Journal of Surgical Research最新文献

{"title":"Alemtuzumab Associated With Higher Mortality Than Basiliximab in Older Kidney Transplant Recipients.","authors":"Michelle Guo, Vinayak Rohan, Daniela Ladner, John Friedewald, Joshua Cahan, Zachary Dietch","doi":"10.1016/j.jss.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.006","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplantation (KT) in older age is increasingly common as more elderly patients live with end-stage renal disease. Immunosuppression (IS) after KT confers additional risk in aging patients with weakened immune systems. We hypothesized that 1-year mortality among KT recipients aged 70 y and older would be higher in those receiving induction IS with alemtuzumab lymphocyte depletion versus basiliximab interleukin-2 inhibition.</p><p><strong>Methods: </strong>This single-institution retrospective analysis enrolled KT recipients aged 70 y and older who underwent transplantation between January 2010 and June 2022. Data were obtained from the United Network for Organ Sharing and the electronic medical record. Descriptive comparisons were performed using chi-squared, Fisher's exact, and Wilcoxon rank-sum tests as appropriate. The primary outcome was a risk-adjusted analysis to assess the association of induction IS type with 1-year mortality.</p><p><strong>Results: </strong>The median age was 72 y [IQR 70-74] among 146 eligible KT recipients. Induction IS was achieved with alemtuzumab in 47 recipients and basiliximab in 99 recipients. At 1 y, higher rates of mortality (17.0% versus 3.0%, P = 0.005), infectious death (12.8% versus 1%, P = 0.005), and graft failure (21.3% versus 6.1%, P = 0.006) were observed among alemtuzumab compared to basiliximab recipients, with no significant difference in biopsy-proven acute rejection rate. On multivariate analysis, alemtuzumab was independently associated with 1-year mortality (P = 0.012).</p><p><strong>Conclusions: </strong>Alemtuzumab is associated with increased 1-year mortality over basiliximab induction among KT recipients 70 y and older. Lymphocyte-depleting induction may contribute to inferior outcomes via infectious risk. Alemtuzumab induction should be approached with caution in this high-risk population.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"197-203"},"PeriodicalIF":1.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Anesthesia and Surgical Volume in Children Undergoing Nuss Repair: A Multicenter Review.","authors":"Dimitra Lotakis, Jack P Vernamonti, Tiffany N Wright, Kyle J Van Arendonk, Peter C Minneci, Charles M Leys, Matthew P Landman, Shawn D St Peter, Rebeccah L Brown, Grace Z Mak, Tsehay B Abebe, K Elizabeth Speck","doi":"10.1016/j.jss.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.014","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthetic approach and surgical volume have been shown to outcomes in patients undergoing Nuss procedure for pectus excavatum. However, their independent relationship is not described. We investigated how regional anesthesia and surgical volume are associated with length of stay (LOS), postoperative opioid use, operating room utilization, and complications.</p><p><strong>Methods: </strong>This is a 9-center retrospective review of patients ≤21 ys after Nuss procedure for pectus excavatum (2016-2020). High-volume centers and surgeons defined as the upper-quartile for annual procedures. Outcomes were compared with mixed effects linear/logistic regression models with random intercepts by institution as appropriate. A single-center unadjusted analysis was performed of erector spinae catheter (ESC) utilization (due to nonuniform use; high-volume only at 1-center).</p><p><strong>Results: </strong>780 patients were included. Significant variation existed in anesthetic approach and volume. Cryoablation was independently associated with shorter LOS (-2.1 d; 95% confidence interval [CI]: -2.6,-1.7) and lower postoperative opioid utilization (-120 morphine milligram equivalents, 95% CI: -181, -58.1) but increased surgical time (+45 min; 95% CI: 30.3, 59.8). Individual surgeon volume was associated with decreased LOS (-0.3 d; 95% CI: -0.5, -0.01), though high-volume centers had increased complications (odds ratio 2.2; 95% CI: 1.1, 4.2). There was no association between anesthetic approach and surgical complications. Within the single center utilizing ESCs (n = 138), a shorter LOS (2 versus 3 d, P < 0.01) was observed compared to those not receiving an ESC (n = 19).</p><p><strong>Conclusions: </strong>Analgesic approaches varied significantly across institutions and limited our ability to directly compare cryoablation and ESCs. On multivariate analysis, cryoablation was associated with decreased LOS and postoperative opioid use, irrespective of center and surgeon volume. ESCs were similarly associated with improved outcomes. Rigorous prospective comparison of ESCs and cryoablation is warranted.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"190-196"},"PeriodicalIF":1.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline Anal Sphincter Elastance May Predict Long-Term Outcomes of Sacral Neuromodulation for Fecal Incontinence.","authors":"Alexander O'Connor, Sarah Martin, Matthew Davenport, Niels Klarskov, Abhiram Sharma, John McLaughlin, Dipesh H Vasant, Edward S Kiff, Karen J Telford","doi":"10.1016/j.jss.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.012","url":null,"abstract":"<p><strong>Introduction: </strong>Anal acoustic reflectometry (AAR), a novel test of anal sphincter function, was shown to predict a successful trial phase of sacral neuromodulation (SNM) for fecal incontinence. This follow-up study aims to explore if AAR can also predict short- and long-term SNM outcomes at less than and more than 5 y, respectively.</p><p><strong>Methods: </strong>Outcome data were reviewed from a prospectively managed database. Successful treatment was defined as >50% improvement in patient reported fecal incontinence or urgency episodes, or in a symptom severity score.</p><p><strong>Results: </strong>Twenty-six female patients (median: 53 y [range 31-80]) who received a permanent SNM implant were analyzed. In the short-term, no differences were observed in baseline AAR and symptom severity parameters between patients reporting success or failure. At long-term follow-up (median: 122 mo [113-138]) data was available from 17 (17/26, 65%) patients with 7 (7/17, 41%) reporting continued treatment success. Baseline fecal urgency episodes (P = 0.003), and the AAR parameters of opening elastance (P = 0.043) and squeeze opening elastance (P = 0.025) were significantly different between patients reporting success and those reporting failure. Squeeze opening elastance demonstrated the greatest ability to discriminate between success and failure (area under the curve: 0.82 (95% confidence interval 0.60-1.01, P = 0.003)).</p><p><strong>Conclusions: </strong>AAR may have a role in identifying patients suitable for SNM treatment with clinically relevant metrics associated with successful response to treatment. Future work should explore this further to improve SNM patient selection.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"183-189"},"PeriodicalIF":1.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Single Versus Dual Antiplatelet Therapy After Complex Endovascular Aortic Repair.","authors":"Joscha Mulorz, Laura M Costanza, Malwina Vockel, Agnesa Mazrekaj, Amir Arnautovic, Waseem Garabet, Alexander Oberhuber, Hubert Schelzig, Markus U Wagenhäuser","doi":"10.1016/j.jss.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.018","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the widespread use of branched (bEVAR) and fenestrated endovascular aortic repair (fEVAR) for complex aortic pathologies, there are no reliable recommendations regarding postsurgery antiplatelet therapy. We therefore evaluated the outcome of single (SAPT) and dual antiplatelet therapy (DAPT) following fEVAR and bEVAR.</p><p><strong>Methods: </strong>A total of 63 patients from two German centers treated for complex aortic pathologies were included in this retrospective study. Patient data and computed tomography angiograms were analyzed. Kaplan-Meier analyses for overall survival and freedom from target vessel (TV)-related complications were performed. The outcomes were compared between SAPT versus DAPT and bEVAR versus fEVAR. Univariate logistic regression was applied to analyze the correlation between TV patency and various anatomical aortic parameters.</p><p><strong>Results: </strong>In total, 30 patients were treated with fEVAR and 33 with bEVAR. Of these, 19 patients received SAPT and 44 received DAPT postsurgery. Anatomical aortic characteristics and comorbidities were comparable among groups. Overall survival was 95% (±5.1) for SAPT and 88% (±8.8) for DAPT after 36 mo of follow-up. Patency was evaluated individually for each TV SAPT versus DAPT (celiac trunk 100% ± 0 versus 87% ± 9.6; superior mesenteric artery 86% ± 13.2 versus 100% ± 0; left renal artery 92% ± 8.0 versus 95% ± 3.6; right renal artery 72% ± 15.2 versus 81% ± 9.9). Freedom from endoleak was 35% (±13.7) for SAPT versus 30% (±13.8) for DAPT. There was no statistically significant difference for SAPT versus DAPT or for bEVAR versus fEVAR. Further, none of the anatomical aortic characteristics and bridging stent graft-related parameters analyzed predicted TV occlusion in logistic regression analysis.</p><p><strong>Conclusions: </strong>We did not observe differences in overall survival, endoleak, and TV patency rates between SAPT and DAPT treated patients following bEVAR and/or fEVAR. Patient-specific factors therefore appear to be more relevant for the long-term outcomes rather than the antiplatelet regime applied postsurgery.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"171-182"},"PeriodicalIF":1.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delays in Care for Children With Low Anorectal Malformations in Southwestern Uganda.","authors":"Felix Oyania, Caroline Q Stephens, Sarah Ullrich, Meera Kotagal, Daniel Kisitu, Francis Bajunirwe, Doruk E Ozgediz, Dan Poenaru","doi":"10.1016/j.jss.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.013","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in anorectal malformation (ARM) outcomes between high- and low-income countries may be due to delayed diagnosis in the latter setting. The Three Delays model, comprising delays in seeking, accessing, and receiving care, provides a framework for exploring these challenges. We sought to examine the frequency and nature of the preoperative delays in children presenting for surgical correction of low ARMs.</p><p><strong>Methods: </strong>We conducted a cross-sectional study examining the delays in care among children with low ARMs in Southwestern Uganda between June 2021 and July 2023. Delayed diagnosis was defined as a diagnosis made >48 h of life. Potential associated factors such as caregiver, community, and aspect of health-care system factors were examined. Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>A total of 80 patients were included in the study. The median age at diagnosis was 29.2 d. In 82% of patients, the parents diagnosed the abnormality and 74% experienced delayed diagnosis. Among delays in seeking care, 23% of caregivers reported no knowledge of their child's disease. For delays in reaching care, 37% encountered financial problems, and 28% lacked an appropriate diagnosis from a health center, contributing to delays in receiving care.</p><p><strong>Conclusions: </strong>Delays in care are frequent for children with low ARMs. Finances and caregivers' and health-care workers' knowledge contribute significantly to these delays. To mitigate these delays, we recommend improving referral processes, prioritizing newborn screening examinations, advocating for a national child health insurance policy, and enhancing the training of primary health-care providers.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"156-162"},"PeriodicalIF":1.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracobiliary Fistula Complications Following Concomitant Diaphragm and Liver Injury.","authors":"Nathan Y Kim, Mordechai G Sadowsky, Kiersten C Woodyard De Brito, Christina Williams, Christopher F Janowak","doi":"10.1016/j.jss.2024.11.009","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.009","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracobiliary fistula (TBF) is a rare and highly morbid complication of hepatic trauma. There is a paucity of literature regarding incidence, disease course, and treatment. This study identifies etiologic factors and outcome patterns in patients at risk for TBF.</p><p><strong>Methods: </strong>A retrospective review of patients presenting with concern for trans-diaphragmatic bile leak over an 8-y period was performed at an urban level 1 trauma center. Early postinjury deaths were excluded. Records were reviewed for presence of a delayed bile leak. Patient characteristics with concern for (No-TBF) and confirmed fistula (TBF) were compared using Fisher's exact and Mann-Whitney U-tests. The disease courses of patients with TBF were further examined.</p><p><strong>Results: </strong>Over the study period, 118 patients with concomitant right diaphragm and liver injury were reviewed, of these 114 patients (96.6%) survived longer than 72 h. Four patients developed TBF (3.5%). Patients with TBF were younger (P = 0.01) and had trends toward less frequent liver repair (P = 0.061) or concomitant liver and diaphragm repair (P = 0.061). Video-assisted thoracoscopic surgery for retained hemothorax was associated with increased risk of TBF (P = 0.005). Patients with TBF were significantly more likely to develop infectious complications such as sepsis, pneumonia, or complicated parapneumonic effusion (P < 0.001). Treatment of TBF included endoscopic retrograde cholangiopancreatography, sphincterotomy, and stent placement.</p><p><strong>Conclusions: </strong>Although TBF incidence is low, patients with concomitant right hemidiaphragm and liver trauma may be at higher risk for developing TBF without prompt and definitive operative intervention. This injury is characterized by infectious complications requiring further interventional treatment and monitoring.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"163-170"},"PeriodicalIF":1.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing How Three Frailty Scales Predict Negative Outcomes in Trauma Patients With Rib Fractures.","authors":"Lawrence R Feng, Colette Galet, Dionne A Skeete","doi":"10.1016/j.jss.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.016","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is a risk factor for adverse outcomes after injury. Herein, we compared three frailty scales: the Canadian Study of Health and Aging clinical frailty scale, the rib fracture frailty index (RFFI) and the modified frailty index-5, to assess which scale is most applicable in predicting risk for negative outcomes in older patients with rib fractures.</p><p><strong>Methods: </strong>Patients ≥65 admitted for rib fractures were retrospectively scored for frailty using the RFFI, Canadian Study of Health and Aging clinical frailty scale, and modified frailty index-5. Outcomes examined were in-hospital mortality, pneumonia, in-hospital intubation, hospital length of stay, and discharge to skilled nursing facilities. Areas under the curve, sensitivity, specificity, negative predictive value, and positive predictive value were determined for each frailty scale with each outcome. Agreement was determined using Fleiss' Kappa. P <0.05 was considered significant.</p><p><strong>Results: </strong>Three hundred forty-one patients were included. All three scales demonstrated similar predictive abilities for the measured outcomes. RFFI predicted mortality and pneumonia 70% of the time. All three scales predicted discharge to skilled nursing facilities 60% of the time. The concordance for all three frailty scales was 241/341 (70.7%). Fleiss Kappa was 0.40 [0.34-0.46] (P < 0.001), indicating a fair to moderate agreement. The predictive ability of all three scales was higher in patients 65-74 y old than in patients ≥75.</p><p><strong>Conclusions: </strong>Overall, no scale appeared to significantly outperform the others by areas under the curve estimation. Interrater reliability was higher in the 65 to 74-y-old population compared to the 75 and older population.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"136-144"},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Hyperparathyroidism: An Updated Contemporary Surgical Experience at a Tertiary Center.","authors":"Sara Abou Azar, Joseph Tobias, Rachel Nordgren, Edwin L Kaplan, Peter Angelos, Xavier M Keutgen, Megan K Applewhite","doi":"10.1016/j.jss.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.007","url":null,"abstract":"<p><strong>Introduction: </strong>Primary hyperparathyroidism (pHPT) in children is uncommon, resulting in a paucity of data describing the disease process in this population. Herein, in an effort to bridge the information gap, we review our experience with pHPT in adolescent patients under 20 y of age at a specialized tertiary referral center.</p><p><strong>Methods: </strong>A retrospective chart review included all adolescent patients with pHPT, who underwent surgery at our institution between 2004 and 2023. Presenting symptoms, biochemical workup, intraoperative findings, and outcomes were collected and analyzed.</p><p><strong>Results: </strong>Forty-nine adolescent patients were included, with 45% (n = 22) being male. The median age at diagnosis was 16.6 y (14.1-20). On presentation, 71% (n = 35) were symptomatic, most commonly nephrolithiasis (35%, n = 17). The median preoperative calcium and parathyroid hormone were 12 mg/dL (11.3-12.6) and 128pg/mL (105-170.5), respectively. Focused parathyroidectomy was performed in 61% (n = 30) and four-gland exploration in 39% (n = 19) of patients. Eighty-six percent were found to have a single adenoma and 14% had multigland disease. Preoperative localization with ultrasound and Sestamibi had a sensitivity of 57% and 59%, respectively. When combining both imaging modalities, sensitivity increased to 78% (positive predictive value 91%). There were no surgical complications. At the median follow-up of 61.0 mo, 4% of patients were found to have recurrent pHPT. Younger age (OR 0.64, P = 0.038) and sporadic disease (OR 0.04, P = 0.050) had less likelihood of recurrence.</p><p><strong>Conclusions: </strong>Most adolescent patients with pHPT present with symptoms and have single gland disease. Adolescent pHPT should be treated like adult pHPT, utilizing intraoperative PTH and two preoperative imaging modalities.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"150-155"},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational Exposures During Emergency Department Thoracotomies.","authors":"Richard Preus, Melody Zeidan, Connor Posey, Anjali Vira, Steven Miller, Thomas Capasso, Ashley Williams, Charles Butts, Christopher Kinnard, Jon Simmons, Yann-Leei Lee, Maryann Mbaka","doi":"10.1016/j.jss.2024.11.019","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.019","url":null,"abstract":"<p><strong>Introduction: </strong>Recent studies investigating emergency department (ED) thoracotomies (EDTs) focus on patient outcomes to identify optimal candidates for this procedure. However, there is limited but concerning literature regarding healthcare workers occupational exposures resulting from EDT. In this study, we compare rates of blood-borne exposure to immediate procedural success (i.e., regaining pulses) as well as patient outcome.</p><p><strong>Methods: </strong>A retrospective chart review of the trauma registry was performed from January 2019 to January 2023. We included all trauma patients who underwent EDT during the study period. 58 patients met the inclusion criteria and were reviewed, and no patients were excluded. The primary endpoint was the rate of occupational exposure as defined by mucous membrane or percutaneous exposure to the patient's blood during the procedure. Additional endpoints include rate of survival to operating room, intensive care unit (ICU), and discharge, type of exposure, Glasgow Coma Score score, and blood products transfused.</p><p><strong>Results: </strong>Of the 58 patients, 10 EDTs (17%) had reported healthcare occupational exposure, 24 patients (41%) were resuscitated in the ED and moved to the OR or the ICU. 9 patients (16%) survived the OR, with 2 patients (3%) surviving to discharge from the hospital. Of the 10 patients with reported exposures, 4 (40%) regained spontaneous circulation in the ED, 2 patients (20%) survived the OR to the post anesthesia care unit and ICU, but neither survived to discharge (0%). Of the 48 patients without exposures reported, 20 (42%) regained spontaneous circulation in the ED, 7 (15%) survived to the ICU after the OR, and 2 (4%) survived to discharge. Of the 9 patients that survived the OR, 3 showed improvement in neurologic status shown by an improved Glasgow Coma Score.</p><p><strong>Conclusions: </strong>The noted rate of healthcare worker exposures during these procedures is higher than expected. The rate of survival to the operating room and subsequently to the ICU was higher than current reported rates. Further research needs to be done to investigate ways to improve training and protocols to make this procedure safer for the patient and the team of providers.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"145-149"},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Transplant Centers With and Without Liver Transplant Programs: Analysis of Scientific Registry of Transplant Recipients Metrics.","authors":"Faizaan Siddique, Sanath Patil, Keshava Rajagopal, John W Entwistle, Rohinton J Morris, Adam Bodzin, Vakhtang Tchantchaleishvili","doi":"10.1016/j.jss.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.015","url":null,"abstract":"<p><strong>Introduction: </strong>We studied the relationship between heart transplant centers with and without liver transplant programs regarding volume, waitlist duration, waitlist survival, and 1-y posttransplant survival.</p><p><strong>Methods: </strong>Scientific Registry of Transplant Recipients data were acquired in July 2023 and represented transplant centers with adult organ transplant volumes in the United States over the past year. This system involved a five-tier ranking system from one to five, where tier one programs had the lowest rating and tier five programs had the highest rating.</p><p><strong>Results: </strong>Among heart transplant centers, there were 37 (29.6%) heart-only centers and 88 (70.4%) heart-liver centers. Median heart transplant volume was greater in heart-liver centers (28 [interquartile range: 18-47]) relative to heart-only centers (10 [2-20]; P < 0.001). Median heart waitlist duration rating was higher among heart-liver centers (3 [2-4] versus 2 [2-3]; P = 0.05). A higher waitlist duration rating was associated with greater annual transplant volume (P < 0.001). Waitlist survival rating distributions were similar across heart-only and heart-liver centers (3 [2-4] versus 4 [2-4]; P = 0.33). No significant association was observed between heart transplant volume and waitlist survival rating (P = 0.52). Median posttransplant survival rating between the two transplant center types was also comparable (3 [2-4] versus 3 [2-4]; P = 0.43). A higher posttransplant survival rating was associated with higher transplant volume (P < 0.05).</p><p><strong>Conclusions: </strong>Heart transplant centers with concomitant liver transplant programs have a superior waitlist duration rating as well as higher overall transplant volumes when compared with heart-only transplant centers.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"131-135"},"PeriodicalIF":1.8,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}