Journal of Surgical Research最新文献

{"title":"Trauma, Gender, and End-Of-Life Care: A Propensity-Matched Cohort Study Analyzing Disparities in Withdrawal of Life Support","authors":"Priya Pathak MBBS, MPH ,&nbsp;Jonathan Laredo BS ,&nbsp;Sonal Swain MBA ,&nbsp;Scott F. Gallagher MD, FACS ,&nbsp;Jennifer Freeman MD, MPH, FACS ,&nbsp;Suresh M. Agarwal MD, FACS ,&nbsp;Krista L. Haines DO, MA","doi":"10.1016/j.jss.2025.04.003","DOIUrl":"10.1016/j.jss.2025.04.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Men are known to have more severe injuries at younger ages compared to women. However, the relationship between gender and other sociodemographic factors in the context of end-of-life care after traumatic injuries is not well understood.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study utilized data from the American College of Surgeons Trauma Quality Programs in 2022 and included all patients who were 18 y or older while those with missing information on withdrawal of life-sustaining treatment (WLST) were excluded. Descriptive analysis and multiple logistic regression, following propensity score nearest neighbor matching, were performed to determine the association between WLST and gender after traumatic injury.</div></div><div><h3>Results</h3><div>Among the 843,135 patients who met the inclusion criteria, 43.6% were female. Compared to females, males were younger. A higher proportion of females had Medicare than males (56.7% <em>versus</em> 31.1%). In contrast, other insurance such as private, Medicaid, self-pay, and others were comparatively more frequently utilized by males. Among injury characteristics, assault was more common among males compared to females (11.0% <em>versus</em> 3.0%). Not surprisingly, initial Glasgow Coma Scale and injury severity were comparatively severe among males. WLST was reported in 2.5% of males and 1.9% of females. After propensity score matching, compared to males of age 18-35 y, males of increasing age had higher odds of WLST. Similar trends were seen among females of increasing age compared to males aged 18-35 y. However, the magnitude of the estimates was higher among males. Of note, compared to private insurance, those with Medicare were likelier to have WLST.</div></div><div><h3>Conclusions</h3><div>One in every two patients who died after traumatic injury had WLST, whereas males have an increased likelihood of WLST despite matching and adjusting for injury site and severity. These findings suggest a need for policies addressing demographic and insurance-related disparities to ensure equitable end-of-life care across diverse patient populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 43-53"},"PeriodicalIF":1.8,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072008","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":"Barriers to and Facilitators of a Novel Preprofessional Patient Navigation Program in Surgery","authors":"Adora N. Moneme BS ,&nbsp;Solomiya Syvyk BA ,&nbsp;Emna Bakillah MD ,&nbsp;Shimrit Keddem PhD, MPH ,&nbsp;Marilyn M. Schapira MD, MPH ,&nbsp;Angela T. Chen MA ,&nbsp;Carrie Morales MD ,&nbsp;Mathew Goldshore MD, PhD ,&nbsp;Jon B. Morris MD ,&nbsp;Rachel R. Kelz MD","doi":"10.1016/j.jss.2025.03.066","DOIUrl":"10.1016/j.jss.2025.03.066","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients without adequate insurance often face barriers to surgical care, resulting in disparities in health outcomes. Patient navigation programs, often reliant on trained health professionals, have been successful in addressing these barriers in oncology, but few exist for patients with benign surgical disease. This study aims to identify the barriers to and facilitators of a novel surgical preprofessional patient navigation program for underinsured patients.</div></div><div><h3>Methods</h3><div>A semistructured qualitative interview study was performed from February 7, 2023, to November 2, 2023, at a single center using freelisting and open-ended responses. Preprofessional navigators included volunteer medical students, postbaccalaureate students, and research personnel. Navigators with an active or prior affiliation with the navigation program and who had navigated at least two patients, were selected using purposeful sampling. The primary outcomes were navigator perceptions of barriers to and facilitators of patient navigation and suggested interventions to improve the navigation experience. Interview responses were analyzed using salience indices and a modified grounded theory approach.</div></div><div><h3>Results</h3><div>Among 22 navigators interviewed (14 women [63.6%], 14 medical students [63.6%]), the average navigation experience was 1.3 y. In freelisting and open-ended responses, participants reported barriers and facilitators related to patient, provider, administrative, and health system factors. Key barriers included language and cultural barriers, patient engagement, and limited workforce. Facilitators included organizational leadership support, standardized navigator operating procedures, and coordination within the health system. Participants suggested several interventions to improve patient navigation, including patient support groups, language support, integration of social support services, and establishment of shadowing opportunities during the navigator onboarding process.</div></div><div><h3>Conclusions</h3><div>Preprofessional navigators can expand the workforce and provide critical experiences with underinsured populations for future health professionals. Surgical patient navigation was impacted by four disparity domains including patient, provider, administrative, and health system factors. Standardized procedures for navigators and the complexity of the insurance application impact the success of navigation toward surgical health equity. Broad institutional, state, and national support for patient navigation may be associated with increase reductions in disparities for marginalized patient populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 54-63"},"PeriodicalIF":1.8,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072009","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":"Competence by Design in Cardiac Surgery Resident Training: A Qualitative Thematic Analysis","authors":"Kerem M. Vural MD, FETCS ,&nbsp;Elias Hirsch BSc ,&nbsp;Christine Herman MD ,&nbsp;David Horne MD","doi":"10.1016/j.jss.2025.04.009","DOIUrl":"10.1016/j.jss.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>A new training model known as “Competence by Design” (CBD) is centered on evaluating “entrustable professional activities” and “milestones” and it represents a paradigm change from time-based to outcome-based learning and evaluation. This study presents a qualitative quality assurance and improvement assessment of the current state of CBD in cardiac surgery training at a single center.</div></div><div><h3>Methods</h3><div>An initial questionnaire was distributed to three focus groups: educators, traditional-system trainees, and CBD trainees. Building on the questionnaire responses, in-depth interviews were conducted and qualitative thematic data analysis was performed to identify recurrent themes.</div></div><div><h3>Results</h3><div>Thirteen participants were interviewed (6 educators and 7 residents, <em>n</em> = 4 traditional-system trainees and <em>n</em> = 3 CBD trainees). Thematic analysis generated 16 themes, including six major themes. CBD (1) promotes a more standardized approach to surgical training, (2) allows for more objective assessment of residents’ progress, (3) encourages a focused approach to specific skill development, (4) comes with increased administrative workloads, (5) allows for early recognition of struggling or failing residents with documentation, and (6) presents challenges in understanding and implementation for both residents and educators.</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first study to assess the benefits and pitfalls of CBD in a Canadian cardiac surgery training program with feedback from both educators and trainees. Our participants felt that CBD has value in providing more standardized training, more elaborate and well-documented assessments, more detailed and meaningful feedback, and outcome-based training focused on the acquisition of surgical skills despite increased administrative workloads. Our participants identified specific challenges involved in understanding and implementing the CBD model.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 31-42"},"PeriodicalIF":1.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072007","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":"Ischemia-Modified Albumin and Oxidative Stress Marker in Acute Appendicitis: A Prospective Study","authors":"Ozan Caliskan MD ,&nbsp;Beyza Nur Ozkan MD ,&nbsp;Mehmet Taner Unlu MD ,&nbsp;Nurcihan Aygun MD ,&nbsp;Eray Metin Guler MD ,&nbsp;Mehmet Uludag MD","doi":"10.1016/j.jss.2025.03.070","DOIUrl":"10.1016/j.jss.2025.03.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute appendicitis is a common surgical emergency in childhood and adulthood. However, perforated appendicitis is a condition that requires early diagnosis and treatment due to the increased risk of complications. In our study, we aimed to evaluate the clinical values of various biochemical, hematological, and inflammatory parameters in order to distinguish acute appendicitis from perforated appendicitis.</div></div><div><h3>Materials and methods</h3><div>A total of 87 participants aged 18-65 y were enrolled in this prospective study. 29 patients with acute appendicitis, 29 patients with perforated appendicitis, and 29 healthy controls were included. Serum urea, creatinine, lactate dehydrogenase, and C-reactive protein concentrations were measured using an automated analyser, and whole blood parameters were measured using a haematological analyser. Total antioxidant status, total oxidant status, total thiol (TT), and native thiol (NT) levels were measured photometrically. Oxidative stress index and disulfide (DIS) level were calculated mathematically. Interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and ischemia-modified albumin (IMA) levels were measured photometrically using commercially purchased kits.</div></div><div><h3>Results</h3><div>The elevated levels of urea, lactate dehydrogenase, C-reactive protein, white blood cell, and platelet count in the acute and perforated appendicitis groups compared to controls, significantly (<em>P</em> &lt; 0.001). Oxidative stress markers (total oxidant status, oxidative stress index, DIS, DIS/TT, DIS/NT, and IMA) were higher, while antioxidant markers (total antioxidant status, TT, NT, and NT/TT) were lower in the appendicitis groups (<em>P</em> &lt; 0.001). Additionally, inflammatory markers IL-1β, IL-6, and tumor necrosis factor-α were elevated, particularly in the perforated appendicitis group (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>IMA is a promising biomarker for distinguishing perforated appendicitis from acute appendicitis. Its role, in conjunction with other oxidative stress and inflammatory markers, may enhance diagnostic precision and aid clinicians in timely intervention, potentially reducing complications associated with delayed or missed diagnoses. Further studies are warranted to validate these findings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 23-30"},"PeriodicalIF":1.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069673","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":"Leveraging American Society of Anesthesiologists Physical Status Classification and Surgeon Risk Estimates to Stratify Surgical Risk: A Prospective Observational Study","authors":"Margaret T. Berrigan MD, MS ,&nbsp;Brendin R. Beaulieu-Jones MD, MBA, MBI ,&nbsp;Jayson S. Marwaha MD, MBI ,&nbsp;Stephen R. Odom MD, FACS ,&nbsp;Alok Gupta MD, FACS ,&nbsp;Charles S. Parsons MD, FACS ,&nbsp;Anupamaa J. Seshadri MD, FACS ,&nbsp;Charles H. Cook MD, FACS ,&nbsp;Gabriel A. Brat MD, MPH, FACS","doi":"10.1016/j.jss.2025.03.067","DOIUrl":"10.1016/j.jss.2025.03.067","url":null,"abstract":"<div><h3>Introduction</h3><div>The American Society of Anesthesiologists Physical Status Classification (ASA PS class) is generated by the anesthesiologist before surgery. It is correlated with postoperative complications but does not integrate surgery-specific considerations or intraoperative events. We sought to combine ASA PS class with surgeon-generated risk estimates to create an easily deployed and accurate postsurgical risk stratification tool.</div></div><div><h3>Methods</h3><div>Surgeons at one academic center were surveyed before surgery to evaluate perceived risk of postsurgery complications. ASA PS class, presurgery clinical features, and clinical postsurgery outcomes were abstracted from an institutional database and the electronic health record. Binomial regression models predicting overall 30-d morbidity were trained using presurgery clinical features, ASA PS class, and surgeon risk estimates, alone and in combination.</div></div><div><h3>Results</h3><div>Surgeon risk estimates were collected from 11 surgeons for 286 patients undergoing 68 procedure types. One hundred seventy-five (61.89%) patients had ASA PS class 3 or higher. One hundred twenty (41.96%) patients were estimated to be at higher than average risk before surgery. The overall complication rate was 27.27%. ASA PS class and surgeon risk estimates predicted surgery complication with area under the receiver operating characteristic curve (AUC) 0.79 (95% confidence interval [CI] 0.71-0.86) and AUC 0.71 (95% CI 0.63-0.78), respectively. Combining ASA PS class and the surgeon risk estimate resulted in model discrimination (AUC 0.84, 95% CI 0.78-0.89) similar to that of a clinical data–based model (AUC 0.84, 95% CI 0.78-0.88). Subgroup analysis showed that attending surgeons are better able to predict postsurgery complications than senior trainees; risk estimates from both groups were improved by combination with the ASA PS class.</div></div><div><h3>Conclusions</h3><div>ASA PS class and surgeon risk estimates are independently predictive of overall 30-d morbidity. Taken together, these assessments resulted in improved anticipation of postsurgery complications with model discrimination on par with a traditional clinical data–based model. Judgment-derived assessments alone can be used to accurately predict a patient's postsurgery risk. Future research should identify scenarios where clinician judgment is especially valuable for postsurgery risk stratification and how to best integrate clinician judgment with risk stratification systems to encourage routine use of these tools and promote optimal postsurgery management.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 323-330"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949086","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":"Derivation of FAST CLOTS: A Multivariable Risk Assessment Model for Postoperative Venous Thromboembolism","authors":"Eli Mlaver MD, MSc ,&nbsp;Jyotirmay Sharma MD ,&nbsp;Elizabeth M. Hechenbleikner MD ,&nbsp;Jordan A. Kempker MD, MSc","doi":"10.1016/j.jss.2025.03.069","DOIUrl":"10.1016/j.jss.2025.03.069","url":null,"abstract":"<div><h3>Introduction</h3><div>Venous thromboembolism (VTE) remains a leading preventable cause of postoperative morbidity and mortality in part due to failure of consistent, standardized risk assessment. Available risk assessment models (RAMs) are burdensome and lack procedural specificity or actionable thresholds for intervention. A parsimonious, clinically oriented VTE RAM has the potential to increase adherence to risk assessment.</div></div><div><h3>Methods</h3><div>We applied multivariable logistic regression modeling with a clinically guided forward selection process to the 2019 National Surgical Quality Improvement Project public user file. Considered predictors included patient demographics, comorbidities, and elements of the preoperative assessment. Procedural specificity was introduced by grouping Current Procedural Terminology codes and capturing minimally invasive techniques. Model performance was internally compared to three currently available RAMs: the Caprini score, cancer, old age, BMI, race, ASA model, and American College of Surgeons risk calculator.</div></div><div><h3>Results</h3><div>VTE occurred in 8161 (0.76%) of 1,079,441 patients. The following eleven variables were chosen for model inclusion: age, body mass index, functional status, American Society of Anesthesiologists Physical Status classification; history of steroid use, ascites, or cancer; preoperative sepsis or blood transfusion; and Current Procedural Terminology group and minimally invasive surgery. The new FAST CLOTS model has a c-statistic of 0.753 and an 89% sensitivity for VTE outcomes at the chosen cut-off of 6 out of a maximum possible total of 24 points.</div></div><div><h3>Conclusions</h3><div>As it was derived with an emphasis on biological plausibility and face validity to clinicians, the FAST CLOTS model addresses many of the limitations of currently available RAMs. If further validated and refined, adoption may improve care quality and patient outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 362-372"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948686","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":"Evaluating Outcomes in Adolescents With Pilonidal Disease Treated With Pilonidal Sinus Trephination","authors":"Katherine C. Bergus MD, MPH ,&nbsp;Carley Lutz BS ,&nbsp;Josh Bricker PhD ,&nbsp;Lindsey Asti PhD, MPH ,&nbsp;Kyle J. Van Arendonk MD, PhD ,&nbsp;Cory N. Criss MD ,&nbsp;Katherine J. Deans MD, MHSc ,&nbsp;Peter C. Minneci MD, MHSc","doi":"10.1016/j.jss.2025.04.010","DOIUrl":"10.1016/j.jss.2025.04.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Pilonidal disease is a common chronic infectious process caused by entrapment of hair follicles in the gluteal cleft that can be managed with conservative therapies or operative intervention, including pilonidal sinus trephination. While trephination has been found to be safe and effective in adults, outcomes in adolescents are limited. This study investigated wound healing and 1-y disease recurrence in adolescents after trephination.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022. Patient demographics, treatment history, operative management, and clinical outcomes up to 12 mo postoperatively were collected. We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo.</div></div><div><h3>Results</h3><div>Among 63 patients, the median age at the time of index operation was 16.5 y. Most patients were male (52.4%), and most were White (73.0%). At the time of initial clinic intake, all patients had a current or prior chronic gluteal cleft fistula and/or pilonidal sinus, and 93.7% had experienced ≥1 flare of pilonidal disease. Patients more commonly underwent trephination for a chronic wound than active disease (81.0% <em>versus</em> 19.0%). Nearly half of patients had at least one fistula present (49.2%) and a median of three pits. Wound healing was delayed in 20.5% and was associated with non-White race (odds ratio 7.31, 95% confidence interval 1.68, 31.85) but not Fitzpatrick skin type (<em>P</em> = 0.29) in univariable analysis. Recurrence at 1 y was 25.0% and was also associated with non-White race (odds ratio 8.85, 95% confidence interval 2.02, 38.71) but not Fitzpatrick skin type (<em>P</em> = 0.10) in univariable analysis.</div></div><div><h3>Conclusions</h3><div>Pilonidal sinus trephination may be an appropriate surgical option for select adolescents with chronic, fistulous pilonidal disease. Further research is needed to determine if race and ethnicity are associated with healing complications and recurrence of pilonidal disease.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 331-339"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949085","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":"Association of Body Mass Index With Severe Sepsis Outcomes in Critically-Ill Severely Injured Adult Trauma Patients: A National Analysis","authors":"Sanjan Kumar BS ,&nbsp;Hazem Nasef BS ,&nbsp;Zackary Yates BS ,&nbsp;Nickolas Hernandez BS ,&nbsp;Brian Chin BS ,&nbsp;Logan Rogers BS ,&nbsp;Sarthak Kumar BS ,&nbsp;Tracy Zito MD, FACS ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2025.04.006","DOIUrl":"10.1016/j.jss.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study is to evaluate clinical outcomes of critically-ill adult trauma patients with severe sepsis and severe injuries by body mass index (BMI) classification.</div></div><div><h3>Methods</h3><div>This retrospective study utilized the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2021 to evaluate the relationship between BMI and severe sepsis outcomes. Patients included in this study included critically-ill adult (age ≥18 ys) trauma patients with severe injuries (injury severity score [ISS] ≥15) and a diagnosis of severe sepsis. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit length-of-stay, ventilation-free-days, and complications, including acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, ventilator-associated pneumonia, and acute kidney injury.</div></div><div><h3>Results</h3><div>There were a total of 3268 patients included in this analysis. There was no significant association between obesity and odds of in-hospital mortality (odds ratio [OR]: 0.811, 95% confidence interval [CI]: 0.410-1.601, <em>P</em> = 0.545), intensive care unit length-of-stay (B = 5.114, 95% CI: −4.041-14.328, <em>P</em> = 0.268), ventilation-free-days (B = −0.280, 95% CI: −8.558-7.999, <em>P</em> = 0.946), deep vein thrombosis (OR: 1.625, 95% CI: 0.368-7.174, <em>P</em> = 0.522), pulmonary embolism (OR: 5.4 × 10ˆ14, 95% CI: 0.000-N/A, <em>P</em> = 0.992), acute respiratory distress syndrome (OR: 1.858, 95% CI: 0.668-5.179, <em>P</em> = 0.235), ventilator-associated pneumonia (OR: 0.809, 95% CI: 0.312-2.099, <em>P</em> = 0.664), or acute kidney injury (OR: 0.984, 95% CI: 0.449-2.154, <em>P</em> = 0.967) when compared to being normal weight. There was also no significant association between the remaining BMI classifications and all study outcomes.</div></div><div><h3>Conclusions</h3><div>Obesity had no association with outcomes of severely injured critically ill adult trauma patients with severe sepsis as demonstrated through comparable clinical outcomes between study populations regardless of BMI classification.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 353-361"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948685","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":"Low-Cost, High-Fidelity Skin and Intestine Surrogates for Surgical Training","authors":"Oliver Giraldo-Londoño PhD ,&nbsp;Chadwick Bettale BS ,&nbsp;Kyle Martinez BS ,&nbsp;Milot Thaqi MD ,&nbsp;Andrew Wheeler MD","doi":"10.1016/j.jss.2025.03.068","DOIUrl":"10.1016/j.jss.2025.03.068","url":null,"abstract":"<div><h3>Introduction</h3><div>Organ surrogates play a pivotal role in training surgical residents, offering a safe and cost-effective alternative to live human patients or animals. However, existing surrogates often fall short, either due to their high cost or inability to accurately replicate the mechanical behavior and anatomical complexity of human tissue. This study aims to address these limitations by developing affordable, realistic, and biomechanically accurate organ surrogates tailored for surgical training.</div></div><div><h3>Materials and Methods</h3><div>Our methods involve 3D printing customized molds for pour casting, injection molding, and rotational molding, employing off-the-shelf platinum-cure silicone rubbers and specially formulated silicone-based blends as base materials. This approach ensures cost-effectiveness and allows utilizing commercially available materials and accessible laboratory equipment, enabling low-cost in-house fabrication of multi-layered skin and intestine surrogates for surgical training.</div></div><div><h3>Results</h3><div>Feedback received from surgical residents and surgeons at the University of Missouri School of Medicine indicates that our surrogates consistently outperform industry-standard models in terms of biomechanical accuracy. Moreover, our cost analysis revealed that our fabrication methods yield surrogates that are over 90% less expensive than commercial alternatives.</div></div><div><h3>Conclusions</h3><div>The skin and intestine surrogates developed in this study demonstrate the feasibility of creating affordable, high-fidelity surgical training models using accessible materials and established fabrication techniques. By addressing the limitations of existing surrogates, this work lays the foundation for developing a broader range of anatomical models. These advances have the potential to improve the effectiveness and accessibility of surgical training.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 8-22"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946654","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":"Association of Trainee Gender With Critically-Ill Trauma Patient Outcomes","authors":"Nicole B. Lyons MD,&nbsp;Luciana Tito Bustillos MD,&nbsp;Brianna L. Collie MD,&nbsp;Akki Gunda BA,&nbsp;Victoria DeTrolio BS,&nbsp;Christopher F. O'Neil MD,&nbsp;Walter A. Ramsey MD,&nbsp;Enrique Ginzburg MD,&nbsp;Nicholas Namias MD, MBA,&nbsp;Carl I. Schulman MD, PhD, MSPH,&nbsp;Joyce I. Kaufman MD","doi":"10.1016/j.jss.2025.04.004","DOIUrl":"10.1016/j.jss.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent research has shown that female attending surgeons have slightly better outcomes than male attending surgeons. We aimed to evaluate if this gender difference extends to trainees caring for critically-ill trauma patients.</div></div><div><h3>Methods</h3><div>The trauma registry at a level 1 academic trauma center was reviewed from October 2015 to December 2021. All patients admitted with an injury severity score ≥25 were included. The trauma team members for each patient were determined by the past resident and fellow call schedules. Teams with two female (female/female) or two male (male/male) trainees were included in the analysis. Primary outcome was mortality. Secondary outcomes included hospital and intensive care unit length of stay, return to intensive care unit, readmission, infectious complications, and venous thromboembolism.</div></div><div><h3>Results</h3><div>1909 patients met inclusion criteria; of which, 625 were on an FF or MM team. Median age was 37 y and 80% were male. The mortality on female/female teams was 22.7%, compared to 25.5% on male/male teams, <em>P</em> = 0.496. There were also no differences between teams for any of the secondary outcomes.</div></div><div><h3>Conclusions</h3><div>There was no statistically significant difference in mortality rates for severely injured trauma patients based on whether the trainees on their team were men or women. As gender discrimination still exists in the field of surgery, studies like this that demonstrate similar or better outcomes for female surgeons can help to dissipate bias.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 1-7"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946655","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}