Journal of Surgical Research最新文献

{"title":"Automobile-Pedestrian Injuries: Are Pedestrian Safety Features Associated With Injury Severity?","authors":"Rebecca Minas-Alexander, Essam Hashem, Amber Jones, Matthew Hannon","doi":"10.1016/j.jss.2024.11.011","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.011","url":null,"abstract":"<p><strong>Introduction: </strong>Automobile-pedestrian (AP) crashes can cause severe injuries and are increasing in frequency. We sought to determine factors contributing to severe injuries.</p><p><strong>Methods: </strong>Patients ≥15 y with AP injuries admitted from January 1, 2020, through December 31, 2022, comprised the study population. Demographic data, injury severity score (ISS), and abbreviated injury scale (AIS) were obtained from the trauma registry. An electronic medical record review collected location, time and description of the incident, and substance use. Locations were grouped into multilane, high speed (>40 mph) streets, residential streets, and off-road. Pedestrian safety features were assessed using Google Street View. Each location census tract Area Deprivation Index was determined. Logistic regression was used to determine if safety features predicted increasing ISS or AIS.</p><p><strong>Results: </strong>There were 426 patients. The mean ISS was 13.3. AP patients struck with a sidewalk present had a higher ISS (P = 0.03) and higher AIS head or neck (P = 0.01). Those struck on a street with <6 lanes had a lower ISS (P = 0.035). AP victims under the influence of a substance had higher ISS (P = 0.035) and AIS external (P = 0.049). More AP accidents occurred between 18:00-23:59 (43.8%). Most AP fatalities occurred between 18:00-5:59 (76%). Most AP injuries, 94.06% (P = 0.0), occurred in areas with an Area Deprivation Index of 9 or 10.</p><p><strong>Conclusions: </strong>More severe AP injuries occurred along multilane roads with high-speed traffic and with a sidewalk. Injuries and fatalities more commonly occurred at night. Pedestrians using substances suffered more severe injuries. Most AP injuries occurred in socioeconomically disadvantaged areas.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"126-130"},"PeriodicalIF":1.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823747","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":"Real-Time Pain Control Education After Outpatient General Surgery: A Randomized Controlled Trial.","authors":"William G Lee, Farin F Amersi, Monica Jain, Scott A Cunneen, Miguel Burch, Edward Phillips, Yufei Chen","doi":"10.1016/j.jss.2024.10.053","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.053","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid-related morbidity and mortality continue to rise with surgery often serving as the first exposure to opioids for patients. Few interventions focus on real-time education in the outpatient setting while patients are experiencing pain. The effect of short-messaging service (SMS) surveys with real-time opioid-use education (SMSE) and without (SMS) on outpatient postoperative opioid use was studied.</p><p><strong>Methods: </strong>A double-blinded randomized controlled trial enrolled adults (≥18 y) who underwent outpatient general surgery procedures from January 1, 2020, to January 2, 2021. Participants received an automated daily SMS or SMSE for 10 d postoperatively. Primary outcomes included total opioid use in oral morphine equivalents (OMEs) and total pain scores. Data were gathered via real-time SMS patient responses.</p><p><strong>Results: </strong>One hundred sixty patients were randomized to SMS (n = 82) or SMSE (n = 78). Patient demographic/clinical characteristics and surgery type were similar. Between SMS and SMSE, there were no differences in total pain scores (25 [interquartile range (IQR): 25.0] versus 31 [IQR: 35.7], P = 0.291) or total OME used (15.5 mg [IQR: 37.5] versus 15.8 mg [IQR: 45.6], P = 0.762). Increased total OME correlated with younger age (P = 0.001), opioids prescribed (P = 0.001), and preoperative opioid use (P = 0.018). Higher patient satisfaction was observed in patients with lower total pain scores and OME used, with no difference in opioids prescribed (P = 0.352). Subgroup analysis revealed open hernia repair patients in the SMSE group had lower OME used (0 mg [IQR: 0] versus 14.2 mg [IQR: 11.6], P = 0.004).</p><p><strong>Conclusions: </strong>Real-time opioid-use education via SMS did not lead to a difference in opioid use, but demonstrated a high acceptance rate as a mode of communication and feedback. This finding should encourage further optimization of the SMS tool to rapidly identify patients with inadequate pain control while promoting appropriate opioid use and disposal.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"118-125"},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822050","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":"Adventitial Injection of HA/SA Hydrogel Loaded With IL-33 Antibody Decreases Neointimal Hyperplasia.","authors":"Pengfei Shi, Peng Sun, Chunyang Lou, Jianbang Fang, Liwei Zhang, Boao Xie, Cong Zhang","doi":"10.1016/j.jss.2024.11.017","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.017","url":null,"abstract":"<p><strong>Introduction: </strong>Neointimal hyperplasia is one of the persistent complications after vascular interventions, and is the major cause of treatment failure. Interleukin-33 (IL-33) emerges as a crucial factor in many biological processes and plays an important role in vascular diseases. Adventitial injection is catching attention for its effectiveness and fewer side effects. We hypothesize that targeting IL-33 by adventitial injection can be a therapeutic method to inhibit neointimal hyperplasia.</p><p><strong>Method: </strong>IL-33 expression was examined in human vein graft. The hydrogel was fabricated by the interaction of hyaluronic acid, sodium alginate, and CaCO₃; and phosphate buffered saline (PBS) or IL-33 antibody or recombinant IL-33 was mixed within the hydrogel uniformly. A rat aortic wire injury-induced neointimal hyperplasia model was developed; rats were divided into three groups and received an adventitial injection of a hydrogel loaded with PBS or IL-33 antibody or recombinant IL-33 after wire injury. Tissues were harvested at day 21 and analyzed by histology and immunohistochemical staining. Hydrogel loaded with PBS, IL-33 antibody, or IL-33 was also used in a mouse carotid artery ligation neointimal hyperplasia model.</p><p><strong>Result: </strong>There was a high expression of IL-33 in human vein graft neointima. Hydrogel can be successfully injected into the aortic wall and is encapsulated by the adventitia. The hydrogel could be seen beneath the adventitia after adventitial injection and was partly degraded at day 21. There was a significantly thinner neointimal thickness and less proliferation and inflammation in the IL-33 antibody group compared to the control group. On the contrary, the IL-33 group has a thicker neointima, increased proliferation, and inflammation. The mouse carotid artery ligation model showed similar results.</p><p><strong>Conclusions: </strong>IL-33 plays a role in arterial neointimal hyperplasia in both human and rodent models; adventitial injection of hydrogel loaded with IL-33 antibody can effectively decrease neointimal thickness. Neutralizing IL-33 by IL-33 antibody may be a potential therapeutic method to inhibit intimal hyperplasia after vascular interventions.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"107-117"},"PeriodicalIF":1.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818185","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":"Use of Pancreatic Density on Computed Tomography to Predict Postendoscopic Retrograde Cholangiopancreatography Pancreatitis.","authors":"Mert Guler, Omer Akay, Anil Demir, Ibrahim Taskin Rakici, Husnu Sevik, Sukru Colak, Coskun Cakir, Mert Mahsuni Sevinc, Ufuk Oguz Idiz","doi":"10.1016/j.jss.2024.11.010","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.010","url":null,"abstract":"<p><strong>Introduction: </strong>Postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a frequent complication, and its pathogenesis remains unclear, with various patient and procedural factors proposed as potential contributors. This study aimed to assess the predictive value of pancreatic to splenic density ratio on computed tomography (CT) for PEP in patients with inadvertent pancreatic duct cannulation.</p><p><strong>Methods: </strong>This retrospective study involved 2556 patients undergoing ERCP from January 2014 to December 2020. Inclusion criteria comprised patients with choledocholithiasis, preprocedural CT imaging, and inadvertent pancreatic duct cannulation during ERCP. Demographics, preprocedural laboratory values, pancreatic to splenic density ratios from CT scans, and pancreatic stent usage were analyzed in relation to the development of PEP.</p><p><strong>Results: </strong>A total of 90 patients were included in the study. Of all patients, 51.1% were female (n = 46), and 48.9% were male (n = 44). The mean (±standard deviation) age was 58.93 (±17.01). Significant differences in sodium levels and the pancreatic to splenic density ratio were noted between the PEP and non-PEP groups. Pancreatic to splenic density ratio <0.74 (odds ratio: 8.253; P = 0.020) was identified as an independent risk factor for PEP.</p><p><strong>Conclusions: </strong>Pancreas to spleen density ratio on CT imaging serves as a potential predictive marker for PEP, offering insights into risk stratification and guiding prophylactic measures in high-risk patients.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"100-106"},"PeriodicalIF":1.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818186","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":"Anterior Transversus Abdominis Plane Block for Lower Extremity Revascularization.","authors":"Carmelina Gurrieri, Ghaith Almhanni, Indrani Sen, Jason Beckermann, Thomas Carmody, Tiziano Tallarita","doi":"10.1016/j.jss.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.004","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia remains underutilized in vascular surgery; therefore, we retrospectively reviewed and compared the usage of perioperative opioids in patients undergoing lower extremity revascularization surgery, who received the anterior transversus abdominis plane (TAP) block along with local anesthesia at the incision site versus who did not receive any regional anesthesia.</p><p><strong>Methods: </strong>We conducted a retrospective review of 107 patients undergoing open or hybrid lower extremity revascularization under general anesthesia at a single institution between 2017 and 2022. Patients were divided into two groups. Regional block group (n = 41 [38%]) (femoral endarterectomy 27%; femoral endarterectomy + endovascular intervention 51%; infrainguinal bypass 22%) received both an intraoperative anterior TAP block and local anesthesia at the incision site; No regional block group (n = 66 [62%]) (femoral endarterectomy 29%; femoral endarterectomy + endovascular intervention 13%; infrainguinal bypass 58%) did not receive either regional or local anesthesia.</p><p><strong>Results: </strong>There were no significant differences in either the procedural metrics or intraprocedural complications between the two groups. The in-hospital stay was shorter in the Regional group, 1 (1, 3) versus the No regional group, 3 (2, 7), P < 0.001. The median intraoperative morphine milliequivalents use was 20 (15, 25) in the Regional block group and 25 (20, 35) in the No regional block group, P = 0.008. The median postoperative opioids use at 24h was 75 (60, 98) in the Regional block group and 113 (83, 151) in the No regional block group, P < 0.001; at 48h was 103 (70, 118) in the Regional block group and 148 (90, 210) in the No regional block group, P = 0.027; at 72h was 105 (70, 138) in the Regional block group and 196 (113, 263) in the No regional block group, P = 0.010.</p><p><strong>Conclusions: </strong>Anterior TAP block combined with local anesthesia at the incision site seems to be a safe postoperative analgesia option for patients undergoing lower extremity revascularization surgery that could potentially help reducing both intra and postoperative opioids requirement.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"93-99"},"PeriodicalIF":1.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813566","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 Prognostic Value of Preoperative C-Reactive Protein Levels in Resected Early-Stage Lung Cancer.","authors":"Alberto Lopez-Pastorini, Zehra Tatli, Antonia von Bargen, Dennis Faltenberg, Hendrik Beling, Thomas Galetin, Aris Koryllos, Erich Stoelben","doi":"10.1016/j.jss.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.003","url":null,"abstract":"<p><strong>Introduction: </strong>C-reactive protein (CRP) is the most widely used marker of the systemic inflammatory response. An association between preoperative elevated levels and prognosis has been demonstrated for numerous tumors. The aim of this study was to investigate the association between preoperative CRP levels and survival in early-stage nonsmall cell lung cancer.</p><p><strong>Methods: </strong>Data from 915 consecutive patients who underwent complete resection for stage I and II nonsmall cell lung cancer were retrospectively analyzed. Recurrence-free survival (RFS) and overall survival (OS) according to preoperative CRP levels were evaluated by the Kaplan-Meier method. The Cox proportional hazards model and logistic regression analysis were used for multivariate analysis.</p><p><strong>Results: </strong>Five-year RFS and OS were 61.0% and 70.3% in the low CRP group (<4 mg/L) and 41.8% and 49.4% in the high CRP group (≥4 mg/L), respectively (P < 0.001). In univariate analysis, CRP levels were correlated with indicators of tumor burden and pulmonary comorbidity. In multivariate analysis, CRP levels were identified as an independent predictor of RFS and OS.</p><p><strong>Conclusions: </strong>Elevated preoperative CRP is associated with poor prognosis in patients with early-stage lung cancer. CRP may guide risk-adapted follow-up and adjuvant therapy decisions. As CRP elevation is also associated with nontumor related conditions patients need to be screened for coexisting comorbidities.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"85-92"},"PeriodicalIF":1.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813569","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":"Standardization of Narcotic Prescriptions in Minimally Invasive General Surgery Procedures.","authors":"Astrid Leon, Justin Robbins, Ashley Hughes, Oumou Fofana, Corinna Crayton, Priti P Parikh, Timothy Crawford, Samantha Shugar, Casey Walk, Michelle DeGroat, Randy Woods","doi":"10.1016/j.jss.2024.10.045","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.045","url":null,"abstract":"<p><strong>Introduction: </strong>The opioid crisis is a major public health issue, and postoperative opioids play a unique role. Many institutions have implemented standardized protocols to decrease excess opioids available. The objective of this study was to establish a standardized pain protocol for common surgical procedures and assess postoperative pain control.</p><p><strong>Methods: </strong>This is a prospective observational study based on the Michigan Opioid Prescribing Engagement Network network guidelines which provides prescription recommendations for surgical procedures. We evaluated all laparoscopic/robotic cholecystectomy, appendectomy, and all herniorrhaphies. Patients were prescribed a predetermined number of narcotics by procedure as part of a multimodal pain regimen. A survey was conducted within 14 d postoperatively to assess pain control and narcotic utilization.</p><p><strong>Results: </strong>A total of 442 patients were included from July 1, 2022 to October 28, 2022. Survey response was 40% (178/442) with 56% (249/442) prescribed per protocol. Fewer patients prescribed per protocol required refills, 9.6% (24/249) compared to 18.1% (35/193) (P = 0.007) without protocol. Patients reported taking significantly fewer narcotics with the protocol versus without (median = 5.0 versus 10.0, P < 0.001). The median number of narcotics taken were 5.5 for appendectomy, 7.0 for cholecystectomy, and 9.0 for herniorrhaphy. There was no difference in pain control when comparing patients with and without protocol (91.1% versus 90.5%, P = 1.0).</p><p><strong>Conclusions: </strong>This study demonstrated that postoperative opioid prescriptions can be decreased by implementing a standardized protocol incorporating a multimodal regimen while adequately controlling pain following surgery.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"80-84"},"PeriodicalIF":1.8,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807447","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":"Adipose-Derived Stem Cells Prevent Anastomotic Leak: A Porcine Ischemic Esophagectomy Model.","authors":"Jennifer Williams, Kristen Knapp, Brian Zilberman, Andrew Lin, Vincent Verchio, Zeus Antonello, Ping Zhang, Drew Delong, Francis Spitz, Julieta E Barroeta, Xiaoxin Chen, David Shersher","doi":"10.1016/j.jss.2024.10.054","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.054","url":null,"abstract":"<p><strong>Introduction: </strong>Esophagectomy is a lifesaving procedure plagued by an anastomotic leak rate of 11%-35%. Ischemia is widely accepted to be the most significant risk factor for anastomotic leak. We hypothesized that the injection of adipose-derived stem cells (ASCs) into an ischemic esophagogastric anastomosis would prevent leakage.</p><p><strong>Methods: </strong>We developed a leaking ischemic esophagogastric anastomosis model in pigs using indocyanine green and the Elevision device to quantify perfusion. Anastomoses created using a gastric conduit with a relative perfusion of 50%-60% produced an anastomosis that consistently leaked (n = 3) compared to nonischemic controls (n = 3). We then injected either human (n = 2) or porcine (n = 2) ASCs around an ischemic anastomosis. We analyzed clinical outcomes including postoperative sepsis, weight loss, and disruption of the anastomosis and histopathology as well as immunohistochemistry.</p><p><strong>Results: </strong>All of the ischemic controls (3/3, 100%), as well as the xenograft human ASC-injected experimental group (2/2, 100%), became septic postoperatively and were found to have an anastomotic breakdown or disruption on necropsy. However, in the porcine allograft ASC-injected experimental group, the animals did well, with none of the subjects experiencing postoperative sepsis, and none were found to have disrupted anastomoses on necropsy. Histopathology revealed improved apposition of the anastomosis and immunohistochemistry revealed improved epithelization and submucosal fibrosis of the porcine ASC group compared to ischemic and human ASC groups.</p><p><strong>Conclusions: </strong>Allogenic ASCs prevented anastomotic leakage of esophagogastric anastomosis in a porcine ischemic esophagectomy model.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"65-79"},"PeriodicalIF":1.8,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801419","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":"Housing Instability and Outcomes Among Patients With Access-Sensitive Surgical Conditions.","authors":"Emily E Evans, Nicholas Kunnath, Esther J Oh, John W Scott, Megan Janeway","doi":"10.1016/j.jss.2024.10.050","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.050","url":null,"abstract":"<p><strong>Introduction: </strong>Housing instability is a significant contributor to poor health but remains understudied among surgical patients. We evaluated the association between housing instability and rates of unplanned surgical procedures, as well as resultant health and financial outcomes, for patients with access-sensitive conditions.</p><p><strong>Methods: </strong>Using the Healthcare Cost and Utilization Project National Inpatient Sample, we identified patients who underwent one of four selected procedures for access-sensitive surgical conditions (abdominal aortic aneurysm repair, colectomy, incisional hernia repair, and lower extremity bypass). Housing status was determined using International Classification of Disease, 10th Revision, Clinical Modification codes Z59.0 (homelessness) and Z59.1 (lack of adequate housing). Risk-adjusted multivariable logistic regression compared outcomes between patients with and without housing instability.</p><p><strong>Results: </strong>Of 1,761,965 individuals admitted for access-sensitive surgical conditions, 2280 were experiencing housing instability. Housing-unstable individuals had more than four times the odds of undergoing unplanned surgery than housing-stable individuals (odds ratio 4.41, P < 0.001). Across all procedures, individuals with housing instability experienced longer lengths of stay (planned: 5 d versus 4 d, P < 0.001; unplanned: 8 d versus 7 d, P < 0.001) and higher costs per admission following planned surgery ($20,379 versus $18,152, P < 0.001) than housing-stable individuals. Housing-unstable individuals had lower odds of complications and in-hospital mortality following planned surgeries. No differences in morbidity or mortality were identified following unplanned surgeries.</p><p><strong>Conclusions: </strong>Patients experiencing housing instability had higher odds of undergoing unplanned surgical procedures, had longer hospital stays and higher costs, and had similar or better outcomes following surgery. Efforts to expand affordable housing opportunities may improve access to timely surgical care.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"56-64"},"PeriodicalIF":1.8,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794783","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":"Implementation of Music in the Perioperative Standard Care of Colorectal Surgery: A Cost-Effectiveness Analysis.","authors":"Saskia H Van Bergen, Jorrit G Verhoeven, Ellaha Kakar, Johannes Jeekel, Erwin Birnie, Markus Klimek","doi":"10.1016/j.jss.2024.10.052","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.052","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials and meta-analyses have provided evidence of the positive effects of perioperative music interventions on pain, anxiety, and stress. However, the cost-effectiveness is unknown. The objective of this study was to analyze the cost-effectiveness of the implementation of a music intervention in the perioperative care of patients undergoing colorectal surgery.</p><p><strong>Methods: </strong>A post hoc analysis was performed on patients included in the Implementation of Music Intervention in the PeRiOperatiVe standard care study: a clinical implementation study comparing the effects of perioperative music interventions (post-implementation group, N = 50) to standard care in colorectal surgery (pre-implementation group, N = 50). Main outcomes analyzed were postoperative pain scores and healthcare costs. Propensity score matching with inverse probability weighting was applied. Incremental costs and cumulative pain score differences were estimated using bootstrap analysis with 1000 replications.</p><p><strong>Results: </strong>Median age of the entire patient population was 62.5. Mean sum of postoperative pain scores on postoperative days 0 to 3 was 9.8 (range 0-40) (95% confidence interval [CI] 8.3-11.4) and 9.9 (95% CI; 7.0-12.9) in the pre- and post-implementation group, respectively (P = 0.970). The total costs were not significantly different between the pre- and post-implementation group in the entire group (€7000 versus €8,070, mean difference of €1070 (bootstrap 95% CI - €1190 - €3336), P = 0.353). Incremental costs were €1288 and €5030 (intention-to-treat and per protocol analysis, respectively) per clinically relevant decrease in pain during postoperative day 0-3.</p><p><strong>Conclusions: </strong>The implementation of music intervention does not lead to a significant difference in costs. These results can aid clinicians considering the implementation of perioperative music.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"47-55"},"PeriodicalIF":1.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792042","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}