Journal of Surgical Research最新文献

{"title":"Predictors of Cumulative 90-D Mortality for Septic Patients Undergoing Abdominal Surgery","authors":"Shachi Srivatsa MD ,&nbsp;Courtney M. Collins MD ,&nbsp;Whitney Kellett MD, PhD ,&nbsp;Daniel S. Eiferman MD, MBA ,&nbsp;Jon Wisler MD, MS ,&nbsp;Anahita Jalilvand MD, PhD","doi":"10.1016/j.jss.2025.03.052","DOIUrl":"10.1016/j.jss.2025.03.052","url":null,"abstract":"<div><h3>Introduction</h3><div>Septic surgical patients undergoing emergency general surgery represent a distinct population with unique challenges. This study aimed to identify predictors of cumulative 90-d mortality, including clinical and socioeconomic factors, and to analyze causes of death in this cohort.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients admitted to a surgical intensive care unit from 2011 to 2019 with sepsis (sequential organ failure assessment score ≥2) undergoing emergency intra-abdominal surgery (<em>n</em> = 498). Demographics, comorbidities, sepsis presentation, and socioeconomic metrics, including the area deprivation index (ADI), were analyzed. Independent predictors of mortality were identified using multiple logistic regression. The causes of death were categorized and analyzed.</div></div><div><h3>Results</h3><div>Among 498 patients, 46% (<em>n</em> = 229) died within 90 d. Nonsurvivors were older (65 ± 13.7 <em>versus</em> 61.2 ± 13.5 y, <em>P</em> &lt; 0.01), more often transferred from external facilities (59% <em>versus</em> 46%, <em>P</em> &lt; 0.01), and had higher rates of liver disease, chronic kidney disease, metastatic cancer, obesity, and higher Charlson comorbidity index scores (<em>P</em> &lt; 0.01 for all). Independent predictors of 90-d mortality included admission sequential organ failure assessment scores, serum lactate, obesity, ADI, Charlson comorbidity index, and transfer status. ADI remained a significant predictor, while the distressed communities index did not. Of the deaths, 76.9% were in-hospital deaths, with intra-abdominal catastrophes (35.4%), multisystem organ failure (25.2%), and pulmonary causes (16.4%) as the most common causes.</div></div><div><h3>Conclusions</h3><div>Intra-abdominal catastrophes, multiorgan failure, and pulmonary complications are leading causes of death in septic emergency general surgery patients. ADI is a robust socioeconomic predictor of mortality, underscoring the need for integrating social determinants into risk assessment and tailored care strategies. Developing comprehensive risk models may enhance prognostication and guide clinical decision-making in this critical population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 218-225"},"PeriodicalIF":1.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878968","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":"Emergency Department Thoracotomy: Time to Stop – A Trauma Video Review","authors":"Sriharsha Gummadi MD ,&nbsp;Shyam Murali MD ,&nbsp;Kristen Chreiman MSN, RN, CCRN, TCRN ,&nbsp;Liam Forsythe BS ,&nbsp;Jay A. Yelon DO ,&nbsp;Jeremy W. Cannon MD ,&nbsp;Mark J. Seamon MD","doi":"10.1016/j.jss.2025.03.016","DOIUrl":"10.1016/j.jss.2025.03.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency department thoracotomy (EDT) can restore spontaneous circulation in selected trauma patients as a bridge to definitive operating room repair. Compared with medical cardiopulmonary resuscitation, there is little guidance on EDT resuscitation duration in trauma. We hypothesized that prolonged EDT resuscitation efforts was not associated with durable return of spontaneous circulation (ROSC) (ROSC with survival to operating room).</div></div><div><h3>Methods</h3><div>This institutional review board approved study was performed at a level 1 trauma center from January 2022 to January 2023. Trauma bay video and electronic medical data were reviewed on patients undergoing EDT. Patients with inadequate video data, known to be under the age of 18, known to be a prisoner, or known to be pregnant were excluded. Resuscitation duration was defined as EDT incision start to ROSC and/or death pronouncement.</div></div><div><h3>Results</h3><div>Seven of 41 patients (39 gunshots, 2 blunt) achieved ROSC after EDT. Comparing patients achieving durable ROSC <em>versus</em> not, there was no difference in median time until incision (ROSC 3.2 min <em>versus</em> no ROSC 2.7 min, <em>P</em> = 0.85) or resuscitation duration (ROSC 8.2 min <em>versus</em> no ROSC 10.5 min, <em>P</em> = 0.62). No patients achieved durable ROSC after 20 min of resuscitation. Two of seven durable ROSC patients survived through hospital discharge—both were neurologically intact and achieved durable ROSC within 10 min.</div></div><div><h3>Conclusions</h3><div>In this trauma video review study, prolonged EDT resuscitation times was not associated with increased durable ROSC rates. Prolonged resuscitations should prompt critical re-evaluation for futility.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 203-208"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874229","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":"Women in Orthopedics and Their Residency Programs: What Influenced Their Choices?","authors":"Katherine Ji BS ,&nbsp;Jackson Mitchell BS ,&nbsp;Kailey C. Marlowe CCRP ,&nbsp;Andrew W. Froehle PhD ,&nbsp;Jennifer Jerele MD","doi":"10.1016/j.jss.2025.03.031","DOIUrl":"10.1016/j.jss.2025.03.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Orthopedic surgery lacks gender parity owing to several barriers to women. Residency programs may increase gender parity by considering factors influencing women's residency choices. The purpose of our study is to determine if factors such as having a women-friendly institutional climate, transparent parental leave policy, or more women residents, faculty, and leaders related to a higher percentage of women interns in orthopedic residency programs. We also aimed to find how women consider the above factors compared to others such as early surgical experience and program prestige.</div></div><div><h3>Methods</h3><div>Residency program websites (<em>n</em> = 188) were reviewed for percentage of women interns, residents/alumni, and faculty; women leaders; parental leave transparency; and other key institutional factors. Orthopedic attendings/residents (<em>n</em> = 84) were surveyed on the importance of these factors <em>versus</em> other factors (e.g., program prestige) in ranking residencies.</div></div><div><h3>Results</h3><div>With respect to the first study question, percentage of women interns was positively correlated with percentages of women residents/alumni/faculty and woman-friendly institutional factors. With respect to the second study question, survey respondents valued numbers of women attendings/leaders/residents and institutional climate while deemphasizing parental leave policy. However, greater importance was placed on other factors (early surgical experience, location, program prestige).</div></div><div><h3>Conclusions</h3><div>Literature shows that orthopedic surgery lacks gender diversity. Institutional climate and other women in the program are important factors in women's residency program choices, along with other variables. Programs emphasizing these factors may increase numbers of women applicants. Orthopedic residency programs can increase their percentage of women interns by increasing their percentage of women alumni/faculty and women-friendly institutional factors. This will improve practicing physician demographics and reduce gender disparities in healthcare.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 177-185"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874228","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":"Machine Learning to Predict Early Death Despite Pancreaticoduodenectomy","authors":"Kaleem S. Ahmed MD, MSAI,&nbsp;Clayton T. Marcinak MD,&nbsp;Sheriff M. Issaka BS,&nbsp;Muhammad Maisam Ali MBBS,&nbsp;Syed Nabeel Zafar MD, MPH, FACS","doi":"10.1016/j.jss.2025.03.047","DOIUrl":"10.1016/j.jss.2025.03.047","url":null,"abstract":"<div><h3>Introduction</h3><div>About 25% of patients undergoing pancreaticoduodenectomy (PD) for right-sided pancreatic ductal adenocarcinoma (PDAC) die within 1 y of diagnosis. These patients carry all the risks of significant morbidity with no survival advantage when compared to nonsurgical options. We aimed to determine if machine learning models have superior accuracy to traditional regression models at predicting futile surgery in patients with PDAC.</div></div><div><h3>Methods</h3><div>We analyzed data from patients in the National Cancer Database undergoing PD for PDAC between 2004 and 2020. PD was defined as futile if the patient died within 12 mo of cancer diagnosis. We trained predictive models using 80% of the dataset and 16 preoperative input variables. Models included logistic regression, multilayer perceptron, decision tree, random forest, and gradient boosting classifiers. Models were tested on a 20% test set using area under the receiver operating characteristic curve and Brier scores.</div></div><div><h3>Results</h3><div>Of the 66,331 patients identified, 34,260 (51.7%) were men, with a median age of 67 y (interquartile range, 59 to 74 y). A total of 16,772 (25.3%) patients met the criteria for futile surgery. The gradient boosting model outperformed other models with an area under the receiver operating characteristic curve of 0.689, followed by logistic regression (0.679), random forest (0.675), and decision tree (0.664). Key predictors of futile PD included advanced age (&gt; 79 y), tumor size ≥ 4 cm, and poor differentiation. Neoadjuvant therapy was associated with lower futility risk.</div></div><div><h3>Conclusions</h3><div>We demonstrated the ability of machine learning models to predict the odds of futile PD with moderate accuracy. Although similar analyses are needed on more granular datasets, our study has important implications for shared decision-making and optimized care for patients with PDAC.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 186-193"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874232","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":"Prenatal Urologic Consultation for Prenatal Hydronephrosis: True Equity or Hidden Disparity?","authors":"Aiden Hoefer BS ,&nbsp;Meridiana Mendez BS ,&nbsp;Gemima Nanizao BS candidate ,&nbsp;Kathleen Kieran MD, MS, MME","doi":"10.1016/j.jss.2025.03.009","DOIUrl":"10.1016/j.jss.2025.03.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Prenatal urologic consultation (PUC) is now offered to many prospective parents for fetal prenatal hydronephrosis (PH). This study aims to describe patient- and community-level differences in prenatal and postnatal urologic care patterns for patients with PH and to identify potentially modifiable factors that would improve timely access to care.</div></div><div><h3>Methods</h3><div>We identified all patients with PH aged &lt;6 mos seen at a single freestanding children’s hospital from January 2021 to December 2022. Data were collected on patient gender, race/ethnicity, characteristics of upper tract dilatation, timing of delivery, and socioeconomic status. Patients with and without PUC were compared.</div></div><div><h3>Results</h3><div>Two hundred and fifty patients met inclusion criteria. One hundred seventy-nine (71.6%) were male, 122 (48.8%) were White, and 56 (22.4%) had PUC. Patients with PUC had postnatal evaluation earlier than those without PUC (0.62 [0.2-5.0] <em>versus</em> 2.1 [0.1-12.8] months (<em>P</em> &lt; 0.0001) but were equally likely to have bilateral PH (41.1% <em>versus</em> 41.2%, <em>P</em> = 0.73). Patients speaking English (54/229; 23.6%) and other languages (LOE; 2/21; 9.5%) were equally likely to have PUC. Children living in the least (Area Deprivation Index [ADI], 1-2) and moderately disadvantaged areas (ADI, 3-8) were equally (odds ratio [OR] = 1.52; 95% confidence interval [CI]: 0.55-4.23) and three times (OR = 2.99; 95% CI: 1.16-7.67) as likely to have PUC as those living in the most disadvantaged areas (ADI, 9-10), respectively. Of preterm infants, 25% of those living in ADI 1-2 had PUC, compared with 0% of those living in ADI 9-10 (OR = 3.32; 95% CI, 0.57-11.4), and 24% of those speaking English had PUC, compared with 0% of those with LOE (OR = 1.98; 95% CI, 0.09-45.6). The likelihood of PUC for patients with bilateral PH was similar for patients living in ADI 1-2 (6/33; 18.2%) and ADI 9-10 (2/19; 10.5%; OR = 1.89 [95% CI, 0.34-10.45]) and for those speaking English (23/96; 24%) and LOE (0/7; 0%; OR = 4.80 [95% CI, 0.26-87.2]).</div></div><div><h3>Conclusions</h3><div>PUC is associated with earlier postnatal urologic evaluation, but—in our series—not with PH laterality, language, race, or lowest levels of neighborhood disadvantage. However, the proportion with and without PUC in certain subgroups was notably low. Further research centering on patient groups with low PUC utilization may identify patient- and community-level factors associated with differential access to care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 162-169"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874230","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":"Trisomy 21 Children With Duodenal Atresia or Anorectal Malformation: NSQIP-P Surgical Outcomes Study","authors":"Yumiko Gely MD ,&nbsp;Rebecca Moreci MD ,&nbsp;Hiyori Roberts MS ,&nbsp;Denise Danos PhD ,&nbsp;Jessica Zagory MD","doi":"10.1016/j.jss.2025.03.020","DOIUrl":"10.1016/j.jss.2025.03.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Patients with Trisomy 21 (T21) have significantly different surgical outcomes when compared to their non-T21 counterparts. Using a national database, we sought to determine if operative complications are increased in T21 patients undergoing duodenal atresia (DA) or anorectal malformation (ARM) surgery, two commonly associated congenital surgical conditions in T21, compared to their non-T21 counterparts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;We used the deidentified National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database to identify children under 18 with an ICD-9 diagnosis of congenital malformations related to DA or ARM from 2012 to 2020. We stratified patients based on T21 ICD-9 diagnosis. CPT codes were used to identify all surgical procedures related to DA or ARM. Primary outcomes were clinical outcomes (operative time, readmission, reoperation, length of stay [LOS], death) and complications (infectious, cardiac, respiratory, renal, neurological, and hematologic). Unadjusted and adjusted analyses were used for statistical analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 2242 patients with DA, 17.5% had T21. The most common procedure overall was enterectomy (38.7%). DA patients with T21 were more likely to be neonates or small children (&lt;em&gt;P&lt;/em&gt; = 0.0002), White or Hispanic (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), with cardiac risk factors (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), previous cardiac surgery (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), hematologic disorders (&lt;em&gt;P&lt;/em&gt; = 0.0045), underwent elective cases (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), and had higher ASA class (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), compared to non-T21 counterparts. In unadjusted analyses, T21 patients with DA were less likely to have hematologic complications (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001). T21 patients with DA were also less likely to have any complications in adjusted analyses (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001). Of 2532 patients with ARM, 112 had T21 (4.4%). The most common procedure performed was the perineal/sacroperineal approach repair of a high imperforate anus with a fistula (32.3%). T21 patients with ARM were more likely to be infants (&lt;em&gt;P&lt;/em&gt; = 0.0188), older gestational age (&lt;em&gt;P&lt;/em&gt; = 0.0008), Hispanic (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), with major or minor cardiac risk factors (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001), and higher ASA class (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001). In unadjusted analysis, T21 patients with ARM were more likely to have superficial surgical site infections (SSI) (&lt;em&gt;P&lt;/em&gt; = 0.0057), organ/space SSI (&lt;em&gt;P&lt;/em&gt; = 0.0456), and sepsis (&lt;em&gt;P&lt;/em&gt; = 0.0364), compared to their non-T21 counterparts. In adjusted analyses, T21 was not a significant risk factor for any complication (OR 1.79 [0.92, 3.47], &lt;em&gt;P&lt;/em&gt; = 0.0866). No differences were found in operative time, unplanned reoperations, readmissions, LOS of more than 30 d, death, or LOS in both DA and ARM patients with and without T21.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This study reveals that T21 patients are less like","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 194-202"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874231","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":"Unexpected Admissions and Patient-Directed Discharges – Understanding Trauma Patients: Scoping Review","authors":"Susan S. You BA ,&nbsp;Michael Kell BA ,&nbsp;Travis Nace MSLIS ,&nbsp;Elizabeth Dauer MD","doi":"10.1016/j.jss.2025.03.049","DOIUrl":"10.1016/j.jss.2025.03.049","url":null,"abstract":"<div><h3>Introduction</h3><div>Few studies have explored patient-directed discharges (PDDs), previously referred to as leaving against medical advice, in trauma patients, a unique patient population given the unanticipated nature of their injury and suddenness of hospital admission. This scoping review focuses on PDDs in trauma patients and aims to explore who may be at risk and what factors influence this decision.</div></div><div><h3>Methods</h3><div>A literature search was performed using five databases for publications between 1956 and 2023. Articles were included if they discussed admitted trauma patients who underwent a PDD and/or if they proposed why trauma patients choose to undergo a PDD. Articles that solely discussed PDDs from the emergency department were excluded as were PDDs for patients presenting with traumatic brain injuries. Studies were screened by two blinded independent reviewers with a third, tiebreaker reviewer if needed.</div></div><div><h3>Results</h3><div>7931 articles were screened. Eleven (0.1%) articles were included. Demographic information associated with increased odds of PDD were as follows: younger age, lower socioeconomic status, and undomiciled. Those with substance use disorders and pre-existing psychiatric history had a higher rate of PDD. Stab and gunshot wounds, injuries to the upper and lower extremities and face were associated with increased odds of PDD. Hypotheses for PDDs were distrust in the health-care system, injury characteristics and workup (e.g., diagnostic testing <em>versus</em> direct therapeutic care), and impulsive decision-making secondary to substance intoxication or withdrawal.</div></div><div><h3>Conclusions</h3><div>Further research is required to better understand what interventions are successful for patients at risk of discharging themselves and implementation of these interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 170-176"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874273","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":"Researcher's Guide for the Preparation of Tables","authors":"Siv Fonnes PhD, MD,&nbsp;Jacob Rosenberg DMSc, MD","doi":"10.1016/j.jss.2025.03.034","DOIUrl":"10.1016/j.jss.2025.03.034","url":null,"abstract":"<div><div>Almost all scientific articles include tables, but there is little guidance on how to prepare tables. Authors should enhance the focus on the tables’ data-ink, the essential information, and minimizing the no-data-ink, nonessential elements. The six principles of Gestalt on human perception can also be applied to the table to increase readability. Through this review, we provide a practical guide and an overview of how to prepare readable, informative tables. The five steps for the preparation of tables include (1) tables with a clear purpose; (2) using a universal layout; (3) selecting relevant data for Table 1 <em>versus</em> other tables; (4) simplifying variables by categorizing, standardizing, and reducing; and (5) enhancing the readability of numbers and decimals. This results in informative tables that contain data, serving a specific purpose for the reader and increasing readability.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 209-217"},"PeriodicalIF":1.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876637","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":"REBOA Use and Complications in Geriatric Trauma Patients: Insights From a Multicenter Database","authors":"Parvathy Balamurugan BS ,&nbsp;Pavan Guduri BA ,&nbsp;John P. Hunt MD, MPH ,&nbsp;Alan Marr MD, FACS ,&nbsp;Patrick Greiffenstein MD, FACS ,&nbsp;Jonathan Schoen MD, MPH, FACS ,&nbsp;Lance Stuke MD, MPH, FACS ,&nbsp;Juan Duchesne MD, FACS ,&nbsp;Charles F. Bellows MD, FACS ,&nbsp;Alison A. Smith MD, PhD, FACS","doi":"10.1016/j.jss.2025.03.028","DOIUrl":"10.1016/j.jss.2025.03.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Resuscitative endovascular balloon occlusion of the aorta (REBOA) usage in the geriatric population has not been well studied. This study aimed to define REBOA use and complications in the geriatric population. It was hypothesized that geriatric patients may have greater rates of complications compared to younger patients due to geriatric patients having a greater likelihood of preexisting comorbidities.</div></div><div><h3>Methods</h3><div>Using the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry database, adult trauma patients were stratified by age (18-64 y <em>versus</em> ≥ 65 y). Data collected included demographic information, injury severity score (ISS), mechanism of injury, zone of placement, length of occlusion, development of acute kidney injury, and access site complications. Univariate analyses were performed with <em>P</em> value &lt; 0.05 considered to be significant.</div></div><div><h3>Results</h3><div>Of the 1156 patients, 157 (13.6%) were geriatric. There was no significant difference in ISS with both groups having a median ISS of 34 (interquartile range [IQR] 22, 43), <em>P</em> = 0.98. The distribution of REBOA zone placement was similar for both groups. The time of occlusion was not significantly different with geriatric median of 30 min (IQR 11,47) and nongeriatric median of 33 min (IQR 21, 60), <em>P</em> = 0.18. There was no significant difference in the rate of acute kidney injury (21.7% geriatric <em>versus</em> 22.1% nongeriatric, <em>P</em> = 1.0). There was a significantly lower rate of extremity ischemia (0% geriatric <em>versus</em> 3.7% nongeriatric, <em>P</em> = 0.006). There was no significant difference in rates of hematoma, arteriovenous fistula, stenosis, pseudoaneurysm, or distal embolism.</div></div><div><h3>Conclusions</h3><div>Age greater than or equal to 65 y was associated with a significantly lower rate of extremity limb ischemia. This difference could be due to preexisting comorbidities in this patient population. Future prospective studies are needed to further study this phenomenon.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 155-161"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870365","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 Provider and Adolescent Estimates of Postoperative Opioid Use","authors":"Emma Kirkpatrick BS ,&nbsp;Olivia A. Keane MD ,&nbsp;Shadassa Ourshalimian MPH ,&nbsp;Madeleine Ing MD, MPH ,&nbsp;Marjorie Odegard MD ,&nbsp;Eugene Kim MD ,&nbsp;Lorraine I. Kelley-Quon MD, MSHS, FACS","doi":"10.1016/j.jss.2025.03.057","DOIUrl":"10.1016/j.jss.2025.03.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Most adolescents report unused opioids after surgery. Current interventions compare opioid prescribing between surgeons without capturing actual patient-reported use.</div></div><div><h3>Methods</h3><div>We recruited pediatric surgery residents, fellows, advanced practitioners, and surgeons from four surgical divisions at a tertiary care children's hospital. Providers reviewed clinical vignettes based on adolescent-reported postoperative opioid use data from our institution. Afterward, providers were asked to select the number of opioid pills they would prescribe and compare their responses to adolescent-reported use. We then measured provider willingness to change prescribing practices based on this comparison.</div></div><div><h3>Results</h3><div>Overall, provider response rate was 41.3% (<em>N</em> = 38/92). Providers underestimated the number of opioids used for posterior spinal fusion, open pectus excavatum repair, open pectus carinatum repair, knee arthroscopy, and tonsillectomy and overestimated opioid use following hip reconstruction. Differences in median postoperative opioid use estimates from providers versus adolescent-reported use were significant for knee arthroscopy (10 interquartile range [IQR, 0-3] <em>versus</em> 3 IQR [1.5-13]; <em>P</em> &lt; 0.001) and tonsillectomy (0 IQR [0-2.5] <em>versus</em> 1 IQR [0-7]; <em>P</em> = 0.043). Overall, general pediatric surgery providers underestimated opioid use while orthopedic and cardiothoracic providers overestimated opioid use. Differences between provider specialty were significant for posterior spinal fusion (<em>P</em> = 0.022), knee arthroscopy (<em>P</em> &lt; 0.001), and tonsillectomy (<em>P</em> = 0.005). The number of opioids prescribed varied by provider role and 88.9% of providers (<em>N</em> = 32/36) reported that they would change prescribing habits based on adolescent reports.</div></div><div><h3>Conclusions</h3><div>There are differences in provider estimates of postoperative prescription opioid use versus adolescent-reported use. Fortunately, providers report a willingness to change prescribing practice based on these differences. Feedback incorporating patient-reported postoperative opioid use may be a more accurate and patient-centered way to decrease excess opioid prescribing.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 137-144"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870364","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}