 · Publisher ↗
The American Society of Anesthesiologists (ASA) Physical Status classification is widely used as a proxy for perioperative risk, yet its relationship to contemporary ventral hernia repair (VHR) case mix and patient-cente...
The American Society of Anesthesiologists (ASA) Physical Status classification is widely used as a proxy for perioperative risk, yet its relationship to contemporary ventral hernia repair (VHR) case mix and patient-centered outcomes remains incompletely defined.MethodsWe performed an unadjusted retrospective cohort study of adult VHRs in the Abdominal Core Health Quality Collaborative, comparing ASA I-II versus ASA III-IV patients. Analyses emphasized clinically interpretable effect sizes (Cohen's d and h) with conventional values reported for completeness.ResultsWe analyzed 28,779 ASA I-II and 26,436 ASA III-IV repairs. ASA III-IV patients were older (60.65 ± 12.42 vs 52.38 ± 13.92 years; d = 0.63), had higher BMI (33.52 ± 7.41 vs 30.19 ± 5.83 kg/m²; d = 0.50), and greater comorbidity burden (hypertension 61.2% vs 30.9%; h = 0.62). Hernias were larger in ASA III-IV patients (width 7.91 ± 6.59 vs 3.93 ± 4.07 cm; d = 0.73), and operative complexity markers were higher, including dirty/infected wounds (2.1% vs 0.6%; h = 0.14) and longer operations (≥240 min: 21.0% vs 7.4%; h = 0.40). ASA III-IV patients had longer length of stay (3.72 ± 12.06 vs 1.44 ± 12.14 days; d = 0.19) and higher 30-day mortality (0.361% vs 0.035%; OR = 10.42). Among cases with non-missing 1-year outcome fields, 1-year recurrence (12.1% vs 10.4%; = .10) and 1-year reoperation (7.0% vs 7.1%; = .86) were similar. Higher-risk patients demonstrated greater 6-month quality-of-life improvement (ΔHerQLes 29.99 ± 30.35 vs 24.40 ± 28.45; d = 0.19).DiscussionAlthough ASA class stratifies physiological risk and complexity, it does not imply diminished reconstructive benefit, supporting individualized, risk-informed decision-making rather than exclusion based on ASA status alone.
Cloud Computing Startup for Data Science- A Tutorial.
Kuo AC, Hiraldo L, Wolansky RL … +2 more , Sujka J, Kuo PC
Am Surg · 2026 Mar · PMID 41863225 · Publisher ↗
Cloud computing has revolutionized analysis of large datasets. This tutorial provides a comprehensive, practical guide for research groups seeking to leverage cloud platforms for data analysis. The tutorial covers the fo...
Cloud computing has revolutionized analysis of large datasets. This tutorial provides a comprehensive, practical guide for research groups seeking to leverage cloud platforms for data analysis. The tutorial covers the foundations of cloud computing, including its history, rationale, and use cases for research, followed by detailed comparisons of the 3 major platforms: Google Cloud Platform (GCP), Amazon Web Services (AWS), and Microsoft Azure. Side-by-side comparisons of services, costs, ease of use, and selection guidelines assist researchers in choosing the most appropriate platform. A complete step-by-step example using hospital price transparency data demonstrates the entire workflow from account creation through results retrieval, enabling researchers to begin productive cloud-based analysis within hours.
Impact of Kidney and Liver Transplant Following Blunt Trauma: A Propensity-Matched National Database Study.
Wolansky RL, Zander T, Sujka J … +2 more , Kuo PC, Kendall MA
Am Surg · 2026 Mar · PMID 41848231 · Publisher ↗
BackgroundTransplant recipients represent a growing population with unique medical complexities, yet trauma outcomes remain poorly characterized. We investigated mortality and complications in kidney transplant (KT) and...
BackgroundTransplant recipients represent a growing population with unique medical complexities, yet trauma outcomes remain poorly characterized. We investigated mortality and complications in kidney transplant (KT) and liver transplant (LT) patients following blunt trauma.MethodsThe Healthcare Cost and Utilization Project National Inpatient Sample (2019-2022) was queried for adults admitted following blunt trauma. ICD-10 codes identified KT/LT patients. Propensity score matching controlled for confounders.Results1,117,744 patients were included 2237 (0.20%) KT and 1250 (0.11%) LT. No mortality differences were observed. After matching, KT patients had lower renal failure risk (OR 0.83, 95% CI: 0.72-0.95, = .007) and higher risk of pneumonia (OR 1.41, 95% CI: 1.09-1.82, = .009). LT patients had higher renal failure risk (OR 1.56, 95% CI: 1.31-1.87, < .001).ConclusionTransplant recipients experienced mortality rates comparable to matched controls after controlling for hospital characteristics and patient-level confounders. However, organ-specific specific vulnerabilities were identified: KT recipients demonstrated significantly increased pneumonia risk (OR 1.41), while LT recipients had 56% increased odds of renal failure. These associations may inform future investigation into targeted monitoring strategies and interventions for this population.
Effect of Narrative-Based Palliative Care on Psychological Stress, Quality of Life, and End-of-Life Acceptance in Elderly Terminal Cancer Patients and Their Families.
Li J, Zhou L, Sun L
Am Surg · 2026 Mar · PMID 41823672 · Publisher ↗
ObjectiveThis study aimed to preliminarily evaluate the impacts of narrative-based palliative care on psychological stress, end-of-life acceptance, and quality of life in elderly terminally ill cancer patients and their...
ObjectiveThis study aimed to preliminarily evaluate the impacts of narrative-based palliative care on psychological stress, end-of-life acceptance, and quality of life in elderly terminally ill cancer patients and their family caregivers.MethodsThis single-center, small-sample randomized controlled study enrolled 50 elderly terminal cancer patients. Patients were randomly assigned to either the observation group or the control group (n = 25 each). The observation group received narrative-based palliative care, while the control group received routine standard care. Family psychological stress was assessed using the Relative Stress Scale (RSS), and patients' perceived stress was evaluated with the Perceived Stress Scale-10 (PSS-10). Caregiver satisfaction was measured using a hospital-developed questionnaire. Patients' quality of life was evaluated using the SF-36, Chinese Version of the Death Attitude Profile (DAP-C), and Pittsburgh Sleep Quality Index (PSQI), respectively.ResultsBaseline characteristics did not differ significantly between the two groups ( > .05). Post-intervention, the observation group demonstrated significantly lower psychological stress among family members and higher caregiver satisfaction ( < .05). Patients in the observation group reported better quality of life, improved sleep, and greater acceptance of death than those in the control group ( < .05).ConclusionAs a small-sample, single-center study, these findings offer preliminary evidence that narrative-based palliative care may reduce psychological stress in elderly terminal cancer patients and caregivers while enhancing patients' quality of life, sleep quality, and acceptance of death. However, the limited sample size, single-site design, and narrow inclusion criteria restrict generalizability. Larger multicenter trials are needed to confirm these results.
Safety and Efficacy of Ketorolac in the Management of Pain for Postoperative Pediatric General Surgery Patients.
Flyer Z, Giron A, John R … +7 more , Schomberg J, Carlson A, Dumitr AM, Wen D, Rohloff A, Lusk J, Yu PT
Am Surg · 2026 Mar · PMID 41823440 · Publisher ↗
PurposeKetorolac is commonly cautioned with a possible effect of bleeding. The safety and efficacy of Ketorolac has not been examined in children who have undergone general surgery procedures.MethodsA single institution...
PurposeKetorolac is commonly cautioned with a possible effect of bleeding. The safety and efficacy of Ketorolac has not been examined in children who have undergone general surgery procedures.MethodsA single institution retrospective cohort study examining children ages 0-18 from 2017-2022 with and without Ketorolac <24 hours after the following operations: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic or open inguinal hernia repair, umbilical hernia repair, and ventral hernia repair. Demographics were reported using bivariate inferential statistics. A Cox proportional hazards model identified associations between Ketorolac and time to pain score ≤3. Logistic regression measured odds of opioid use in morphine equivalents 24-hour after surgery.Results5455 patients were identified. Children who received Ketorolac after surgery were more likely to be older (11.5 vs 7.0 years, < .0001). Compared to Whites, Asian Americans (OR .50, CI .36-.63, < .0001) and African Americans (OR .22, CI .13-.37, < .0001) were less likely to receive Ketorolac. Patients receiving Ketorolac were more likely to have a high pain score (>5) after surgery (40% vs 23%, < .0001) when receiving Ketorolac vs opioid alone ( < .0001). Patients receiving Ketorolac had 40% decreased odds of receiving opioid after surgery (OR .90, 95% CI: .87-.94, < .0001). Blood transfusions were less common in patients that received Ketorolac (0.2% vs 0.7%, = 0.005).ConclusionKetorolac does not increase the risk of bleeding requiring transfusion and decreases opioid administration. Ketorolac is efficacious in this patient population either alone or in combination with opioids and improves pain control compared to opioids alone.
Prognostic Significance of the Cholinesterase-Prognostic Nutritional Index Score in Patients With Colorectal Cancer.
Takano Y, Kamada T, Goto K … +8 more , Tsukihara S, Kobayashi Y, Imaizumi Y, Ryu S, Takeda Y, Ohkuma M, Kosuge M, Eto K
Am Surg · 2026 Mar · PMID 41810877 · Publisher ↗
BackgroundsThis study aimed to evaluate the prognostic value of the cholinesterase-prognostic nutritional index (ChE-PNI) score in patients undergoing curative colorectal resection for colorectal cancer.MethodsThis retro...
BackgroundsThis study aimed to evaluate the prognostic value of the cholinesterase-prognostic nutritional index (ChE-PNI) score in patients undergoing curative colorectal resection for colorectal cancer.MethodsThis retrospective study included 628 patients who underwent curative colorectal resection for stage II/III CRC. Preoperative serum ChE levels and PNI were used to calculate the ChE-PNI score, and patients were categorized into 3 groups (score 0, 1, or 2). We investigated the association between the ChE-PNI score and survival outcomes.ResultsAmong all patients, 88 (14%) were classified as the ChE-PNI score of 2. Multivariate analysis revealed that American Society of Anesthesiologists physical status ≥3 ( = .009), T stage 3-4 ( = .004), N stage 1-3 ( < .001), ChE-PNI = 2 ( = .031), and serum carcinoembryonic antigen ≥5.0 ng/ml ( = .002) were independent predictors of disease-free survival. While, age ≥65 ( = .027), Anesthesiologists physical status ≥3 ( < .001), N stage 1-3 ( = .013), and ChE-PNI = 2 ( = .005) were independent predictors of overall survival.ConclusionThe ChE-PNI score is a novel, simple, and effective marker that independently predicts postoperative prognosis in patients with colorectal cancer.
Early Repair of Common Bile Duct Injuries Achieves Superior Outcomes and May Reduce Malpractice Litigation.
Liao P, Bolton N, Brown R … +4 more , Bolton J, Guillory C, Coogan C, Fuhrman G
Am Surg · 2026 Mar · PMID 41810491 · Publisher ↗
UNLABELLED: The optimal timing of repair after common bile duct injury (CBDI) during cholecystectomy remains controversial. We evaluated outcomes after early versus late repair and examined associated malpractice litigat...
UNLABELLED: The optimal timing of repair after common bile duct injury (CBDI) during cholecystectomy remains controversial. We evaluated outcomes after early versus late repair and examined associated malpractice litigation. METHODS: We retrospectively reviewed patients who underwent surgical repair of CBDI between January 2012 and December 2023. Collected data included demographics, operative indication, timing of injury recognition and repair, preoperative assessment, operative classification (primary repair, single anastomosis, multiple anastomoses), and postoperative outcomes. Early repair was defined as intraoperative or ≤3 days after injury and late repair as >3 days. Malpractice claims were identified via the Westlaw database and institutional release-of-information requests. RESULTS: Fifty-four patients met inclusion criteria: 12 primary repairs, 37 single anastomoses, and 5 multiple anastomoses. 23 patients underwent early repair and 31 underwent late repair. Groups were comparable in demographics and baseline laboratory values. Median time from diagnosis to repair was 0 days in the early repair group versus 10 days in the late repair group ( < 0.001). All strictures (n = 5) occurred in the late repair group ( = 0.023); one required partial hepatectomy and the remainder were managed with dilation. Bile leaks were managed with percutaneous drainage in 1 early-repair and 4 late-repair cases. One death occurred in the late-repair group. Three patients filed malpractice suits; one plaintiff verdict occurred. CONCLUSION: Early repair of CBDI yielded excellent clinical outcomes in our series. The incidence of malpractice litigation after CBDI is uncommon. Early definitive intervention by experienced hepatobiliary surgeons should be considered when feasible.
Chronic Anastomotic Leaks After Low Anterior Resection: Rethinking Evaluation and Management.
Boyer ME, Hilty Chu BK, Loria A … +3 more , Dhimal T, Cupertino P, Fleming FJ
Am Surg · 2026 Mar · PMID 41805457 · Publisher ↗
BackgroundChronic anastomotic leaks following low anterior resection (LAR) with primary anastomosis and diverting loop ileostomy (DLI) pose a complex management challenge. Optimal strategies for evaluating and managing c...
BackgroundChronic anastomotic leaks following low anterior resection (LAR) with primary anastomosis and diverting loop ileostomy (DLI) pose a complex management challenge. Optimal strategies for evaluating and managing chronic leaks remain poorly defined, particularly regarding the timing and safety of stoma reversal.MethodsWe conducted a retrospective study of patients with stage I-III rectal cancer who underwent LAR with DLI between 2011-2022 and subsequently developed a chronic anastomotic leak, defined as a defect persisting beyond 30 days on imaging or endoscopy. Demographic, procedural, and outcome data were abstracted from the electronic medical record. Patterns of imaging and procedural evaluation, time to clinical disposition (defined as DLI reversal, conversion to colostomy, or decision to maintain DLI), and clinical decision-making factors were analyzed.ResultsNineteen patients met inclusion criteria. During their clinical course, 68.4% of patients underwent percutaneous drainage, with management guided by serial abdominopelvic computed tomography (CT). Gastrografin enemas and endoscopies were performed for anastomotic assessments but demonstrated limited predictive value, as one patient with a normal study developed postoperative pelvic sepsis, while three patients with persistent defects achieved successful reversal. The median time to clinical disposition was 367 days. Ten patients remained with a permanent ostomy, while nine underwent attempted reversal, of whom seven (36.8%) achieved durable bowel continuity.DiscussionManagement of chronic anastomotic leaks was individualized, influenced by imaging findings, patient preferences, and surgeon judgment. These findings highlight the limitations of relying solely on structural assessments and underscore the need for integrated, patient-centered frameworks to guide evidence-based reversal decisions.
Impact of CT-Based Body Composition Analysis on Postoperative Survival in Patients Undergoing Colorectal Cancer Surgery.
Kojima M, Miyake T, Tani S … +11 more , Bamba S, Muramoto K, Nishina Y, Kaida S, Takebayashi K, Maehira H, Otake R, Mori H, Nitta N, Shimizu T, Tani M
Am Surg · 2026 Mar · PMID 41801706 · Publisher ↗
BackgroundColorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, underscoring the need for reliable prognostic biomarkers. Emerging evidence suggests that body composition parameters may i...
BackgroundColorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, underscoring the need for reliable prognostic biomarkers. Emerging evidence suggests that body composition parameters may influence cancer outcomes. This study aimed to evaluate whether low skeletal muscle mass, high visceral fat, and their coexistence predict long-term outcomes in patients with CRC.MethodsThis retrospective study included 103 patients with pathological stage III CRC who underwent curative resection. Skeletal mass index (SMI) and visceral fat index (VFI) were calculated from preoperative CT images at the L3 level by dividing skeletal muscle and visceral fat areas by height squared. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier and Cox regression models.ResultsLow-SMI and high-VFI were present in 52.4% and 28.2% of patients, respectively. In Cox regression, low-SMI independently predicted poor OS (HR 5.14, = 0.004), while high-VFI was an independent predictor of RFS (HR 2.72, = 0.012). In the four-group analysis, for OS, both the coexistence of low-SMI and high-VFI (low-SMI-high-VFI, = 0.021) and low-SMI-only ( = 0.023) had worse survival than controls, with no difference between them ( = 0.77). For RFS, high-VFI alone was associated with worse prognosis compared with controls ( = 0.040). Low-SMI-high-VFI patients had significantly poorer prognosis than both controls ( < 0.001) and low-SMI alone ( = 0.024).ConclusionsLow skeletal muscle mass and high visceral fat are associated with poorer OS and RFS, respectively. The coexistence of them may have an additive adverse association with recurrence risk in patients with low skeletal muscle mass. Preoperative body composition assessment may facilitate risk stratification in CRC, and improving these parameters could potentially contribute to better oncologic outcomes.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe