Journal of Surgical Research最新文献

{"title":"Benchmarking Ensemble Models to Predict Prolonged Hospital Stay in Traumatic Brain Injury: A Single-Institution Study","authors":"Shrinit Babel BS ,&nbsp;Jade Vanderpool BS ,&nbsp;Maurice Inkel MD ,&nbsp;Sandra M. Farach MD ,&nbsp;Jose J. Diaz MD ,&nbsp;Milad Behbahaninia MD","doi":"10.1016/j.jss.2025.05.014","DOIUrl":"10.1016/j.jss.2025.05.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Prolonged length of stay (PLOS) in hospitals is a critical metric representing quality and efficiency of care, especially for patients with traumatic brain injury (TBI). Machine learning offers the potential to predict PLOS, although class imbalance, limited sample size, or lack of generalizability impact their real-world application. This study benchmarks machine learning models from prior studies and explores ensemble models to predict PLOS in TBI patients and address domain adaptation concerns in surgical settings.</div></div><div><h3>Methods</h3><div>An anonymized dataset of 263 adult TBI patients admitted to a single level 1 trauma intensive care unit was used. Nine features were used across basic demographic, clinical, and procedure status variables. Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), and Artificial Neural Network (ANN) machine learning algorithms were used, with hyperparameters optimized using GridSearchCV. The SA2DELA framework was used to build ensemble models. Performance metrics were analyzed holistically using a critical difference diagram and post hoc analyses.</div></div><div><h3>Results</h3><div>The ensemble models combining XGBoost, ANN, and SVM, as well as XGBoost with a snapshot ANN, outperformed the base models (are under the curve: 0.87, critical difference rank: 2.3, Conover post hoc <em>P</em> &lt; 0.05). Bias–variance–diversity decomposition highlighted the complementary strengths of XGBoost and ANN, whereas SVM added incremental improvements. Feature importance identified age, body mass index, and injury severity score as predictors of PLOS.</div></div><div><h3>Conclusions</h3><div>This study is the first to benchmark established machine learning models and implement ensemble techniques for predicting PLOS in TBI patients. Combining complementary algorithms in a standardized framework can improve robustness in data-constrained and diverse settings. Future studies should incorporate multiclass or regression models and use stronger domain adaptation analyses.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 244-251"},"PeriodicalIF":1.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563377","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":"Who Gets Referred? Disparities in Access to Specialist Care for Hyperparathyroidism","authors":"John P. O'Connor BS ,&nbsp;Rebecca Sippel MD ,&nbsp;Courtney Balentine MD, MPH ,&nbsp;Lily Stalter MS ,&nbsp;Amy Kind MD, PhD ,&nbsp;Alexander Chiu MD, MPH","doi":"10.1016/j.jss.2025.05.025","DOIUrl":"10.1016/j.jss.2025.05.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary hyperparathyroidism (PHPT) is associated with significant patient morbidity, including increased risk of fractures, nephrolithiasis, and cardiovascular events. Parathyroidectomy remains an underutilized therapy, particularly among historically disadvantaged populations. We sought to better understand the association social determinants, as measured by neighborhood advantage, have on particular steps of the diagnostic and treatment pathway for PHPT to better identify targets for intervention.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of all patients ≥18 y of age with an elevated calcium value (&gt;10.2 mg/dL), and without a prior diagnosis of PHPT, secondary or tertiary hyperparathyroidism, or kidney failure, between January 1, 2021 and January 1, 2023. Patients’ neighborhood advantage was stratified using the Area Deprivation Index to create three cohorts—disadvantaged, moderate, advantaged. The rates of repeat calcium check, parathyroid hormone (PTH) evaluation, specialist referral, and parathyroidectomy were compared.</div></div><div><h3>Results</h3><div>A total of 6749 patients with hypercalcemia were identified, and 3976 (58.9%) met inclusion criteria. Repeat calcium was checked for 3646 (91.7%) of patients, and PTH checked in only 872 patients (57.5% of patients with repeat hypercalcemia). There was no difference in repeat calcium (<em>P</em> = 0.53) or PTH evaluation (<em>P</em> = 0.18) by neighborhood advantage. Significant differences were noted in rate of specialist evaluation (74.9% advantaged, 66.3% moderate, 59.8% disadvantaged, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Referral to specialist is the step that contributed most to disparities in treatment rates of PHPT. Interventions addressing both individual- and community-level barriers, particularly in the transition of care from primary care to specialists, are needed to increase access to parathyroidectomy and further health equity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 236-243"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517789","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":"Bridging the Learning Gap: Surgery Trainees Hone Vascular Trauma Skills via High-Fidelity Simulation","authors":"Nikita Chernetskii CMC ,&nbsp;Edward Chao MD ,&nbsp;Eric A. Grin MS ,&nbsp;Christopher Decker MD ,&nbsp;Michael J. Klein MD","doi":"10.1016/j.jss.2025.05.023","DOIUrl":"10.1016/j.jss.2025.05.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Advancing developments of endovascular approaches and subspecialty vascular care have significantly diminished general surgery residents' exposure to essential vascular techniques in trauma. This has led to a deficiency in preparedness among residency graduates in handling basic vascular emergencies. The Open Surgical Simulation System (OS3) is a high-fidelity trauma surgery model that allows for skill acquisition through hands-on practice.</div></div><div><h3>Methods</h3><div>We evaluated the effect of a new OS3 surgical skills curriculum on residents' self-assessed knowledge, technical skills, and confidence using precourse and postcourse surveys with 5-point Likert scales. Procedures performed included resuscitative thoracotomy, exploratory laparotomy, splenectomy, liver trauma management, small bowel resection, and retroperitoneal exploration. Determinants of skill self-assessments, perceived challenges, and course utility for skill acquisition were analyzed using linear regression modeling.</div></div><div><h3>Results</h3><div>One hundred eighty-three trainees completed the simulation and surveys. Each increasing postgraduate year level above 2 was associated with increases in self-assessment of knowledge, skills, and experience (<em>P</em> &lt; 0.001); prior Advanced Trauma Operative Management and Advanced Surgical Skills for Exposure in Trauma course participation was not. Vascular shunt insertion, aortic crossclamp, and vascular anastomosis consistently ranked among the most challenging procedures regardless of training levels. Overall, the OS3 simulation significantly increased trainees’ confidence in performing resuscitative thoracotomy, exploratory laparotomy, splenectomy, liver trauma management, retroperitoneal exploration, and small bowel resection (<em>P</em> &lt; 0.02).</div></div><div><h3>Conclusions</h3><div>When self-assessing technical skills in trauma, almost half of surveyed general surgery trainees describe significant difficulty with essential vascular procedures such as shunting and aortic crossclamping. The OS3 may allow for consistent and readily reproducible training in these and other procedures to alleviate this confidence gap.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 214-220"},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517790","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":"Increased Associated Risk of Surgical Site Infections in Trauma Patients Who Are Smokers","authors":"Carlin Lee MD,&nbsp;Areg Grigorian MD,&nbsp;Raven Rutledge BS,&nbsp;Matthew Dolich MD,&nbsp;Michael E. Lekawa MD,&nbsp;Negaar Aryan MD,&nbsp;Cristobal Barrios MD,&nbsp;Jeffry Nahmias MD, MHPE","doi":"10.1016/j.jss.2025.05.024","DOIUrl":"10.1016/j.jss.2025.05.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Smoking has been shown to increase the risk of surgical site infection (SSI) in elective surgery. This study aimed to determine the association between smoking and SSI in trauma patients (TPs), hypothesizing that TPs who are smokers have an increased associated risk of SSI compared to nonsmokers.</div></div><div><h3>Methods</h3><div>The Trauma Quality Improvement Program database (2017-2022) was queried for adults (age ≥ 18 y) undergoing any surgery related to trauma. Patients with length of stay &lt; 48 h were excluded. The primary outcome was SSI. In addition to bivariate analyses, multivariable logistic regression analyses were performed to assess the associated risk of SSI in smokers <em>versus</em> nonsmokers, as well as planned subgroup analyses in patients with severe trauma (injury severity score (ISS) ≥16 and ≥ 25).</div></div><div><h3>Results</h3><div>Of 1,043,112 TPs, 254,017 (24.3%) were smokers. Compared to nonsmokers, smokers were younger (42 <em>versus</em> 53 y old, <em>P</em> &lt; 0.001) and had higher rates of SSIs (0.9% <em>versus</em> 0.7%, <em>P</em> &lt; 0.001). This was consistent in patients with ISS ≥16 (1.7% <em>versus</em> 1.4%, <em>P</em> &lt; 0.001) and ISS ≥25 (2.0% <em>versus</em> 1.6%, <em>P</em> &lt; 0.001). An increased associated risk for smokers persisted in multivariable analyses after controlling for age and steroid use in all patients (Odds ratio (OR) 1.15, 1.09-1.20 <em>P</em> &lt; 0.001), as well as TPs with ISS ≥16 (OR 1.19, 1.12-1.26, <em>P</em> &lt; 0.001) and ISS ≥25 (OR 1.19, 1.10-1.29, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Nearly a quarter of TPs were smokers, and these patients had an increased rate and associated risk of SSI. Interestingly, smoking was more strongly associated with SSI in patients suffering severe trauma. Given the urgent nature of trauma operations, patients should be counseled appropriately regarding their increased associated risk of SSI, and more research is required to determine if any preventative public health measures or perioperative interventions can mitigate the increased risk of SSI in this high-risk population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 221-226"},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517791","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 Perspectives About the Informed Consent Conversation for Laparoscopic Cholecystectomy","authors":"Stephanie M. Cohen MD ,&nbsp;Holly Bernard MD, MS ,&nbsp;Eduardo A. Vega MD ,&nbsp;Tovy H. Kamine MD, MBA ,&nbsp;Tara Kent MD","doi":"10.1016/j.jss.2025.05.020","DOIUrl":"10.1016/j.jss.2025.05.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Cholecystectomy is one of the most common operations performed. However, there is no consensus regarding the baseline level of detail to be communicated to patients to constitute truly informed consent. The purpose of this study is to compare attending to resident perspectives of the details deemed essential to the informed consent conversation surrounding laparoscopic cholecystectomy.</div></div><div><h3>Methods</h3><div>Attending surgeons performing laparoscopic cholecystectomies (<em>n</em> = 60) and general surgery residents (<em>n</em> = 105) from three institutions were invited to participate in this study. An electronic survey was distributed to all surgeons assessing the background knowledge, risks, benefits, alternative options, and postoperative expectations that surgeons believe should be routinely communicated to patients undergoing laparoscopic cholecystectomy for gallstone disease.</div></div><div><h3>Results</h3><div>Response rates were 57.4% and 38.1% for attending surgeons and residents, respectively. There were no differences of opinions regarding discussing the risks of bleeding, infection, bile leak, retained stones, bowel injury, potential need for intraoperative cholangiogram, or conversion to an open operation. Seventy-four percent of attendings reported that the potential need for postoperative endoscopic retrograde cholangiopancreatography should be discussed compared to 37.5% of residents (<em>P</em> = 0.001). All attending surgeons believe biliary tree injury should be communicated as a surgical risk compared to 85% of residents (<em>P</em> = 0.017).</div></div><div><h3>Conclusions</h3><div>This study identifies gaps in resident understanding of what is essential to communicate to patients prior to cholecystectomy compared to experienced surgeons. These results suggest areas for improvement in resident comprehension of the importance of discussing the risk of bile duct injury and in the role of endoscopic retrograde cholangiopancreatography for patients with benign biliary disease. The findings of this study advocate for structured and deliberate training programs focused on the informed consent process.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 196-203"},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514093","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":"Surgical Refinement in Porcine Renal Autotransplantation – Flattening the Learning Curve in an Established Training Program","authors":"Decan Jiang MD ,&nbsp;Lisa Ernst DVM, PhD ,&nbsp;Wenjia Liu MD ,&nbsp;Mareike Schulz BSc ,&nbsp;Fabiola Bechtiger MD ,&nbsp;Aghnia J. Putri MD ,&nbsp;Georg Lurje MD ,&nbsp;Rene H. Tolba MD ,&nbsp;Zoltan Czigany MD, PhD","doi":"10.1016/j.jss.2025.05.013","DOIUrl":"10.1016/j.jss.2025.05.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Complex animal models, such as the porcine renal autotransplantation (pRaTx) model, provide an excellent platform for translational research. The pRaTx model is challenging, offering many possibilities to refine surgical procedures and optimize learning curves and outcomes. In this study, we described the critical initial steps toward flattening the learning curve in pRaTx.</div></div><div><h3>Methods</h3><div>We performed 51 consecutive cases of pRaTx in German landrace pigs divided between two teams, based on the experience level of the lead surgeon. Duration of all surgical steps, graft and recipient outcomes were monitored and specific pitfalls and possible refinement approaches were pointed out.</div></div><div><h3>Results</h3><div>Significant (<em>P</em> &lt; 0.05) differences were observed between team-1/2 concerning warm-ischemia (28.0(24.0-34.5) <em>versus</em> 40.0(34.5-47.0) min) and anastomosis times (27.0(22.0-33.0) <em>versus</em> 38.0(33.0-44.0) min). Consequently, retention parameters were higher in the animals of team-2. Nevertheless, these differences did not manifest in “hard” clinical outcomes, such as vascular complications, survival. About 10 cases were required in both teams for a stable surgical performance.</div></div><div><h3>Conclusions</h3><div>As machine perfusion approaches and xenotransplantation are increasing in the spotlight of clinical interest, setting up a reliable and reproducible model for pRaTx is critical for translational research. As we could show, the pRaTx model requires an optimized team approach to refine the procedure.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 185-195"},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514092","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":"Factors Influencing End-of-Life Decisions in Cancer Patients After Traumatic Injuries","authors":"Priya Pathak MBBS, MPH ,&nbsp;Jonathan Laredo BS ,&nbsp;Sonal Swain MBA ,&nbsp;Benjamin Nguyen MD ,&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.2025.05.017","DOIUrl":"10.1016/j.jss.2025.05.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe traumatic injuries are frequently associated with poor outcomes, and withdrawal of life-sustaining treatment (WLST) after traumatic brain injury is common. However, the association between WLST and pre-existing cancer in all trauma patients remains underexplored.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed data from the American College of Surgery Trauma Quality Programs in 2022. Patients aged 18 y or older with information on pre-existing disseminated cancer and chemotherapy status at the time of trauma were included. Descriptive statistics and multiple logistic regression, combined with propensity score matching, were used to assess the association between WLST and pre-existing cancer after traumatic injury.</div></div><div><h3>Results</h3><div>A total of 936,410 patients met the study criteria. Of these, 3827 (0.4%) were undergoing chemotherapy without metastatic cancer, 1528 (0.2%) had metastatic cancer but were not receiving chemotherapy, while 5399 (0.6%) were on chemotherapy. Significant differences in patient demographics, injury characteristics, and outcomes were observed across these groups. After matching on age, sex, race and ethnicity, insurance, injury severity, region and type, advance directives (ADs), functional dependence, prehospital cardiac arrest, and initial Glasgow Coma Scale, the adjusted odds ratio for WLST was 2.02 (95% CI: 1.39-2.95) for patients with metastatic cancer not on chemotherapy and 2.47 (95% confidence interval [CI]: 1.78-3.42) for patients with metastatic cancer on chemotherapy, compared to patients without cancer. Severe injuries were associated with 2.83 times higher odds of WLST (95% CI: 2.42-3.71) compared to mild injuries. Patients with chest, abdominal, and extremity injuries had lower odds of WLST compared to head and neck injuries. The presence of ADs limiting care was strongly associated with WLST (adjusted odds ratio: 3.62, 95% CI: 2.91-4.51).</div></div><div><h3>Conclusions</h3><div>Patients with metastatic cancer, regardless of chemotherapy status, had up to three times higher odds of WLST after traumatic injury. The presence of ADs was also strongly linked to increased WLST, emphasizing the importance of patient preferences and personalized care approaches in end-of-life decisions for cancer patients in trauma settings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 227-235"},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517792","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 Relation Between the Prognostic Nutritional Index and 30-d Mortality in Patients With Acute Respiratory Distress Syndrome: A Retrospective Study Based on the MIMIC-IV Database","authors":"Mao Wang MM ,&nbsp;Weixia Li BS ,&nbsp;Haiyan Xu BS ,&nbsp;Bo Li MM ,&nbsp;Li He BS ,&nbsp;Hanbing Zhang BS","doi":"10.1016/j.jss.2025.05.021","DOIUrl":"10.1016/j.jss.2025.05.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute respiratory distress syndrome (ARDS) has a high mortality rate. The prognostic nutritional index (PNI), as a comprehensive indicator of nutritional and immune status, has shown prognostic value in various diseases, however, its role in predicting prognosis in ARDS remains uncertain.</div></div><div><h3>Materials and methods</h3><div>This study is a retrospective study based on data from the Medical Information Mart for Intensive Care IV database. This study enrolled 2829 patients with ARDS. Kaplan–Meier survival curve and Cox proportional hazard model were applied to analyze the association between PNI and 30-d mortality in patients with ARDS according to the tertiles of PNI. Through subgroup analysis and interaction testing, further exploration was undertaken to illuminate the influence conferred by PNI on prognosis across different populations.</div></div><div><h3>Results</h3><div>The 30-d mortality rate for ARDS patients was 26.5%. The Kaplan–Meier survival curve revealed that higher PNI indicated higher survival probability. After adjustment for all confounding factors, PNI was significantly inversely associated with 30-d mortality in patients with ARDS (hazard ratio = 0.981, 95% confidence interval: 0.969-0.993). Subgroup analysis indicated that the negative correlation between PNI and 30-d mortality was more pronounced in males, married individuals, and those without comorbidity. In addition, PNI interacted significantly with cerebrovascular diseases, suggesting that the presence of cerebrovascular diseases may weaken the predictive efficacy of PNI.</div></div><div><h3>Conclusions</h3><div>PNI is an effective predictor of 30-d mortality for ARDS patients, with a higher PNI being linked with improved survival rates.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 204-213"},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517793","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":"When Is Old NOT Gold? Identifying Global Age Risk Surgical Thresholds to Improve Outcomes","authors":"Komal Abdul Rahim BScN, MSc ,&nbsp;Kinzah Razzak Ghazi MBBS ,&nbsp;Kantesh Kumar MBBS ,&nbsp;Aiman Arif MBBS ,&nbsp;Saad Bin Zafar Mahmood MBBS, FCPS ,&nbsp;Saqib Kamran Bakhshi MBBS, FCPS ,&nbsp;Hasnain Zafar MBBS, FRCS ,&nbsp;Adil Hussain Haider MD, MPH, FACS","doi":"10.1016/j.jss.2025.05.015","DOIUrl":"10.1016/j.jss.2025.05.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Patient age has been shown to influence health-care outcomes; however, there is limited evidence on the optimal cutoff where age increases the risk of adverse outcomes. This study aims to identify the age at which patients undergoing surgery in Pakistan can be classified as high-risk using the modified frailty index which can help in preoperative risk stratification, optimizing surgical outcomes, and guiding clinical decision-making.</div></div><div><h3>Methods</h3><div>American College of Surgeons National Surgical Quality Improvement Program data of adult patients undergoing major elective surgeries from 2019 to 2022 were used. High-risk patients were identified using the modified frailty index tool with a score of 2 and above. A receiver-operator curve (ROC) was used to determine the optimal age threshold for high-risk patients. Cox proportional regression identified hazard ratios for low and high-risk patients.</div></div><div><h3>Results</h3><div>A total of 10,060 surgical patients were identified. The optimal age threshold was 52.595 years (sensitivity: 79%, specificity: 72%, area under the curve 0.72). An age of 52.595 years and above was the high-risk group. The postoperative mortality was twice in the high-risk group compared to the low-risk group (2.95% &amp; 1.11%; <em>P</em> value&lt;0.001). All postoperative complications were higher in the high-risk compared to the low-risk group (27.01% &amp; 19.28%). Case acuity and postoperative cardiac complication were significantly associated with mortality in low- and high-risk group.</div></div><div><h3>Conclusions</h3><div>Our findings indicated that age was associated with adverse outcomes in surgical population. Determining this age threshold in low- and middle-income countries is crucial for improving surgical outcomes via targeted interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 177-184"},"PeriodicalIF":1.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502742","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 Total Body Surface Area and Body Part With Mental Health Outcomes in Pediatric Burn Patients","authors":"Jazzalyn Zou BSA ,&nbsp;Jaclyn Dempsey MD ,&nbsp;Rahul Venna BSA ,&nbsp;Sonia Patel BSA ,&nbsp;Briana Syed BS ,&nbsp;Hoang Nguyen PhD ,&nbsp;Oscar Suman PhD ,&nbsp;Steven Wolf MD ,&nbsp;Bindi Naik-Mathuria MD, MPH, FACS, FAAP","doi":"10.1016/j.jss.2025.05.018","DOIUrl":"10.1016/j.jss.2025.05.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Burn injuries in children are associated with negative impacts on psychological and emotional well-being, yet specific risk indicators are not well researched. We hypothesize that children with greater total body surface area (TBSA) burned and burns in highly visible and functionally significant body parts are more likely to experience negative mental health outcomes compared to their counterparts.</div></div><div><h3>Materials and methods</h3><div>Database review of 178 pediatric burn patients (median age: 13 ± 2.99) utilizing the Burns Model System National Database, retrospectively collected data between 2010 and 2023. Patient-Reported Outcomes Measurement Information System surveys obtained at 6 mo, 1 y, and 2 y postburn were utilized to assess mental health factors (anxiety, depression, peer relationships, pain interference, fatigue, and physical function). Mental health status was defined using Patient-Reported Outcomes Measurement Information System cut-off points with T-scores. Data were stratified by TBSA quartiles and body part affected (arm, head/neck/face, trunk, perineum, hand, leg, foot). Associations with TBSA and body parts were analyzed with chi-squared calculations using Excel, and demographic data was analyzed using logistic regression using R Studio.</div></div><div><h3>Results</h3><div>At 1-y postburn, higher TBSA was associated with increased anxiety (<em>P</em> = 0.005), fatigue (<em>P</em> = 0.04), pain interference (<em>P</em> = 0.02), and poorer physical function (<em>P</em> = 0.003); however, there was no correlation with body part burned. By 2 y postburn, the difference in mental health outcomes by TBSA was no longer significant. Increased age was associated with a higher likelihood of depression (<em>P</em> = 0.002) and poorer peer relationships (<em>P</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>Children with greater TBSA burns or older age were associated with a higher likelihood of mental health consequences by 1 y postburn, regardless of which body part was affected. Understanding these relationships is essential for developing targeted interventions to support the psychological recovery of pediatric burn patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"312 ","pages":"Pages 94-103"},"PeriodicalIF":1.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491458","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}