American journal of surgery

Publisher: Elsevier

Current impact factor: 2.29

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 2.291
2013 Impact Factor 2.406
2012 Impact Factor 2.516
2011 Impact Factor 2.776
2010 Impact Factor 2.68
2009 Impact Factor 2.363
2008 Impact Factor 2.605
2007 Impact Factor 2.337
2006 Impact Factor 2.101
2005 Impact Factor 1.924
2004 Impact Factor 2.349
2003 Impact Factor 2.183
2002 Impact Factor 1.758
2001 Impact Factor 2.131
2000 Impact Factor 2.116
1999 Impact Factor 1.721
1998 Impact Factor 1.874
1997 Impact Factor 2.174
1996 Impact Factor 2.302
1995 Impact Factor 1.954
1994 Impact Factor 1.927
1993 Impact Factor 2.23
1992 Impact Factor 2.168

Impact factor over time

Impact factor

Additional details

5-year impact 2.74
Cited half-life >10.0
Immediacy index 0.44
Eigenfactor 0.02
Article influence 0.96
ISSN 1879-1883

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Authors pre-print on any website, including arXiv and RePEC
    • Author's post-print on author's personal website immediately
    • Author's post-print on open access repository after an embargo period of between 12 months and 48 months
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months
    • Author's post-print may be used to update arXiv and RepEC
    • Publisher's version/PDF cannot be used
    • Must link to publisher version with DOI
    • Author's post-print must be released with a Creative Commons Attribution Non-Commercial No Derivatives License
    • Publisher last reviewed on 03/06/2015
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract] ABSTRACT: Background: Current major national guidelines recommend early mammographic evaluation after completion of breast conservation therapy (BCT). However, the clinical utility of these recommendations are not well defined. Our objective was to determine the role of post-treatment mammogram after BCT. Methods: A retrospective review at a single tertiary referral institution of all female patients (>18 years old) who underwent BCT for invasive breast cancer and ductal carcinoma in situ was performed. Results: Between 2004 and 2013, 342 patients met inclusion criteria. All patients underwent post-BCT mammograms with a mean time of 198 ± 59 days after treatment. Nineteen patients (5%) had findings that prompted biopsy on initial post-treatment mammogram. Of those 19 patients, there was 1 (5%) patient that had malignancy identified on biopsy. This represents .3% of overall patients who underwent mammography in the early postoperative period. Conclusions: The utility of early mammogram after BCT is limited and prompts unnecessary diagnostic procedures, which are marginally beneficial. We recommend resetting the timing of mammography to resume 12 months after BCT is complete.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Duodenal gastrointestinal tumors (GIST) present infrequently, and surgical resection with negative margins remains the mainstay of therapy; however, given the lack of lymphatic and submucosal spread and anatomic location near the bile duct and pancreas, the optimal approach for resection is unknown. Options include local resection (LR), segmental resection, and pancreaticoduodenectomy (PD). Methods: All cases of gastrointestinal stromal tumors originating from the duodenum from 2000 to 2015 were identified from administrative databases. Clinical and pathologic information was abstracted from the medical record and compared between patients who received LR vs PD. The chi-square with Fisher's exact test was used to detect differences between groups. Results: Fifteen patients met the inclusion criteria, of which 7 had an LR and 8 had a PD. The second portion of the duodenum was the most common origin of GIST in the PD group, whereas the third portion was most common in the LR group. Patients who underwent LR tended to be younger, but there was no difference in tumor size, mitotic rate, margin positivity, readmission rate, or recurrence. PD was associated with more complications, higher blood loss, and longer length of stay. Conclusions: Local resection is a reasonable option for resection of duodenal GIST and should be routinely considered if technically feasible.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The Institute of Medicine has recently prioritized access of quality cancer care to vulnerable persons including multimorbid patients. Despite promotional efforts to regionalize major surgical procedures to high-volume hospitals (HVHs), little is known about change in access to HVH over time among multimorbid patients in need of major cancer surgery. We performed a time-trend appraisal of access of multimorbid persons to HVH for major cancer surgery within a large nationally representative cohort. Methods: We identified 168,934 patients who underwent 6 major cancer surgeries from the Nationwide Inpatient Sample (1998 to 2010). Comorbidities were identified using Elixhauser's method. HVHs were defined as hospitals of highest procedure volumes that treated 1/3 of all the patients. Logistic regression models and predictive margins were used to assess the adjusted effects of comorbidity on receiving major cancer surgeries at HVH. Results: Of all, 45.7% of the patients had 2 comorbidities or more. Multimorbidity predicted decreased access to HVH for esophagectomy, total gastrectomy, pancreatectomy, hepatectomy, and proctectomy, but not for distal gastrectomy, after controlling for covariates. A comorbidity level by year interaction analysis also showed that little disparity existed for receiving distal gastrectomy at an HVH, whereas the predicted difference in probability of receiving any of the other 5 major cancer procedures remained prominent between the years 1998 and 2010. Conclusions: In this large 12-year time-trend study, multimorbid cancer patients have sustained low access to HVH for major cancer surgery across many oncologic resections. These results continue to reinforce and highlight the need for policy targeted research and intervention aimed at improving these access gaps.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The perioperative outcomes of patients who underwent straight laparoscopic (LAP) vs hand-assisted laparoscopic (HALS) surgery were compared using a recently released procedure-targeted database. Methods: The 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database was used and patients were classified into 2 groups according to the final surgical approach: LAP vs HALS. Demographics, comorbidities, and 30-day outcomes were compared. Results: A total of 7,843 patients met the inclusion criteria. There were 4,656 (59%) patients in LAP colectomy and 3,187 (41%) in HALS colectomy groups. Groups were comparable in terms of preoperative characteristics and demographics. Mean operative time was slightly longer in LAP group (178 ± 86 vs 171 ± 84 minutes, P < .001). After covariate-adjustment analysis, the overall morbidity, superficial surgical site infection, and ileus rates remained slightly higher in HALS group. Conclusions: Both straight laparoscopic and hand-assisted approaches are used in colorectal surgery and may complement each other in challenging cases. Implementing the best approach to decrease postoperative complication rates and increase use of minimally invasive techniques may play a role in improving patient care and overall quality.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Outcome measures after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis in established centers are well defined. However, results from newly emerging US centers have not been reported. Methods: This is a retrospective review of a prospectively maintained database of patients with peritoneal malignancies undergoing CRS/HIPEC. Results: Fifty-six patients underwent exploratory laparotomy with 36 receiving CRS/HIPEC over 36 months. The median peritoneal cancer index score was 18, and the cytoreduction 0/1 rate was 92%. Postoperative major morbidity was 16.7% with one perioperative death. The median length of hospital stay and intensive care unit days were 9 and 3 days, respectively. Disease-free survival in high-grade vs low-grade tumors was 12.6 and 31.0 months (P, .03), respectively. Average direct cost for patients undergoing CRS/HIPEC was $25,917. Conclusions: Our emerging center's short-term results are comparable with established programs with a trend toward more selective intraoperative judgment on who undergoes CRS/HIPEC.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: To investigate whether post-treatment recurrence differs by tumor size or surgical extent in clinically early-stage papillary thyroid carcinoma (PTC) patients. Methods: A total of 1,041 surgical patients with PTC 4 cm or less and no clinical evidence of metastases to regional or distant sites were included. Cox proportional hazard models were used to identify the clinicopathological variables predictive of post-treatment recurrence. Results: Central nodal involvement was found in 313 (34.1%) of 918 patients who underwent prophylactic central lymph node dissection. For the median follow-up of 83 months, 25 (2.4%) of 1,041 patients had a regional recurrence and 12 (1.2%) patients died of other causes. Male gender, tumor size, extranodal extension, and positive resection margin remained independent variables predictive of recurrence by multivariate analysis (P < .05 each). There was no significant impact of age (<45 vs ≥45 years, P = .944) or surgical extent (unilateral vs bilateral thyroidectomy, P = .776) on recurrence. Conclusions: Tumor size in patients with PTC of 4 cm or less is an important predictive factor for post-treatment recurrence.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: All surgical deaths in Queensland, Australia are reviewed by external surgeon peers, and clinical events are recorded. The study objective was to classify clinical events in surgical patients who died. Methods: Deaths notified to the Queensland Audit of Surgical Mortality between 2007 and 2013 were assessed by surgeons' peers who decided whether a clinical event occurred. The most serious clinical event per patient was analyzed. Results: Peer surgeons reviewed 4,816 deaths. Most patients (70.7%) had no clinical event. Events were preventable in 58% of patients and less than 1 in 10 events was severe. The most frequent events were classified as patient assessment (34.5%), suboptimal therapy (15.3%), and delays (15.1%). Conclusions: Peer review of all surgical deaths identifies preventable clinical events and provides opportunities to improve decision making, better therapy and reduce delay in implementing appropriate surgical care. Review feedback to surgeons and other stakeholders should improve patient safety and quality.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Balancing patient safety with hospital length of stay (LOS) and associated cost is critically important. Subjectively, we have observed that patients undergoing ostomy creation early in the week have a shorter LOS. Methods: We retrospectively reviewed LOS based on day of the week the operation was performed. Results: We reviewed 180 patients undergoing minimally invasive surgery with planned ostomy. Group 1 underwent surgery on Monday to Wednesday (n = 77), Group 2 on Thursday (n = 49), and Group 3 on Friday (n = 54). The average LOS for Group 1, 2, and 3 was 6.2, 4.9, and 7.2 days, respectively. The average number of visits with ostomy nursing for Group 1, 2, and 3 was 2.7, 1.8, and 2.3, respectively. Day of initial ostomy nursing visit was significantly correlated between the delay to initial visit and LOS with Group 3 delayed most. Conclusions: Patients with the longest delay to initial nurse visit had the longest LOS, with Friday operations being most delayed. A contributing factor may be absence of ostomy teaching over the weekend.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Patients with advanced colorectal cancer have a high incidence of postoperative complications. We sought to identify outcomes of patients who underwent resection for colon cancer by cancer stage. Methods: The National Surgical Quality Improvement Program database was used to evaluate all patients who underwent colon resection with a diagnosis of colon cancer from 2012 to 2014. Multivariate logistic regression analysis was performed to investigate patient outcomes by cancer stage. Results: A total of 7,786 colon cancer patients who underwent colon resection were identified. Of these, 10.8% had metastasis at the time of operation. Patients with metastatic disease had significantly increased risks of perioperative morbidity (adjusted odds ratio [AOR]: 1.44, P = .01) and mortality (AOR: 3.72, P = .01). Patients with metastatic disease were significantly younger (AOR: .99, P < .01) had a higher American Society of Anesthesiologists score (AOR: 1.29, P < .2) and had a higher rate of emergent operation (AOR: 1.40, P < .01). Conclusions: Overall, 10.8% of patients undergoing colectomy for colon cancer have metastatic disease. Postoperative morbidity and mortality are significantly higher than in patients with localized disease.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The role of augmenter of liver regeneration (ALR) on liver transplantation immune regulation remains unknown. Methods: Male Lewis and Brown-Norway (BN) rats were assigned to allograft group (Lewis-to-BN liver transplantation), isograft group (BN-to-BN), and ALR group (Lewis-to-BN, ALR, 100 μg/kg/d, intramuscular injection postoperatively). Rats were sacrificed at indicated times for assessment of cytokines production, T-cell (TC) activation and apoptosis. Kupffer cells (KCs) and TCs were isolated from grafts to assess cytokine expression. Effect of ALR and KCs on TCs was monitored by co-culture of (3)H-thymidine TCs. Results: (1) Treatment with ALR significantly decreased interleukin-2 and interferon-γ expression, promoted TC apoptosis, and prolonged the survival of allografts; (2) KCs in ALR group and isograft group that had significantly increased interleukin-10 and decreased tumor necrosis factor-α expression were able to inhibit TC proliferation and induce their apoptosis relative to KCs in the allograft group; (3) ALR and KCs directly inhibited TC proliferation and activation and induced TC apoptosis. Conclusions: ALR could inhibit TC proliferation and function both in vivo and in vitro and attenuate acute rejection after liver transplantation.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Reversal of warfarin-induced coagulopathy after traumatic injury may be done exclusively with prothrombin complex concentrates (PCCs). No direct comparisons between different PCC regimens exist to guide clinical decision-making. Our institution has used 2 distinct PCC strategies for warfarin reversal; a 3-Factor PCC (Profilnine) combined with activated Factor VII (3F-PCC+rVIIa), and a 4-Factor PCC (Kcentra) given without additional factor supplementation. Methods: Retrospective review of all PCC administrations to trauma patients with acute bleeding who were taking warfarin before injury. Primary endpoints were international normalized ratio (INR) reduction, in-hospital mortality, and diagnosis of deep venous thrombosis (DVT). Results: Eighty-seven patients were identified from 2011 to 2015. Fifty-three were treated with 3F-PCC+rVIIa and 34 with 4F-PCC. Patient demographics, injury severity, and presenting laboratory data were similar. The 3F-PCC+rVIIa produced a lower median (IQR) INR postreversal compared with 4F-PCC (.75 (.69, 1.00) vs 1.28 (1.13, 1.36), P<.001). Both regimens were able to obtain an INR lower than 1.5 immediately after administration (3F+rVIIA 93.9% vs 4F 97.1%, P =.51). In the 4F-PCC group, there was a significant decrease in the incidence of DVT (2.9% vs 22.6%), P < .01), and a nonsignificant reduction in mortality (2.9% vs 17.0%, P = .08). Conclusions: Use of 4F-PCC for warfarin reversal after traumatic hemorrhage is associated with a less severe decrease in INR, a significant reduction in DVT rates and a trend toward reduced mortality when compared with similar patients treated with 3F-PCC+rVIIa.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Remote-telementored ultrasound involves novice examiners being remotely guided by experts using informatic-technologies. However, requiring a novice to perform ultrasound is a cognitively demanding task exacerbated by unfamiliarity with ultrasound-machine controls. We incorporated a randomized evaluation of using remote control of the ultrasound functionality (knobology) within a study in which the images generated by distant naive examiners were viewed on an ultrasound graphic user interface (GUI) display viewed on laptop computers by mentors in different cities. Methods: Fire-fighters in Edmonton (101) were remotely mentored from Calgary (n = 65), Nanaimo (n = 19), and Memphis (n = 17) to examine an ultrasound phantom randomized to contain free fluid or not. Remote mentors (2 surgeons, 1 internist, and 1 ED physician) were randomly assigned to use GUI knobology control during mentoring (GUIK+/GUIK-). Results: Remote-telementored ultrasound was feasible in all cases. Overall accuracy for fluid detection was 97% (confidence interval = 91 to 99%) with 3 false negatives (FNs). Positive/negative likelihood ratios were infinity/0.0625. One FN occurred with the GUIK+ and 2 without (GUIK-). There were no statistical test performance differences in either group (GUIK+ and GUIK-). Conclusions: Ultrasound-naive 1st responders can be remotely mentored with high accuracy, although providing basic remote control of the knobology did not affect outcomes.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Aging of the population necessitates consideration of the increasing number of older adults requiring emergency care. The objective of this study was to compare outcomes and presentation of octogenarian and/or nonagenarian emergency general surgery (EGS) patients with younger adults. Methods: Based on a standardized definition of EGS, patients in the 2007 to 2011 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample were queried for primary EGS diagnoses. Included patients were categorized into older (≥80 years) vs younger (<80 years) adults based on a marked increase in mortality around aged 80 years. Using propensity scores, risk-adjusted differences in major morbidity, mortality, length of stay (LOS), and cost were compared. Results: Of 3,707,465 included patients, 17.2% (n = 637,588) were ≥80 years. Relative to younger adults, older patients most frequently presented for gastrointestinal-bleeding (odds ratio [95% confidence intervals]: 2.81 [2.79 to 2.82]) and gastrostomy care (2.46 [2.39 to 2.53]). Despite higher odds of mortality (1.67 [1.63 to 1.69]), older adults exhibited lower risk-adjusted odds of morbidity (.87 [.86 to .88]), shorter LOS (4.50 vs 5.14 days), and lower total hospital costs ($10,700 vs $12,500). Conclusions: Octogenarian and/or nonagenarian patients present differently than younger adults. Reductions in complications, LOS, and cost among surviving older adults allude to a "survivorship tendency" to never give up, despite collectively higher mortality risk.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Level IV trauma centers are an integral part of inclusive trauma systems, although sparse data exists for these facilities. Methods: An observational study was conducted using a Midwestern state's inpatient data files to characterize level IV center patients. Injury and severity levels, injury mechanism and/or intent, and distances to nearest tertiary centers were determined. Results: During the study year, 3,346 injured patients were admitted at level IV centers. The median distance to nearest tertiary center was 43 miles. Median patient age was 81 years, and primary injury mechanism was falls. Overall, 22% of patients had an isolated hip fracture. Of moderately injured patients, 64% had an isolated hip fracture, 8% nonisolated hip fractures, and 9% rib fractures without hip fracture. Overall, 30% of patients had a high severity of injury. Conclusions: A large number of patients were admitted to level IV trauma centers. Patients admitted tended to be elderly and have orthopedic fall injuries. Study results provide important implications for provider education, prevention efforts, need for orthopedic surgical capabilities, and necessity of capturing these data in registries.
    No preview · Article · Mar 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission. Methods: All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included. A retrospective cohort study using multivariable forward stepwise logistic regression determined factors associated with unplanned readmission within 30 days of discharge. Results: Among 20,785 patients with an operation there were 26,978 encounters and 3,092 readmissions (11.5%). Thirteen of 33 candidate variables considered in the stepwise regression were significantly associated with readmission. Patients with an emergency department visit within 365 days of operation, American Society of Anesthesiologists class 4 or greater, Hispanic ethnicity and late-day or holiday/weekend discharges were more likely to have an unplanned readmission (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.76 to 2.19, OR = 2.00; 95% CI = 1.58 to 2.53, OR = 1.16; 95% CI = 1.04 to 1.29, OR = 2.27; 95% CI = 1.55 to 3.63. respectively). Conclusions: Patient and hospital factors may be associated with readmission. Day and time of discharge represent variability of care and are important targets for hospital initiatives to decrease unplanned readmission.
    No preview · Article · Feb 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: In the era of increasing endovascular approaches for aortoiliac disease, we sought to determine the role of axillofemoral bypass in contemporary practice. Methods: All axillofemoral bypasses performed at our institution from 2006 to 2013 were reviewed for indication, patency, and survival and compared with our prior published series before the widespread use of endovascular techniques (1996 to 2001). Results: During the study period, 90 bypasses (29 axillofemoral and 61 axillobifemoral) bypasses were performed. The number of procedures performed decreased from an average of 24 to 12 procedures per year in historical and contemporary groups, respectively. Indications have changed significantly with more urgent or emergent procedures. Overall patency at 1 and 2 years was 74.6% and 67.8%, respectively. Median survival was 40.3 months, with overall survival 67.0% and 54.2% at 1 and 2 years, respectively. Conclusions: Axillofemoral bypass is an increasingly uncommon procedure and more likely performed for limb salvage in urgent or emergent settings.
    No preview · Article · Feb 2016 · American journal of surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Colonic resection is increasingly performed laparoscopically, where intraoperative tumor localization is difficult. Incorrect localization can have adverse surgical results. This has not been studied in laparoscopic resection. This study aimed to evaluate colonoscopic localization accuracy, contributing factors, and subsequent surgery. Methods: Retrospective review of patients who underwent colonic resection after colonoscopy between 2008 and 2013 at a single institution, with subsequent univariate and multivariate analysis. Results: Of 221 lesions identified, 79.0% were correctly localized. Nine (4.0%) incorrectly localized cases required changes in surgery. Two factors were significant on multivariate analysis: gastroenterology training and incomplete colonoscopy were associated with incorrect localization. Conclusions: Colonoscopy is reasonably accurate at localizing lesions. Methods such as tattooing should be used, but error is still possible. Communication between endoscopists and surgeons is vital to minimize the risk of incorrect localization. Emphasis is needed during colonoscopic training of awareness and protocolization of colonoscopic position and methods to improve localization.
    No preview · Article · Feb 2016 · American journal of surgery