Journal of Surgical Research最新文献

{"title":"Comparing Provider and Adolescent Estimates of Postoperative Opioid Use","authors":"Emma Kirkpatrick BS ,&nbsp;Olivia A. Keane MD ,&nbsp;Shadassa Ourshalimian MPH ,&nbsp;Madeleine Ing MD, MPH ,&nbsp;Marjorie Odegard MD ,&nbsp;Eugene Kim MD ,&nbsp;Lorraine I. Kelley-Quon MD, MSHS, FACS","doi":"10.1016/j.jss.2025.03.057","DOIUrl":"10.1016/j.jss.2025.03.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Most adolescents report unused opioids after surgery. Current interventions compare opioid prescribing between surgeons without capturing actual patient-reported use.</div></div><div><h3>Methods</h3><div>We recruited pediatric surgery residents, fellows, advanced practitioners, and surgeons from four surgical divisions at a tertiary care children's hospital. Providers reviewed clinical vignettes based on adolescent-reported postoperative opioid use data from our institution. Afterward, providers were asked to select the number of opioid pills they would prescribe and compare their responses to adolescent-reported use. We then measured provider willingness to change prescribing practices based on this comparison.</div></div><div><h3>Results</h3><div>Overall, provider response rate was 41.3% (<em>N</em> = 38/92). Providers underestimated the number of opioids used for posterior spinal fusion, open pectus excavatum repair, open pectus carinatum repair, knee arthroscopy, and tonsillectomy and overestimated opioid use following hip reconstruction. Differences in median postoperative opioid use estimates from providers versus adolescent-reported use were significant for knee arthroscopy (10 interquartile range [IQR, 0-3] <em>versus</em> 3 IQR [1.5-13]; <em>P</em> &lt; 0.001) and tonsillectomy (0 IQR [0-2.5] <em>versus</em> 1 IQR [0-7]; <em>P</em> = 0.043). Overall, general pediatric surgery providers underestimated opioid use while orthopedic and cardiothoracic providers overestimated opioid use. Differences between provider specialty were significant for posterior spinal fusion (<em>P</em> = 0.022), knee arthroscopy (<em>P</em> &lt; 0.001), and tonsillectomy (<em>P</em> = 0.005). The number of opioids prescribed varied by provider role and 88.9% of providers (<em>N</em> = 32/36) reported that they would change prescribing habits based on adolescent reports.</div></div><div><h3>Conclusions</h3><div>There are differences in provider estimates of postoperative prescription opioid use versus adolescent-reported use. Fortunately, providers report a willingness to change prescribing practice based on these differences. Feedback incorporating patient-reported postoperative opioid use may be a more accurate and patient-centered way to decrease excess opioid prescribing.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 137-144"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Complication Self-Reporting Methodologies Improves Standard of Care and Quality","authors":"Anthony C. Antonacci MD, SM, FACS ,&nbsp;Alexander Farrell DO ,&nbsp;Katherine Portelli MD ,&nbsp;Samuel P. Dechario BA ,&nbsp;David Rindskopf PhD ,&nbsp;Gregg Husk MD ,&nbsp;Parswa Ansari MD, FACS ,&nbsp;Robert Andrews MD, FACS ,&nbsp;Alfio Carroccio MD, FACS ,&nbsp;Gary Giangola MD, FACS","doi":"10.1016/j.jss.2025.03.027","DOIUrl":"10.1016/j.jss.2025.03.027","url":null,"abstract":"<div><h3>Introduction</h3><div>We utilized a single adverse event electronic self-reporting platform whose use was distinguished by three levels of faculty supervision, each at a separate hospital within our health system.</div></div><div><h3>Methods</h3><div>The 5-y study population included 83,885 surgical cases, 10,822 complications, 691 deaths and 3779 cases with complications collected from three independent hospitals within our health system. Each hospital reviewed cases with distinctly different levels of rigor: Site #1(Intense): a comprehensive 1-1½ h weekly meeting with resident case reporting/analysis, and in-person supervised attending review; Site #2 (Mild): resident case reporting/analysis, and occasional supervised review; Site #3 (Minimal): resident case reporting/analysis and no supervised review. Complication and mortality rates, standard of care, case mix index, length of stay and contribution margins were evaluated. Complications were treated as polynomial ordered logistic regression and modeled as logarithm of rate of complications per operation as outcome.</div></div><div><h3>Results</h3><div>Complications, deaths, and # cases with complications were significantly underreported at Site #2 and Site #3. Complication and mortality rates decreased 54% and 59% at Site #1, 8% and 36% at Site #2 and increased at Site #3. The rate (%) of “cases with complications” reported was greatest for Site #1 at 5.7%. There was a 35% overall improvement in the standard of care and a reduction in length of stay by 1.83 d at Site #1 with no differences in case mix index. An improvement in resident critical thinking was observed along with a reduction in judgment and communication errors.</div></div><div><h3>Conclusions</h3><div>Self-reporting of complications and mortalities is a valid data collection and quality improvement method when it includes a standardized electronic platform and rigorous in-person, attending review. Concurrent faculty scrutiny improves quality and is a mandatory component of the review process.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 277-287"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870267","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":"Associations in Medical Research Can Be Misleading: A Clinician's Guide to Causal Inference","authors":"Georgios Karamitros MD, MS,&nbsp;Michael P. Grant MD, PhD,&nbsp;Gregory A. Lamaris MD, PhD","doi":"10.1016/j.jss.2025.03.043","DOIUrl":"10.1016/j.jss.2025.03.043","url":null,"abstract":"<div><div>Understanding the difference between correlation and causation is essential in medical research, yet this distinction remains a common source of confusion among clinicians and researchers. While correlation indicates that two variables are related, it does not necessarily mean that changes in one variable directly cause changes in the other—a misunderstanding that can lead to misguided clinical decisions and flawed public health policies. Causal inference provides a powerful statistical framework for estimating true causal relationships, even in the absence of randomized controlled trials, which are often constrained by ethical, financial, and logistical limitations. This paper serves as an introductory guide to the methodologies of causal inference, offering clinicians and medical researchers a clear and practical roadmap for distinguishing correlation from causation. It explores two key frameworks: the potential outcomes model, which relies on counterfactual reasoning, and the structural causal model, which uses directed acyclic graphs to visualize and analyze causal relationships. Practical methods for causal estimation—including regression analysis, instrumental variables, propensity score matching, and inverse probability weighting—are discussed in detail, with a focus on their assumptions, strengths, and limitations. The paper also addresses common challenges such as unmeasured confounding, reverse causality, and model misspecification, offering strategies to mitigate bias and enhance the validity of causal estimates. A structured framework for selecting appropriate causal inference methods is provided to guide researchers in applying these techniques effectively in clinical and surgical research. By equipping clinicians with the tools to make evidence-based decisions, this paper aims to strengthen the scientific foundation of medical research and improve patient outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 145-154"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870366","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":"Treatment at Academic Facilities is Associated With Improved Survival in Late-Stage Colonic Neuroendocrine Tumors","authors":"Nicholas R. Suss MD ,&nbsp;Sara Abou Azar MD ,&nbsp;Kelvin Memeh MD, MS, MBA ,&nbsp;Benjamin D. Shogan MD ,&nbsp;Xavier M. Keutgen MD ,&nbsp;Tanaz M. Vaghaiwalla MD","doi":"10.1016/j.jss.2025.03.060","DOIUrl":"10.1016/j.jss.2025.03.060","url":null,"abstract":"<div><h3>Introduction</h3><div>Colonic neuroendocrine tumors (NETs) are a rare disease entity requiring complex and multidisciplinary management, and the survival benefit of treatment facility type has not been determined.</div></div><div><h3>Materials and methods</h3><div>The National Cancer Database was queried from 2004 to 2021 to identify treatment trends and overall survival (OS) outcomes in patients with stages I-IV colonic NETs who underwent surgery at academic or non-academic facilities.</div></div><div><h3>Results</h3><div>21,838 patients met the inclusion criteria; 71% were treated at non-academic facilities and 29% at academic facilities. Patients at academic facilities were significantly more likely to be younger (odds ratio [OR] 1.16), reside in a metropolitan area (OR 2.37), and travel farther for care (OR 7.35). Academic facilities were more likely to perform complex <em>en bloc</em> resection (OR 1.15) with more extensive lymphadenectomy (OR 1.42). Treatment at academic facilities was associated with a decreased risk of mortality (hazard ratio [HR] 0.89) on adjusted Cox models. Older age (HR 2.14), increased comorbidities (HR 2.22), uninsured status (HR 1.36), low socioeconomic status (HR 1.08), complex <em>en bloc</em> resection (HR 1.12), and increased nodal positivity (HR 2.42) significantly predicted increased mortality of the entire cohort; subgroup analysis found that low socioeconomic status and uninsured status were not significant predictors of survival at academic facilities. Kaplan–Meier analysis identified a benefit in median OS for those treated at an academic <em>versus</em> non-academic facility (161.1 <em>versus</em> 146.6 mo, <em>P</em> = 0.002). On subgroup Cox analyses by individual clinical stage, treatment at academic facilities was associated with a significantly decreased risk of mortality for patients with late-stage disease (stage III: HR 0.83, <em>P</em> = 0.005; stage IV: HR 0.84, <em>P</em> &lt; 0.001); there was no significant difference in survival by treating facility type for early-stage disease (stage I: HR 1.05, <em>P</em> = 0.58; stage II: HR 0.87, <em>P</em> = 0.12).</div></div><div><h3>Conclusions</h3><div>Treatment at academic facilities is associated with a survival benefit for patients undergoing surgical resection for late-stage colonic NETs. Further research is needed to understand these survival differences to bridge the gap in care for patients with colonic NETs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 111-121"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870362","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":"Predictors of Adverse Outcomes Following Nephrectomy for Pediatric Renal Tumors: Analysis of National Surgical Quality Improvement Program—Pediatric Data","authors":"Humza Thobani MBBS ,&nbsp;Rafia Durrani MBBS ,&nbsp;Steven L. Raymond MD ,&nbsp;Adil A. Shah MD ,&nbsp;Bill Chiu MD ,&nbsp;Peter F. Ehrlich MD, MSc ,&nbsp;Saleem Islam MD, MPH ,&nbsp;Faraz A. Khan MD","doi":"10.1016/j.jss.2025.03.026","DOIUrl":"10.1016/j.jss.2025.03.026","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to characterize the 30-d outcomes of nephrectomies for renal tumors (RTs) in children and identify predictors of operative morbidity.</div></div><div><h3>Methods</h3><div>We queried the National Surgical Quality Improvement Program—Pediatric database for children aged &lt;18 y with RTs who underwent nephrectomy from 2012 to 2021. Relevant clinical variables relating to patient demographics, outcomes, and type of nephrectomy were extracted. The primary outcome variable was any major adverse outcome (MAO). The secondary outcome variable was intra- or post-operative transfusion of blood products. Multivariable logistic regression was conducted to identify possible predictors of the primary or secondary outcomes after multiple imputations to account for missing data.</div></div><div><h3>Results</h3><div>We identified 1759 patients with a median age of 3.6 y (interquartile range: 1.9-5.8 y) and an equal sex distribution (51.4% female). Approximately 4.7% of patients had an MAO and 29.8% had a transfusion event. On multivariate regression, the predictors most strongly associated with MAO were a history of chronic lung disease (adjusted odds ratio [aOR] = 1.329, 95% confidence interval [CI] = 1.206-1.465), preoperative nutritional support (aOR = 1.129, 95% CI = 1.074-1.188), and prior inotropic support (aOR = 1.100, 95% CI = 1.010-1.198). A nephron sparing approach was associated with a slightly higher odds of both MAO (aOR = 1.044, 95% CI = 1.015-1.074) and intra-/post-operative transfusion (aOR = 1.109, 95% CI = 1.045-1.177).</div></div><div><h3>Conclusions</h3><div>Patients undergoing nephrectomy for RTs had low rates of surgical mortality and complications. A nephron sparing approach appeared to be associated with a slightly higher odds of operative morbidity—this may be because patients selected for nephron sparing surgery likely had higher stage, bilateral tumors, or a genetic predisposition to developing RTs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 128-136"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870361","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":"To PEG or not to PEG: Trends in Gastrostomy Tube Needs in Patients Requiring Tracheostomy","authors":"Jonas L. Karlsson MD, FACS ,&nbsp;Andrea Slivinski DNP, APRN ,&nbsp;Tammy R. Kopelman MD, FACS ,&nbsp;Luke Habegger MD","doi":"10.1016/j.jss.2025.03.035","DOIUrl":"10.1016/j.jss.2025.03.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Tracheostomy is a commonly performed procedure and often combined with percutaneous endoscopic gastrostomy tube (PEG) placement, a type of gastrostomy tube (GT) utilized to provide durable feeding access. Many patients pass swallow evaluations (SE) prior to discharge, raising the question of optimal timing of GT placement. The purpose of this study was to assess how frequently a GT is required at time of discharge in patients needing a tracheostomy for failure to wean off invasive mechanical ventilation (MV).</div></div><div><h3>Methods</h3><div>This was a retrospective, IRB exempt analysis of all patients that received tracheostomy and GT at a Level II trauma center over an 18-mo period. Medical records were reviewed for key patient demographics and clinical course.</div></div><div><h3>Results</h3><div>159 patients included, median hospital length of stay of 33 d, average time to tracheostomy 17 d, and 17-d median time to oral diet after tracheostomy. PEG was placed at time of tracheostomy in 35% of patients, with 52.8% receiving a GT in the acute care setting. Overall, only 15 patients (9.4%) had continued requirement for a GT at the time of discharge. The remaining 144 patients either died/discharged to hospice (<em>n</em> = 36, 22.6%) or demonstrated the ability to eat prior to discharge from acute care setting (<em>n</em> = 108, 67.9%).</div></div><div><h3>Conclusions</h3><div>In patients requiring tracheostomy for failure to wean off invasive MV, only 9.4% actually needed GT placement. Depending on institutional and regional capabilities, this study suggests that waiting to place a GT may be a reasonable approach in patients who need tracheostomy for failure to wean off invasive mechanical ventilation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 89-97"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864211","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 Complexity of Social Vulnerability of Person and Place on Mortality After Penetrating Trauma","authors":"Monica Patten MD ,&nbsp;Quintin W.O. Myers PhD ,&nbsp;Madeline Thomas MD ,&nbsp;Denise Garofalo MD ,&nbsp;Heather Carmichael MD ,&nbsp;Rachel Graham MD, MPH ,&nbsp;Josue Estrella MD ,&nbsp;Wesley Tran MD ,&nbsp;Kaitlyn Dickinson MS ,&nbsp;Shane Urban BSN, RN ,&nbsp;Catherine G. Velopulos MD, MHS","doi":"10.1016/j.jss.2025.03.048","DOIUrl":"10.1016/j.jss.2025.03.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Social determinants of health impact outcomes after traumatic injury. Patient factors, including race, insurance status, and household income, have been associated with increased risk of mortality and worse outcomes. The social vulnerability index (SVI) is a comprehensive tool that quantifies these factors at the census tract or county level. We hypothesized that mortality after admission for penetrating trauma would be associated with higher vulnerability.</div></div><div><h3>Materials and methods</h3><div>We queried our level 1 trauma center supplemental database from 2019 to 2021 for mortality among adult patients presenting with a penetrating traumatic injury (<em>n</em> = 103). We assigned SVI based on patient address and location of injury. We used chi-square tests for association for all categorical variables and Mann–Whitney <em>U</em> tests for continuous variables. We then conducted a logistic regression and mediation analysis to assess the effect of injury severity score on mortality.</div></div><div><h3>Results</h3><div>We found a significant association between SVI and mortality after comparing low and high SVI. While most patients with penetrating trauma came from the areas of highest SVI (64%), patients with low SVI (2^nd and 3^rd quartiles) had a higher mortality than those of the highest quartile (33.3% <em>versus</em> 14.1%, <em>P</em> = 0.021). High vulnerability was associated with improved survival and lower rates of all-cause mortality; however, this association was entirely mediated by the greater range of injury severity seen in the high-vulnerability group. The correlation between individual SVI and SVI of place of injury was strong.</div></div><div><h3>Conclusions</h3><div>SVI is associated with patient mortality after penetrating trauma in our locale, but not in the ways that we assumed. Our data suggest that we are missing the areas where disparity in care exists when considering only patients who make it to a trauma center. This may reflect the vulnerability of the immediate area around our institution such that a greater range of survivable injury presents and emphasizes the utility of secondary and tertiary violence prevention in the communities immediately surrounding our hospital.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 98-110"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864212","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":"Environmental Exposures to Metal Toxins as a Risk Factor for Colorectal Cancer: A Case-Control Study","authors":"Sandy Kavalukas MD ,&nbsp;Allie Jin BA ,&nbsp;Olufunmilayo Babarinde MPH ,&nbsp;Pawel Lorkiewicz PhD ,&nbsp;Jeevan Adhikari MPH ,&nbsp;Jianxiang Xu PhD ,&nbsp;Lu Cai MD, PhD ,&nbsp;Natalie DuPre ScD","doi":"10.1016/j.jss.2025.03.017","DOIUrl":"10.1016/j.jss.2025.03.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal cancer (CRC) is the third most common and third most deadly cancer in the United States The role environmental toxins may contribute to CRC incidence is unknown. Cadmium and arsenic are known human carcinogens, although previous data have primarily focused on occupational exposures only. There are no studies on the relationship between environment metal exposures and the incidence of CRC using individual-level measurements from biospecimens.</div></div><div><h3>Methods</h3><div>A pilot case-control study was conducted. Urine and blood specimens were collected. Arsenic and cadmium were measured via inductively coupled plasma mass spectrometry. Logistic regression was used to estimate Odds Ratios of CRC incidence and 95% Confidence Intervals (CI) adjusted for age, gender, family history and smoking or urinary cotinine. Each metal was modeled as a binary variable (high <em>versus</em> low) based on the controls’ median value or the limit of detection values.</div></div><div><h3>Results</h3><div>Seventy-nine urine and 84 blood specimens were analyzed. Compared to those with low metal levels, the adjusted odds of incident CRC were 1.77 times higher (95% CI: 0.62-5.00), 1.90 times higher (95% CI: 0.68-5.31), and 1.29 times higher (95% CI:0.45-3.72), for those with higher urinary arsenic, urinary cadmium, and blood arsenic, respectively.</div></div><div><h3>Conclusions</h3><div>This is the first study evaluating individual-level measurements of environmental exposures to metal carcinogens and their association with CRC incidence. These pilot results are not statistically significant, although the mildly positive associations may become more profound as recruitment continues. Continued evaluation of environmental toxins and CRC incidence remains warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 269-276"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870266","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":"Generalizability of Artificial Intelligence Assessments in Laparoscopic Surgery Simulation","authors":"Erin Kim BS ,&nbsp;Lindsay S. Rosenthal MD, MS ,&nbsp;C. Yoonhee Ryder MD, MS ,&nbsp;Chioma Anidi MD, MBA ,&nbsp;Serena S. Bidwell MD, MBA, MPH ,&nbsp;Deborah M. Rooney PhD ,&nbsp;Joon Yu BFA ,&nbsp;Pawel Forczmanski PhD, DSc ,&nbsp;David R. Jeffcoach MD ,&nbsp;Grace J. Kim MD","doi":"10.1016/j.jss.2025.03.030","DOIUrl":"10.1016/j.jss.2025.03.030","url":null,"abstract":"<div><h3>Introduction</h3><div>The application of artificial intelligence (AI) in the assessment of procedural skills on a simulation platform using the global rating scale (GRS) has shown promise. Our team developed an open-source, low-cost simulation platform for the development of laparoscopic skills in low-resource settings, with skill assessment provided by video-based peer review and AI. The generalizability of AI trained on one procedure to evaluate general procedural skills within a single training system is unknown. This study examines the feasibility of generalizing AI-based assessments across procedures in a training system.</div></div><div><h3>Methods</h3><div>AI was trained, with varied combinations of procedures, to score 111 laparoscopic performance videos of four procedures (57 salpingostomies, 20 appendectomies, 15 enterectomies, and 19 diaphragmatic repairs), using time and distance-based calculations. Predicted scores were generated using five-fold cross-validation and K-nearest neighbors, with both 5-class (scored 1-5) and 2-class (pass/fail) scoring systems. Videos were also scored in a conventional fashion using human video-based review, based on GRS competencies.</div></div><div><h3>Results</h3><div>AI assessments achieved 42%-100% concordance with human reviews in the 5-class system and 68%-100% in the 2-class system, <em>P</em> = 0.005. Within the 5-class system, 100% accuracy was reached when AI trained on multiple procedures evaluated appendectomy. The 2-class system attained 100% accuracy in three procedures across the GRS competencies.</div></div><div><h3>Conclusions</h3><div>AI assessment trained on procedures using video-based review evaluated laparoscopic skills across different procedures within a simulation-based training system. Dichotomizing scoring to pass/fail improved accuracy, while supporting the potential to assess procedural competence.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 249-256"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863302","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":"Racial and Gender Disparities in the Management and Outcomes of Patients With Acute Mesenteric Ischemia: A Nationwide Retrospective Cohort Analysis","authors":"Umar F. Bhatti MD ,&nbsp;Eileen Lu MD ,&nbsp;Mohammed A. Quazi PhD ,&nbsp;Amir H. Sohail MD, MSc ,&nbsp;Sage E. Templeton BA ,&nbsp;Hamza Hanif MD ,&nbsp;Yassine Kilani MD ,&nbsp;Saqr Alsakarneh MD ,&nbsp;Abu Baker Sheikh MD ,&nbsp;Rozi Khan MD ,&nbsp;Galinos Barmparas MD ,&nbsp;Hasan B. Alam MD","doi":"10.1016/j.jss.2025.03.014","DOIUrl":"10.1016/j.jss.2025.03.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute mesenteric ischemia (AMI) is often associated with poor prognosis without immediate intervention. Despite the severity of AMI, little is known regarding gender and race specific disparities in outcomes of hospitalized patients. The aim of this study was to characterize gender and race specific disparities in patients hospitalized with AMI using the U.S. National Inpatient Sample (NIS) database.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed on patients admitted with a primary diagnosis of AMI between January 1, 2016, and December 31, 2020, using the NIS database. Demographics, comorbidities, and in-hospital outcomes were compared between racial groups and genders. Categorical and continuous variables were analyzed with chi-squared test and multivariable linear regression, respectively. Odds ratios (ORs) for the race and gender cohorts were obtained with logistic regression models.</div></div><div><h3>Results</h3><div>Of 99,225 patients, 55,420 (55.8%) were female. Compared to males, females had lower odds of in-hospital mortality (OR 0.93, <em>P</em> = 0.04), acute kidney injury (OR 0.70, <em>P</em> &lt; 0.001), vasopressor use (OR 0.79, <em>P</em> &lt; 0.001), invasive (OR 0.77, <em>P</em> &lt; 0.001) and noninvasive mechanical ventilation (OR 0.70, <em>P</em> &lt; 0.001), hemodialysis (OR 0.92, <em>P</em> &lt; 0.001), venous thromboembolism (OR 0.78, <em>P</em> &lt; 0.001), myocardial infarction (OR 0.80, <em>P</em> = 0.003), sudden cardiac arrest (OR 0.89, <em>P</em> = 0.002), and small bowel resection (OR 0.92, <em>P</em> = 0.003).</div><div>Relative to White patients, Hispanic patients had significantly lower odds of inpatient mortality (OR 0.87, <em>P</em> = 0.04) and Native American patients had a higher risk of inpatient mortality (OR 1.64, <em>P</em> = 0.01). African American patients were significantly less likely to undergo percutaneous vascular intervention (OR 0.39, <em>P</em> &lt; 0.001) and more likely to undergo small bowel resection (OR 1.25, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>AMI has worse outcomes in males. Disparities were also observed based on the race of the patients, with a worse complication profile among certain minority groups.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 257-268"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864107","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}