Journal of Surgical Research最新文献

{"title":"Cross-Sectional Study Gender Pay Gap in Industry General Payments to U.S. General and Fellowship-Trained Surgeons","authors":"Heng Jiang MD, MBBS ,&nbsp;Lina M. Adwer BS ,&nbsp;Taoyuan Beninato MD ,&nbsp;Brooke J. Fitzpatrick BA, MPH ,&nbsp;Collin E. Dougherty BS ,&nbsp;Juan A. Santamaria-Barria MD, FACS, FSSO","doi":"10.1016/j.jss.2025.01.001","DOIUrl":"10.1016/j.jss.2025.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Gender disparities exist in nonresearch industry payments to U.S. physicians, but detailed analyses specific to surgeons are limited. This study aims to investigate the gender pay gap in industry general nonresearch payments made to U.S. general and fellowship-trained surgeons between 2016 and 2022.</div></div><div><h3>Methods</h3><div>Data on industry payments to U.S. surgeons were collected from the open payments database. General and fellowship-trained surgeons were included. Gender prediction was conducted using an artificial intelligence tool. Payment type, amount, and company were summarized. Gender differences were compared.</div></div><div><h3>Results</h3><div>Between 2016 and 2022, the medical and device industry made 1,998,110 payments totaling $739,264,940 to U.S. general and fellowship-trained surgeons. The median payment was $31, primarily for food and beverages. Surgeons receiving over $5000 annually accounted for $634,530,579 (86%). Most payments were device-related (92%). Intuitive ($199M), Medtronic ($57M), and Boston Scientific ($46M) were the top-paying companies. California received the highest payments ($90M). Payments peaked in 2019 before falling due to the COVID-19 pandemic. Men were paid significantly more than women, with an average $16,509 annual pay gap favoring men (<em>P</em> &lt; 0.001). In 2019, the industry paid men $44,025 on average, compared to $16,677 for women.</div></div><div><h3>Conclusions</h3><div>Among U.S. general and fellowship-trained surgeons, there is a gender pay gap in industry general payments, where males receive higher compensation for nonresearch-related reasons. Understanding the factors contributing to this disparity, such as differential access to industry opportunities and potential biases in compensation negotiations, is crucial for promoting equity in industry relationships.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 457-464"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039504","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":"Delirium Among Liver Transplant Recipients: A National Analysis Using MarketScan","authors":"Jessica M. Ruck MD, PhD,&nbsp;Maria A. Parra MD,&nbsp;Matthew D. Price MD, MPH,&nbsp;Caitlin W. Hicks MD, MS,&nbsp;Elizabeth A. King MD, PhD","doi":"10.1016/j.jss.2024.12.035","DOIUrl":"10.1016/j.jss.2024.12.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Delirium is a common issue following liver transplantation (LT), but research has mainly focused on single-center cohorts.</div></div><div><h3>Methods</h3><div>We studied delirium in a national cohort of adult LT recipients transplanted October, 2015-December, 2020 using the MarketScan database. Claims data were used to identify LT recipients with delirium. Characteristics and outcomes of LT recipients with and without delirium were compared using descriptive statistics.</div></div><div><h3>Results</h3><div>Among 2051 LT recipients, only 32 (1.6%) had a delirium claim. Recipients with <em>versus</em> without delirium were more likely to have a history of encephalopathy (21.9% <em>versus</em> 8.2%, <em>P</em> = 0.006) but were of similar age and sex. Recipients with <em>versus</em> without delirium were more likely to be discharged to skilled care or rehabilitation facilities (37.5% <em>versus</em> 14.3%, <em>P</em> = 0.003) and had longer median hospital stays (24 <em>versus</em> 14 ds, <em>P</em> = 0.03). Delirium claims were not associated with median hospitalization costs (<em>P</em> = 0.15) or 30-d (<em>P</em> = 0.32) and 60-d (<em>P</em> = 0.99) readmission.</div></div><div><h3>Conclusions</h3><div>Overall, only 1.6% of adult LT recipients had delirium claims, despite prevalence estimates of up to 47% in single-center studies. This underreporting—which is likely limited to the most severe cases—limits our ability to assess associated outcomes and highlights the need for better delirium recognition and reporting.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 510-515"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066312","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":"Spin Reporting Is Common in Pilot Randomized Controlled Trials in Surgery: A Methodological Survey","authors":"Tyler McKechnie MD, MSc ,&nbsp;Tania Kazi BScH ,&nbsp;Victoria Shi MA ,&nbsp;Austine Wang BHSc ,&nbsp;Sophia Zhang BSc ,&nbsp;Alex Thabane MSc ,&nbsp;Keean Nanji MD ,&nbsp;Phillip Staibano MD, MSc ,&nbsp;Lily J. Park MD, MSc ,&nbsp;Aristithes Doumouras MD, MPH ,&nbsp;Cagla Eskicioglu MD, MSc ,&nbsp;Lehana Thabane PhD ,&nbsp;Sameer Parpia PhD ,&nbsp;Mohit Bhandari MD, PhD","doi":"10.1016/j.jss.2024.12.019","DOIUrl":"10.1016/j.jss.2024.12.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Spin reporting has been studied across a variety of study types and domains; however, it has yet to be studied in the context of pilot and feasibility trials. We designed this methodological survey to evaluate spin reporting in surgical pilot and feasibility trials.</div></div><div><h3>Methods</h3><div>Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from January 1, 2011, to December 31, 2011, and January 1, 2021, to December 31, 2021. Studies were included if they were pilot or feasibility randomized trials evaluating a surgical intervention. The primary objective was to determine the proportion of pilot and feasibility trials utilizing spin reporting defined as primary focus on efficacy as opposed to feasibility, focus on statistically significant findings as opposed to feasibility, and/or presentation of results as feasible despite not actually being feasible. Secondary objectives included determining the type of spin reporting and exploring the association between study characteristics and spin reporting.</div></div><div><h3>Results</h3><div>After screening 1991 citations, 38 studies from 2011 to 34 studies from 2021 were included. Overall, 59 of the included pilot and feasibility trials (81.9%: 59/72, 95% confidence interval [CI] 71.4-89.3%) utilized spin reporting. Fifty-eight trials (80.6%, 95% CI 69.8-88.2%) primarily focused on efficacy as opposed to feasibility, 34 trials (47.2%, 95% CI 36.1-58.6%) focused on statistically significant findings as opposed to feasibility, and four trials (5.6%, 95% CI 1.8-13.8%) suggested feasibility objectives were met when they were not. Spin was identified in 94.7% (95% CI 81.8-99.5%) and 67.6% (95% CI 50.7-81.0%) of studies published in 2011 and 2021, respectively.</div></div><div><h3>Conclusions</h3><div>Most pilot and feasibility trials in surgery inappropriately focus on clinical outcomes and statistical significance as opposed to feasibility outcomes for the main future trial. This practice is concerning given that pilot trials are not adequately powered and are intended to serve as exploratory study to increase the likelihood of a successful definitive trial.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 16-25"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics Associated With Early Ileocolonic Resection in Pediatric Crohn's Disease","authors":"Jessica L. Mueller MD ,&nbsp;Amy J. Kaplan BA ,&nbsp;Jess L. Kaplan MD ,&nbsp;Cornelia L. Griggs MD","doi":"10.1016/j.jss.2024.11.041","DOIUrl":"10.1016/j.jss.2024.11.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric-onset Crohn's disease (CD) has a more severe phenotype than adult-onset, and nearly one-third of pediatric CD patients will require surgical therapy. There is limited data on patient/disease characteristics that are associated with earlier surgical management.</div></div><div><h3>Methods</h3><div>All pediatric CD patients (&lt;22 yrs) who underwent ileocolectomy from 2005 to 2021 were included. Unadjusted analyses were performed with Pearson <em>chi-</em>squared tests for categorical dependent variables, and <em>t</em>-tests, or analysis of variance, for numerical dependent variables.</div></div><div><h3>Results</h3><div>One hundred thirty-five pediatric CD patients underwent ileocolectomy. The median time to surgery was 3.75 yrs. Patients treated with early surgery (&lt;3.75 yrs from diagnosis) were older at diagnosis (16.5 <em>versus</em> 11.6 yrs, <em>P</em> &lt; 0.001) yet had surgery at a younger age (16.8 <em>versus</em> 18.9 yrs, <em>P</em> &lt; 0.001). They also were prescribed fewer CD medications (2.0 <em>versus</em> 4.0, <em>P</em> &lt; 0.001), were less likely to have trialed multiple biologics (25.6% <em>versus</em> 54.2%, <em>P</em> = 0.001), had a shorter time from diagnosis to biologic (0.3 <em>versus</em> 3.5 yrs, <em>P</em> &lt; 0.001), and had a shorter interval from biologic to surgery (0.4 <em>versus</em> 2.5 yrs, <em>P</em> &lt; 0.001). Abscess formation was a more common indication for early surgery (39.4% <em>versus</em> 14.7%, <em>P</em> = 0.002), whereas failure to thrive/refractory pain was more common for later surgery (27.3% <em>versus</em> 55.9%, <em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Surgical therapy remains an important component of the overall management of pediatric CD. In our cohort, earlier surgical management was associated with earlier use of biologics, a shorter duration between biologic and surgery, and decreased number of overall medications and biologic agents prior to surgery, suggesting a severe disease phenotype refractory to medical management.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 94-100"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927263","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":"Impact of Locum Tenens Providers on Delivery of Pediatric Surgical Care","authors":"Lindsey L. Wolf MD, MPH ,&nbsp;David E. Skarda MD, MBA ,&nbsp;Jason C. Fisher MD ,&nbsp;Scott S. Short MD ,&nbsp;Romeo C. Ignacio MD ,&nbsp;Hau D. Le MD ,&nbsp;Kyle J. Van Arendonk MD, PhD ,&nbsp;Kenneth W. Gow MD, MHA ,&nbsp;Richard D. Glick MD ,&nbsp;Yigit S. Guner MD, MS ,&nbsp;Hira Ahmad MD ,&nbsp;Melissa E. Danko MD ,&nbsp;Cynthia Downard MD, MMSc ,&nbsp;Mehul V. Raval MD, MS ,&nbsp;Daniel J. Robertson MD ,&nbsp;Richard G. Weiss MD ,&nbsp;Barrie S. Rich MD ,&nbsp;American Association of Pediatrics Section on Surgery Delivery of Surgical Care Committee","doi":"10.1016/j.jss.2024.12.014","DOIUrl":"10.1016/j.jss.2024.12.014","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to understand the impact of <em>locum tenens</em> surgeons on pediatric surgical care delivery.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of Children’s Hospital Association pediatric surgical practices. Anonymous electronic surveys were used to investigate <em>locum tenens</em> utilization, primary reason for use, limitations on clinical activities, and variations in practice standards or quality. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between practice characteristics and <em>locum tenens</em> use.</div></div><div><h3>Results</h3><div>Of 172 practices, 71% (<em>n</em> = 122) completed the survey. Median hospital size was 203 beds (interquartile range = 130-350). Median number of surgeons per practice was 5 (interquartile range = 3-8). Thirty-seven practices (30%) employed <em>locum tenens</em> at primary (<em>n</em> = 27) or satellite (<em>n</em> = 12) sites. <em>Locum tenens</em> utilization was higher in suburban (odds ratio [OR] = 3.78, <em>P</em> = 0.006) and rural (OR = 4.96, <em>P</em> = 0.041) locations and lower at sites with a level 4 neonatal intensive care unit (OR = 0.35, <em>P</em> = 0.035). Most (51%) used <em>locum tenens</em> ≥ 1 time monthly but &lt; 1 time weekly and for ongoing or interim coverage (87%). In total, 14% of practices reported clinical restrictions for <em>locum tenens</em> surgeons, including limitations on extracorporeal membrane oxygenation, neonatal index cases, and operative trauma. Most (76%) practices using <em>locum tenens</em> reported variations in practice standards or quality; all were perceived as negative (57%) or neutral (43%).</div></div><div><h3>Conclusions</h3><div><em>Locum tenens</em> providers are utilized most commonly in suburban and rural sites and hospitals without the highest level of neonatal intensive care. While <em>locum tenens</em> surgeons may help maintain access to pediatric surgical care where gaps exist, there may be a need to improve the quality and reliability of care rendered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 137-143"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950690","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":"Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls","authors":"Brianna L. Collie MD,&nbsp;Luciana Tito Bustillos MD,&nbsp;Shane L. Collins BA,&nbsp;Nicole B. Lyons MD,&nbsp;Walter A. Ramsey MD,&nbsp;Christopher F. O'Neil MD,&nbsp;Joyce I. Kaufman MD,&nbsp;Jonathan P. Meizoso MD, MSPH,&nbsp;Kenneth G. Proctor PhD,&nbsp;Nicholas Namias MD, MBA","doi":"10.1016/j.jss.2024.12.016","DOIUrl":"10.1016/j.jss.2024.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.</div></div><div><h3>Materials and methods</h3><div>Patients of age &gt;65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation &gt;48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score &lt; 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.</div></div><div><h3>Conclusions</h3><div>In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 182-187"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965422","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":"Clinical and Demographic Factors Associated Suicide Risk in Patients With Colorectal Cancer","authors":"Annmarie Butare DO ,&nbsp;M. Drew Honaker MD ,&nbsp;Sydney Taylor BS ,&nbsp;Rebecca A. Snyder MD, MPH ,&nbsp;Alexander A. Parikh MD, MPH","doi":"10.1016/j.jss.2024.12.026","DOIUrl":"10.1016/j.jss.2024.12.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Mental health is adversely affected by a cancer diagnosis. As the incidence of colorectal cancer (CRC) is on the rise, data regarding mental health and suicide among CRC patients is lacking. The primary aim of this study is to investigate the incidence of suicide among CRC patients in comparison to the general population. The secondary aim is to identify factors that are associated with increased risk of suicide among patients with CRC.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted utilizing the Surveillance, Epidemiology, and End Results Program database from 2000 to 2018. Standardized Mortality Ratios (SMRs) were calculated for 5-y age groups. Cox's cause-specific hazards model was utilized to compare covariates that increased the risk of suicide.</div></div><div><h3>Results</h3><div>A total of 530,711 patients were included. 289,363 (54%) were male. Overall, there were 782 (0.15%) suicides, of which 687 (88%) occurred in males. The SMR due to suicide was significantly higher in males (SMR 1.60, 95% confidence interval [CI] 1.481-1.722; <em>P</em> &lt; 0.001) including ages 35-49 ys and over 60 ys, however, not in females (SMR 1.12, 95% CI 0.91-1.375; <em>P</em> = 0.276). Factors independently associated with increased suicide risk included distant disease (hazard ratio [HR] 2.57; CI 1.96, 3.39; <em>P</em>=&lt;0.0001), radiation (HR 1.45; CI 1.16, 1.80; <em>P</em> = 0.0009), and increased age (HR 1.05 per 5-y increase; CI 1.02, 1.09; <em>P</em> = 0.0013). Factors associated with decreased risk of suicide included non-Hispanic Black race (HR 0.27; CI 0.18, 0.41; <em>P</em>= &lt;0.0001), Hispanic race (HR 0.31; 95% CI 0.21, 0.45; <em>P</em>=&lt;0.0001), being married (HR 0.56; CI 0.49, 0.65; <em>P</em>=&lt;0.0001), living in metropolitan area (HR 0.74; CI 0.61, 0.90; <em>P</em> = 0.003), and receiving chemotherapy (HR 0.71; CI 0.58, 0.86; <em>P</em> = 0.0001).</div></div><div><h3>Conclusions</h3><div>Male colorectal patients aged 35-49 ys and over 60 ys are at a higher risk of suicide than the general United States population. Understanding factors that increase a patient's risk for suicide will be important to develop strategies to mitigate this risk and improve overall mental health.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 217-223"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971264","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 Between Blood Type and Mortality Among Severely Injured Patients Enrolled in the Pragmatic Randomized Optimal Platelet and Plasma Ratios Trial","authors":"Emily W. Baird MD, MA ,&nbsp;Daniel T. Lammers MD ,&nbsp;Peter J. Abraham MD ,&nbsp;Zain G. Hashmi MBBS ,&nbsp;Russell L. Griffin PhD ,&nbsp;Shannon W. Stephens EMTP, CCEMTP ,&nbsp;Jessica C. Cardenas PhD ,&nbsp;Jillian R. Richter PhD ,&nbsp;Jan O. Jansen MBBS, PhD ,&nbsp;John B. Holcomb MD","doi":"10.1016/j.jss.2024.12.030","DOIUrl":"10.1016/j.jss.2024.12.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Previous studies suggested that type O blood may be associated with increased mortality and/or thrombotic complications among trauma patients. The purpose of this analysis was to evaluate the relationship between endogenous blood type, mortality, and complications among patients receiving massive transfusions, using data from the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial.</div></div><div><h3>Materials and Methods</h3><div>This was a secondary analysis of the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial that included patients with the reported blood type (A, AB, B, or O) data. Outcomes were early and late mortality and clinical complications. Endogenous von Willebrand Factor (vWF) antigen levels, vWF activity, and factor VIII levels were measured with admission labs and compared. Logistical regression was used to assess associations between mortality and blood type.</div></div><div><h3>Results</h3><div>Among 680 patients, 655 who had admission blood type data were included. 322 (49.2%) were type O, 186 (28.4%) were type A, 27 (4.1%) were type AB, and 120 (18.3%) were type B. The mean age, gender distribution, mechanism of injury, injury severity, and injury patterns were similar between blood types. There were significant racial and ethnic differences (<em>P</em> &lt; 0.001 and <em>P</em> &lt; 0.0018, respectively), and patients with endogenous type O blood had decreased levels of vWF activity and vWF antigen (<em>P</em> = 0.022 and <em>P</em> = 0.016, respectively). Logistical analyses showed no significant associations between blood type and complications, and type O blood was not associated with increased mortality.</div></div><div><h3>Conclusions</h3><div>We found that endogenous blood type was not associated with increased mortality or clinical complications in severely injured patients requiring massive transfusion based on the data from a large multicenter trial.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 283-289"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007373","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":"Standardized Note Template Expedites Completion of Consults for Surgical Fetal Anomalies","authors":"Michael B. Gyimah MD, MS ,&nbsp;Sarah Peiffer MD, MPH ,&nbsp;Shannon M. Larabee MD ,&nbsp;Timothy C. Lee MD ,&nbsp;Sundeep G. Keswani MD ,&nbsp;Alice King MD","doi":"10.1016/j.jss.2024.11.048","DOIUrl":"10.1016/j.jss.2024.11.048","url":null,"abstract":"<div><h3>Introduction</h3><div>We developed standardized electronic medical record templates (EMR-temp) for use in ambulatory prenatal surgical consultations for surgical fetal anomalies (SFAs). Our aim was to evaluate EMR-temp impact in provider documentation in prenatal care of SFA.</div></div><div><h3>Methods</h3><div>Prenatal consultations for SFAs at a single institution were retrospectively reviewed (2019-2022). Disease-specific EMR-templates were developed. Note content and time to encounter closure (TEC) were collected. Descriptive statistics, chi-square, Fisher’s Exact Test, and Wilcoxon rank sum tests were used.</div></div><div><h3>Results</h3><div>Seven hundred twenty-four prenatal consultations were analyzed, with 131 consultations (18%) using EMR-temp for 55 (42%) congenital diaphragmatic hernia, 50 (38%) congenital lung malformations, 9 (7%) neural tube defects, 8 (6%) gastroschisis, and 9 (7%) heterotaxy. Overall median TEC was 23.9 hs [interquartile range (IQR) 1.3-128.6]. EMR-temp use decreases TEC from 28.4 hs [IQR 1.6-159.4] to 2.07 hs [IQR 0.85-76.2] (<em>P</em> &lt; 0.001). The impact of EMR-temp varies depending on pathology. In congenital diaphragmatic hernia, EMR-temp decreased TEC 61%, from 52.0 [IQR 2.6-171.1] to 20.3 hs [IQR 1.5-55.5] (<em>P</em> = 0.01). In neural tube defect, EMR-temp decreased TEC 98% from 48.6 [IQR 2.6-157.1] to 1.02 hs [IQR 0.5-1.5] (<em>P</em> &lt; 0.001). There were no differences in TEC with EMR-temp use in congenital lung malformation, gastroschisis and heterotaxy (<em>P</em> &gt; 0.05). Across all diseases, EMR-temp had more comprehensive documentation of the following content: pathophysiology (92%), pregnancy planning (92%), delivery planning (84%), postnatal planning (95%), and long-term follow-up (90%) compared to nontemplates (<em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>EMR templates in SFA consultations improves encounter closure with comprehensive documentation of disease-specific pathophysiology and plans. However, impact varies across pathology, suggesting other factors are also important.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 299-305"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007375","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":"The Gender Disparity in Operative Opportunities for Trainee Surgeons: A Review","authors":"Sherri Xu MD, BBmed ,&nbsp;Heidi McAlpine MBBS, BSc (Hons) ,&nbsp;Katharine Jann Drummond MBBS, MD, Grad Dip Theol, FRACS","doi":"10.1016/j.jss.2024.12.004","DOIUrl":"10.1016/j.jss.2024.12.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Assessing gender disparity in surgical trainees’ operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included.</div></div><div><h3>Results</h3><div>Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women.</div></div><div><h3>Conclusions</h3><div>A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 327-335"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023904","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}