Journal of Surgical Research最新文献

{"title":"Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery","authors":"Lisa P. Doshi MHS, DrPH ,&nbsp;Richard Nudotor MD, MPH ,&nbsp;Gina Lynn Adrales MD, MPH ,&nbsp;David Chin MD, MBA ,&nbsp;Matt Austin PhD, MS ,&nbsp;Conan Dickson PhD, MPH ,&nbsp;Lilly D. Engineer MD, DrPH, MHA","doi":"10.1016/j.jss.2024.09.082","DOIUrl":"10.1016/j.jss.2024.09.082","url":null,"abstract":"<div><h3>Introduction</h3><div>While the adoption of ERAS protocols in bariatric surgery has increased, variability exists across centers, reflecting a spectrum of implementation stages. The objective of this study is to understand and increase awareness of the effectiveness of enhanced recovery after surgery (ERAS) protocols in bariatric surgery, given the specific perioperative difficulties and risks for this population. We aimed to study the association between implementation of the ERAS program in bariatric surgery and specific outcomes.</div></div><div><h3>Methods</h3><div>Primary bariatric patients (≥18 y old) at a single academic institution were divided into pre-ERAS and post-ERAS groups. Poisson and quantile regressions were used to examine the association between the ERAS protocol and length of stay and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-d readmissions.</div></div><div><h3>Results</h3><div>A total of 680 procedures were performed in the pre-ERAS cohort, compared to 1124 procedures post-ERAS. The median length of hospital stay was shorter, and median cost of surgery was lower for post-ERAS patients compared to pre-ERAS patients by 1 d (<em>P</em> = 0.001) and $2000, respectively. A higher proportion of patients in the pre-ERAS period had one or more unplanned readmissions compared to the post-ERAS period (<em>P</em> &lt; 0.001). The ERAS protocol was associated with decreased length of stay (incidence rate ratio = 0.72, <em>P</em> &lt; 0.001), decreased median cost (−$2230, <em>P</em> &lt; 0.001), and lower risk of 30-d unplanned readmissions (odds ratio = 0.48, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>This study highlights the value of an enhanced recovery program in bariatric surgery, benefiting both patients and health systems.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 19-27"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564250","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":"Rodent Model of Cardiopulmonary Bypass Demonstrates Systemic Inflammation and NeuroMarker Changes","authors":"Aimee Zhang MD ,&nbsp;Nathan S. Haywood MD ,&nbsp;Dustin T. Money RRT-ACCS ,&nbsp;Matthew R. Byler MD, MBA ,&nbsp;Hari P. Osuru PhD ,&nbsp;Navya Atluri PhD ,&nbsp;Victor E. Laubach PhD ,&nbsp;J. Hunter Mehaffey MD, MSc ,&nbsp;Jennifer R. Charlton MD ,&nbsp;Nadia Lunardi MD, PhD ,&nbsp;Irving L. Kron MD ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.jss.2024.09.041","DOIUrl":"10.1016/j.jss.2024.09.041","url":null,"abstract":"<div><h3>Introduction</h3><div>The physiologic derangements imposed by cardiopulmonary bypass (CPB) can result in complications such as postoperative delirium. We aim to validate a rodent survival model of CPB demonstrating a systemic inflammatory response and hypothesize that this contributes to post-CPB delirium.</div></div><div><h3>Methods</h3><div>Adult Sprague–Dawley rats were randomized to three groups: 1) Sham peripheral surgical cannulation, 2) CPB followed by acute phase harvest, or 3) CPB followed by 24-h survival. CPB was carried out for 60 min before decannulation and weaning from mechanical ventilation. Physiological and biochemical endpoints were compared between groups. Gene expression analysis of hippocampal tissue was performed using quantitative RT-PCR panels and protein expression levels were confirmed with Western blot.</div></div><div><h3>Results</h3><div>Sixteen animals underwent cannulation and were successfully decannulated without transfusion requirement or inotrope use with one procedure-related mortality. Serum acute phase proinflammatory chemokines cytokine-induced neutrophil chemoattractant 1, cytokine-induced neutrophil chemoattractant 3, fractalkine, and lipopolysaccharide-induced CXC chemokine as well as interleukin (IL)-10 were increased 1 h following CPB compared to sham (<em>P</em> &lt; 0.05). Significant changes in hippocampal expression of biomarkers apolipoprotein 1, vascular epithelial growth factor A, and synapsin 1 were demonstrated following CPB.</div></div><div><h3>Conclusions</h3><div>This study validated a model of CPB that captures the resultant systemic inflammatory response, and identified differentially expressed proteins that may be associated with brain injury. Modulation of the CPB-induced inflammatory response may be a promising therapeutic target to attenuate post-CPB delirium, and this survival rat model of CPB with low surgical attrition will allow for more comprehensive evaluations of the short- and long-term effects of both CPB and potential therapeutic interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 780-787"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546105","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 Associated With Surgical Management in Gallbladder Cancer—A Surveillance, Epidemiology, and End Results Medicare–Based Study","authors":"Kelsey S. Romatoski MD ,&nbsp;Sophie H. Chung MD ,&nbsp;Veer Sawhney BA ,&nbsp;Marianna V. Papageorge MD, MPH ,&nbsp;Susanna W.L. de Geus MD, PhD ,&nbsp;Sing Chau Ng MS ,&nbsp;Kelly Kenzik MS, PhD ,&nbsp;Jennifer F. Tseng MD, MPH ,&nbsp;Teviah E. Sachs MD, MPH","doi":"10.1016/j.jss.2024.09.084","DOIUrl":"10.1016/j.jss.2024.09.084","url":null,"abstract":"<div><h3>Introduction</h3><div>Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.</div></div><div><h3>Materials and methods</h3><div>SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% <em>versus</em> 65.6%; <em>P</em> = 0.0104), ≥80 y old (48.2% <em>versus</em> 22.4%; <em>P</em> &lt; 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> &lt; 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> &lt; 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> &lt; 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> &lt; 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% <em>versus</em> 47.2%; <em>P</em> &lt; 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> &lt; 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 9-18"},"PeriodicalIF":1.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554640","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":"Antibiotic Prophylaxis and Spinal Infection After Gunshot Wounds to the Spine: A Retrospective Study","authors":"Jaclyn A. Gellings MD,&nbsp;Kathryn Haberman MD ,&nbsp;Abdul Hafiz Al Tannir MD,&nbsp;Thomas Carver MD,&nbsp;Jacob Peschman MD","doi":"10.1016/j.jss.2024.09.083","DOIUrl":"10.1016/j.jss.2024.09.083","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal and paraspinal infections (SPIs) are a potential complication following traumatic spinal column injury, and we sought to determine the association of antibiotic prophylaxis on SPI development following a spinal gunshot wound (GSW).</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed.</div></div><div><h3>Results</h3><div>A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% <em>versus</em> 23.1%, <em>P</em> &lt; 0.001), primarily colon injuries (55.6% <em>versus</em> 12.5%, <em>P</em> &lt; 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% <em>versus</em> 2%; <em>P</em> = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (<em>P</em> = 0.49).</div></div><div><h3>Conclusions</h3><div>Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 1-8"},"PeriodicalIF":1.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546108","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":"Resident Race and Operative Experience in General Surgery Residency: A Mixed-Methods Study","authors":"Nicole Panzica MD ,&nbsp;Alexander R. Cortez MD ,&nbsp;Chukwuma Eruchalu MD ,&nbsp;Kenneth Lynch PhD ,&nbsp;Andrea Gillis MD ,&nbsp;Brenessa Lindeman MD, MEHP ,&nbsp;Herbert Chen MD ,&nbsp;Jessica Fazendin MD ,&nbsp;Polina Zmijewski MD, MA","doi":"10.1016/j.jss.2024.09.049","DOIUrl":"10.1016/j.jss.2024.09.049","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent multi-institutional quantitative work has found that Black general surgery residents perform fewer operations during training. Further mixed-methods research exploring the reasons for this phenomenon is needed to address this inequity for residents who are underrepresented in medicine (URiM).</div></div><div><h3>Material and methods</h3><div>Data were collected through open response and Likert scale questions that were distributed electronically to residents at 21 accredited US general surgery programs within the US Resident Operative Experience Consortium. Questions focused on what barriers prevent residents from going to the operating room and potential solutions. Free text was analyzed by three qualitative reviewers.</div></div><div><h3>Results</h3><div>The online survey was completed by 96 general surgery residents representing a 12% overall response rate from the 21 US Resident Operative Experience Consortium programs. Eight (<em>n</em> = 8/13, 62%) of the URiM residents endorsed that they experienced barriers in obtaining case numbers compared to 13% of non-URiM residents (<em>P</em> &lt; 0.05). A similar proportion of both groups agreed that their quality of training was affected by their race or ethnicity (<em>n</em> = 6/13, 46% <em>versus n</em> = 34/49, 41%; <em>P</em> = 0.77). Floor work and clinical tasks were the most common qualitative themes regarding operative barriers (75 responses). Racial bias (<em>n</em> = 22) was frequently referenced as a barrier specifically experienced by URiM residents. Suggestions to improve the operative experience of URiM residents included increasing mentorship at the attending level (<em>n</em> = 25) and setting objective standards for resident operating room participation (<em>n</em> = 30).</div></div><div><h3>Conclusions</h3><div>Nearly five times as many URiM residents reported experiencing barriers in obtaining case numbers compared to non-URiM residents. Qualitative analysis suggests that clear expectations for resident participation in cases and increasing mentorship at the attending level may be ways to achieve parity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 756-760"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539642","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":"A Qualitative Study of Electronic Patient-Reported Outcome Symptom Monitoring After Thoracic Surgery","authors":"Alix Boisson-Walsh PhD ,&nbsp;Chase Cox MD, MS ,&nbsp;Meghan O'Leary PhD ,&nbsp;Sachita Shrestha MPH ,&nbsp;Philip Carr MPH ,&nbsp;Amanda L. Gentry MPH ,&nbsp;Lauren Hill PhD ,&nbsp;Bernice Newsome AGNP ,&nbsp;Jason Long MD, MPH ,&nbsp;Benjamin Haithcock MD ,&nbsp;Angela M. Stover PhD ,&nbsp;Ethan Basch MD, MSc ,&nbsp;Jennifer Leeman DrPH, MPH, MDiv ,&nbsp;Gita N. Mody MD, MPH, FACS","doi":"10.1016/j.jss.2024.09.051","DOIUrl":"10.1016/j.jss.2024.09.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital health systems can facilitate remote postoperative symptom management yet obstacles persist in their routine clinical adoption. This study aimed to identify patient-perceived barriers and facilitators to using an electronic patient-reported outcome (ePRO) monitoring platform specially designed to detect complications from thoracic surgery postdischarge.</div></div><div><h3>Methods</h3><div>Patients (<em>n</em> = 16) who underwent thoracic surgery and participated in an ePRO parent study completed semistructured interviews, which were analyzed using thematic content analysis and iterative team-based coding. Themes were mapped onto the three domains of the Capability, Opportunity, and Motivation Model of behavior framework to inform ePRO design and implementation improvements.</div></div><div><h3>Results</h3><div>Analysis demonstrated seven dominant themes, including barriers (1. postoperative patient physical and mental health, 2. lack of access to email and poor internet connectivity, 3. lack of clarity on ePRO use in routine clinical care, and 4. symptom item redundancy) as well as facilitators (5. ease of the ePRO assessment completion, 6. engagement with the surgical care team on ePRO use, and 7. increased awareness of symptom experience through ePRO use). Suggested ePRO improvements included offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient education on ePROs for perioperative care.</div></div><div><h3>Conclusions</h3><div>Addressable barriers and facilitators to implementation of ePRO symptom monitoring in the thoracic surgical patient population postdischarge have been identified. Future work will test the impact of design improvements on implementation outcomes of feasibility and acceptability.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 744-755"},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502689","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":"Human Capital and Productivity in Surgery Research Across the Globe: A Big Data Analysis Using Artificial Intelligence","authors":"Georgios Karamitros MD, MS ,&nbsp;Sofoklis Goulas PhD","doi":"10.1016/j.jss.2024.09.047","DOIUrl":"10.1016/j.jss.2024.09.047","url":null,"abstract":"<div><h3>Introduction</h3><div>No investigation of each nation's contribution to knowledge production and human capital in surgery currently exists. Previous studies explored country-level research productivity only in few surgical subspecialties. To identify current and future leaders in surgery research, we conduct a retrospective observational study of each country's human capital and research productivity.</div></div><div><h3>Methods</h3><div>A web-scraping algorithm was deployed on PubMed to retrieve information on the first and senior author of every publication in all PubMed-indexed surgery outlets—a total of 388 journals—between 2010 and 2022, according to the SCImago classification. Each country's human capital is proxied by the number of first and senior authors.</div></div><div><h3>Results</h3><div>A total of 665,668 publications from 110 countries were reviewed. The number of publications rises over time. The United States represents 30.78% and 31.32% of global publications based on first and senior authors, respectively. Other leading contributors include the United Kingdom (5.57% and 5.69% of global first and senior author publications, respectively), China (8.84% and 8.74%), Japan (7.14% and 7.10%), and Italy (4.54% and 4.46%). The number of publications per 100K people ranges between 0.04 and 86.01, suggesting widely varying levels of research productivity relative to the population.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the US dominance in surgery research. Countries with a higher share of first or senior authors may have greater capacity to expand their future research output. As big data research expands, we expect studies deploying artificial intelligence methodologies, such as web scraping, on data repositories to guide healthcare provision and health policy decisions to become mainstream.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 731-743"},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502709","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":"Intensive Care Unit Readmissions in a Level I Trauma Center.","authors":"Benjamin Moore, Kacee J Daniels, Blake Martinez, Kevin W Sexton, Kyle J Kalkwarf, Matthew Roberts, Stephen M Bowman, Hanna K Jensen","doi":"10.1016/j.jss.2024.09.074","DOIUrl":"https://doi.org/10.1016/j.jss.2024.09.074","url":null,"abstract":"<p><strong>Introduction: </strong>Intensive care unit (ICU) readmissions are associated with increased morbidity and mortality rates, longer hospitalization, and increased health-care expenditures. This study sought to present a large cohort of trauma patients readmitted to the ICU, characterizing risk factors and providing quality improvement strategies to limit ICU readmission.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on adult trauma patients admitted to the ICU at a single level I trauma center from 2014 to 2021. Patients were split into readmission and no readmission groups. Patients experiencing readmission were compared to a similar group that was not readmitted using descriptive statistics and logistic regression.</p><p><strong>Results: </strong>In this study, 3632 patients were included and 278 (7.7%) were readmitted to the ICU. Significant differences were found in age, Elixhauser Comorbidity score, number of days on a ventilator, and number of patients requiring ventilator support. Furthermore, logistic regression showed that increasing age and the Elixhauser Comorbidity Score were associated with an increased likelihood of ICU readmission. Over the study period, the ICU readmission rate increased while the ICU length decreased.</p><p><strong>Conclusions: </strong>Age, Elixhauser Comorbidity score, and ventilator use were all significant risk factors for ICU readmission. During our study period, a concerning trend of increasing ICU readmissions and decreased ICU length of stay was found. By identifying this trend, our institution was able to employ mitigation strategies that have successfully reversed the trend in ICU readmissions, decreasing the rate below the national average.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568809","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":"National Health Insurance Claim of Pediatric Appendectomy With Mandatory Diagnosis-Related Group Payment System in Korea","authors":"Yun Jung Lee BS ,&nbsp;Sanghoon Lee MD, PhD","doi":"10.1016/j.jss.2024.09.076","DOIUrl":"10.1016/j.jss.2024.09.076","url":null,"abstract":"<div><h3>Introduction</h3><div>Enforcement of diagnosis-related group system for appendectomy under the National Health Insurance Service has gradually widened and since July 2013 it has been enforced in all medical institutions in Korea. We have analyzed Health Insurance Review &amp; Assessment Service data to observe changes in claim patterns of pediatric appendectomy during this period.</div></div><div><h3>Methods</h3><div>All claims data for appendectomy of patients younger than 18 y from 2011 to 2015 were collected. We analyzed the following factors of all cases: age, gender, length of hospital stay, medical cost, method of insurance claim and region.</div></div><div><h3>Results</h3><div>A total of 112,143 claims were made for appendectomy during the study period. In that, 66,510 (59.3%) were boys and 45,633 (40.7%) were girls. Median length of stay was 5 d and median sum of reimbursement of each claim was 2,198,630 won. Annual number of claims for appendectomy showed a steady decline from 24,888 in 2011 to 19,070 in 2015. Median sum of reimbursement of each claim was 1,862,615, 1,975,500, 2,233,360, 2,376,700, and 2,468,000 won, respectively from 2011 to 2015. Reimbursement for complicated appendectomy increased from 4400 out of 24,888 cases (17.7%) in 2011 to 3865 out of 19,070 cases (20.3%) in 2015. Overall medical cost of all reimbursement for pediatric appendectomy increased from 46,113,202,580 to 47,572,253,300 won.</div></div><div><h3>Conclusions</h3><div>Following the universal enforcement of the diagnosis-related group claim system for appendectomy by the National Health Insurance Service, we observed an increase in the median sum of reimbursement per claim and a rise in the rate of claims for complicated appendectomies. These changes were associated with an overall increase in national medical costs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 709-715"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502712","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":"Prevalence and Extent of Industry Funding to Program Directors Across Pediatric Surgical Specialties","authors":"Jason Silvestre MD ,&nbsp;Abhishek Tippabhatla BS ,&nbsp;Belal Yasinj BS ,&nbsp;Pooya Hosseinzadeh MD","doi":"10.1016/j.jss.2024.09.073","DOIUrl":"10.1016/j.jss.2024.09.073","url":null,"abstract":"<div><h3>Introduction</h3><div>Industry funding in surgical education offers benefits but presents conflicts of interest. This study defines the prevalence and extent of industry funding to fellowship program directors (FPDs) across pediatric surgical specialties.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective cross-sectional analysis of FPDs in pediatric surgical specialties. Data were amalgamated from the Centers for Medicare and Medicaid Services and the Accreditation Council for Graduate Medical Education. Characteristics of FPDs were obtained from academic websites and medical licensing boards. Personal industry payments from 2016 to 2022 were analyzed, and temporal trends were elucidated. Comparisons were made by year, surgical specialty, and control groups with nonparametric tests.</div></div><div><h3>Results</h3><div>A total of 241 FPDs were identified, with 206 (85%) receiving industry payments over the study period. The specialties with the highest prevalence of industry funding to FPDs were pediatric orthopedic surgery (100%), pediatric urology (96%), and pediatric surgery (85%). Total industry payments aggregated to $7.3 million dollars with the majority awarded to pediatric orthopedic surgery (91%). Most industry payments were for royalties or licensing (57%) and consulting fees (31%). Median total industry payments per FPD differed between subspecialties (<em>P</em> &lt; 0.001) and was highest in pediatric orthopedic surgery ($7009, interquartile range [IQR], $1771-$50,239) and lowest in pediatric otolaryngology ($116, IQR, $75-$1626). Male FPDs had higher median total industry payments than female FPDs ($1643, IQR, $172-$8731 <em>versus</em> $193, IQR, $84-$712, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Industry payments to FPDs in pediatric surgical specialties are highly prevalent, but the magnitude varies by specialty. Future work is needed to establish mechanisms that promote equitable partnerships between academia and industry for pediatric surgery training.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 685-690"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502715","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}