Journal of Surgical Research最新文献

{"title":"Association Between Cardiothoracic Fellows and Clinical and Financial Outcomes in Coronary Surgery.","authors":"Brandon Peine, Hanna Long, J Preston Bethea, Yuanyuan Fu, Rob Allman, Olasunkanmi Kehinde, Dmitry Tumin, Linda Kindell, William Irish, Shahab A Akhter","doi":"10.1016/j.jss.2024.12.041","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.041","url":null,"abstract":"<p><strong>Introduction: </strong>Mounting financial pressures on academic institutions highlight the need to understand the effect on outcomes from trainee involvement in cardiac surgery. The purpose of this study is to examine the association between cardiothoracic fellows and clinical and financial outcomes in coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Data for all patients from 2017 to 2022 at a single institution who underwent nonemergent, isolated, open CABG were included in the study, with patients grouped by whether there was fellow operative participation. Financial and clinical outcomes were compared between the two groups using multivariable regression and generalized estimating equations to control for variation in patient characteristics and attending cardiac surgeon practices.</p><p><strong>Results: </strong>A total of 1997 patients met criteria for study inclusion, with 632 (31.5%) cases that had fellow participation and 1365 (68.4%) that did not. Patients in the fellow participation group had a 0.8% higher median preoperative risk score than those that did not have fellow participation. Fellow participation was associated with significantly longer total case length (61 mins) but no differences in postoperative clinical outcomes. There was an increased median total hospitalization cost of approximately $2200 in cases with fellow participation, likely attributable to increased intraoperative costs from longer case times.</p><p><strong>Conclusions: </strong>While CT surgery fellow participation was associated with longer operative times and a small increase in hospitalization cost in CABG, there were no significant differences in clinical outcomes. Continuing to train cardiothoracic surgery fellows in this procedure is safe and would not be expected to significantly impact reimbursement under bundled payment models.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"358-363"},"PeriodicalIF":1.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029078","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":"Disparities in Rehabilitation Services for Victims of Violence.","authors":"Megan G Janeway, Ella Cornell, Sophia M Smith, Anne K Buck, Miriam Neufeld, Janice Weinberg, Stephanie D Talutis, Nina Jreige, Victoria Liang, Timothy Munzert, Tracey Dechert, Sabrina E Sanchez, Lisa Allee","doi":"10.1016/j.jss.2024.12.040","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.040","url":null,"abstract":"<p><strong>Introduction: </strong>Access to rehabilitation services after a traumatic injury improves functional outcomes. No study has examined the association between injury intent, violent versus nonviolent, and receipt of rehabilitation services after injury.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study of injured adult patients admitted to our level I trauma center from January 1, 2014 to December 31, 2021. The primary exposure was violent injury, and the primary outcome was receipt of rehabilitation services upon discharge. An exploratory subgroup analysis evaluated differences in recommended disposition and the reasons for rejection from services.</p><p><strong>Results: </strong>Among 7500 patients, 1677 (22.4%) were violently injured and 5823 (77.6%) were nonviolently injured. Patients were 45% White, 67% male, and 52% had public insurance. Adjusting for age, sex, race, ethnicity, injury severity score, insurance, and length of stay, violently injured patients were 77% less likely to receive inpatient rehabilitation (relative risk ratio 0.23 95% confidence interval [0.18, 0.30], P < 0.001) and 46% less likely to have home services (relative risk ratio 0.54, 95% confidence interval[0.43, 0.69], P < 0.001). A subgroup analysis (n = 328) demonstrated that violently injured patients were more likely to have a downgrade in discharge recommendation (27.8% versus 9.4%, P = 0.04) and more likely to have an emergency department visit within 30 d (32.0% versus 13.3%, P < 0.001).</p><p><strong>Conclusions: </strong>Violent injury is associated with lower likelihood of receiving rehabilitation services. Subgroup analysis indicates this finding associated with facilities' selection bias, and this warrants additional study. Efforts should focus on protecting victims of violence from discrimination during the rehabilitation screening process.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"317-326"},"PeriodicalIF":1.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gender Disparity in Operative Opportunities for Trainee Surgeons: A Review.","authors":"Sherri Xu, Heidi McAlpine, Katharine Jann Drummond","doi":"10.1016/j.jss.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.004","url":null,"abstract":"<p><strong>Introduction: </strong>Assessing gender disparity in surgical trainees' operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy.</p><p><strong>Methods: </strong>A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included.</p><p><strong>Results: </strong>Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women.</p><p><strong>Conclusions: </strong>A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"327-335"},"PeriodicalIF":1.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Intracranial Pressure Monitoring After Open Cranial Procedures Associated With Outcome?","authors":"Peter Aziz, Alison Muller, Christopher Butts, Eugene F Reilly, Anthony Martin, Christopher Lawson, Thomas A Geng, Adrian W Ong","doi":"10.1016/j.jss.2024.12.045","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.045","url":null,"abstract":"<p><strong>Introduction: </strong>It is unclear if intracranial pressure monitoring (ICPM) after open cranial procedures (craniotomy or craniectomy) (OC) for traumatic brain injury is associated with mortality. We hypothesized that ICPM placed early after OC was associated with lower mortality compared to no ICPM or delayed ICPM placement.</p><p><strong>Methods: </strong>Using 2020-2021 data from the American College of Surgeons Trauma Quality Improvement Program, patients ≥16 y from level 1 and 2 trauma centers who underwent OC were divided into two groups: ICPM placed within 72 h of OC (early) and no ICPM or ICPM placed after 72 h (none/delayed). Outcome was in-hospital mortality. Logistic regression was used to elucidate predictors of mortality.</p><p><strong>Results: </strong>A total of 19,830 patients (early ICPM, 29%) were included. Early patients were more likely to be from level 1 centers (63% versus 60%, P = 0.004), younger (median age 47 versus 60, P < 0.0001), to have a lower Glasgow Coma Score (median, 6 versus 14, P < 0.0001), higher injury severity score (median, 26 versus 26, P < 0.0001), an unreactive pupil (33% versus 18%, P < 0.0001), midline shift >5 mm (69% versus 60%, P < 0.0001), received ≥2 units of blood/first 4 h (14% versus 6%, P < 0.0001) and higher mortality (31% versus 19%, P < 0.0001) compared to none/delayed patients. Controlled for significant variables, early ICPM was associated with increased mortality (odds ratio 1.35, 95% confidence interval 1.24-1.47). Analysis of subjects with isolated brain injury found a similar association (odds ratio 1.32, 95% C1 1.15-1.52).</p><p><strong>Conclusions: </strong>ICPM placed within 72 h of OC was associated with increased mortality. Indications for ICPM after OC should be investigated further in multicenter prospective studies.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"344-349"},"PeriodicalIF":1.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023862","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":"Reducing Surgical Site Infections With Silver Impregnated Dressings in Lower Extremity Bypass Patients.","authors":"Pooja T Desai, Ashar Ata, Sandra R DiBrito, Ralph Clement Darling, Adriana Laser","doi":"10.1016/j.jss.2024.12.036","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Surgical site infection (SSI) after lower extremity (LE) bypass surgery is associated with longer length of stay, higher hospital cost, increased morbidity, and even graft loss. Silver impregnated dressings have been used by other surgical subspecialties to decrease SSI with reported success. The National Surgical Quality Improvement Program (NSQIP) published a national expected rate of 7.9% for SSI after open LE bypass surgery in 2018. Our institutional SSI rate in 2018 was 12.8%. In order to reduce this rate, we transitioned to silver impregnated dressings for all LE bypass procedures and studied any subsequent changes in rates of SSI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used NSQIP data to retrospectively study two consecutive cohorts of vascular surgery patients at a single institution who underwent LE bypasses. Inclusion criteria were open infrainguinal LE bypass patients who were selected via Current Procedural Terminology codes. Patients in 2019 who underwent LE bypass received dry sterile dressing (DSD) postoperatively. Patients in 2020 who underwent LE bypass were treated with silver impregnated dressings postoperatively. NSQIP criteria were used to determine if patients in both cohorts developed SSIs within 30 d of surgery. Fischer's exact and Χ2 test were used to compare groups before and after the intervention. Placement of silver dressings in the intervention cohort was confirmed using review of the medical chart and operative billing reports.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 282 patients who underwent LE bypass in 2019 and 2020 met inclusion criteria. The standard of care cohort had 168 patients with DSD, while the cohort after intervention had 114 patients with silver impregnated dressings. The groups were similar in terms of demographics and comorbidities (Table 1). There was a statistically significant reduction in superficial SSI in the silver dressing group compared to the DSD group (9.6% versus 20.8%, P = 0.014, Table 2). There was a 63% compliance with silver dressing placement in the intervention group. This subset of patients with confirmed dressing placement was similar in terms of demographics and comorbidities (Table 3). Superficial SSI in this patient cohort was decreased from 20.8 to 12.5% (P = 0.15, Table 4). There was no observed difference in deep or organ space infections, wound dehiscence, readmission, and return to operating room between both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrated a statistically significant reduction in the rate of superficial SSI in patients undergoing open LE bypass with the use of a silver impregnated dressing when compared to a sterile gauze dressing. Although our study does not demonstrate a causal relationship, this relatively inexpensive and low-risk intervention's association with a significant decrease in an otherwise very serious postoperative complication argues for a change in clinical practice or prospective conf","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"336-343"},"PeriodicalIF":1.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023870","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":"Comparison of Pediatric and Adult Firearm Deaths to Inform Violence Prevention at Pediatric Trauma Centers.","authors":"Maya Guhan, Jaclyn Dempsey, Ojas Dumbre, Saathwik Saladi, Marie Ann Kasbaum, Elisa Benavidez, Jeff Carter, Aaron Martinez, Michal Pierce, Catherine Seger, Bindi Naik-Mathuria","doi":"10.1016/j.jss.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.011","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital-based violence intervention programs primarily target adults, raising questions about the effectiveness in preventing pediatric firearm deaths. We hypothesized that pediatric and adult firearm injury deaths are different enough to require unique intervention strategies.</p><p><strong>Methods: </strong>Retrospective chart review was conducted of medical examiner and trauma center records of firearm-related deaths in the largest metropolitan county in Texas. Data from pediatric patients (0-17 ys) were compared to adults using chi-squared, Fischer's exact test, and Wilcoxon's rank-sum tests. In addition, data from younger children (0-15 ys) were further stratified and compared to adults (16 and above) using similar analyses.</p><p><strong>Results: </strong>During 2018-2020, 117 pediatric and 1803 adult firearm deaths were identified. Homicide was most common in both groups (ped 58% versus adult 41%); however, differences were noted in unintentional shootings (ped 16% versus adult 1%, P < 0.01) and suicides (ped 21% versus adult 34%, P < 0.0 L). Alcohol abuse was more common in adults (ped 10% versus adult 46%, P < 0.01). Children <16 ys had a higher incidence in females (<16y 24% versus 16y+ 12%, P < 0.01), less alcohol abuse (<16y 6% versus 16y+ 62%, P < 0.01), less illegal drug use (<16y 19% versus 16y+ 46%, P < 0.01), and were more commonly killed at home (<16y 60% versus 16+y 43%, P < 0.01). Prevalent victim residence zip codes differed between children and adults.</p><p><strong>Conclusions: </strong>Adult and pediatric firearm deaths differ in shooting intent and many key risk factors. These data can strategically inform focus areas for pediatric hospital-based violence intervention programs as well as resource allocation based on regional-level data.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"350-357"},"PeriodicalIF":1.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023894","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":"Letter Regarding: Improving Research on Racial Disparities in Surgical Training: Methodological Recommendations for DEI Studies.","authors":"Georgios Karamitros, Michael P Grant, Gregory A Lamaris","doi":"10.1016/j.jss.2024.11.050","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.050","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007376","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 Systematic Review and Meta-Analysis of Surgical Approaches for Venous Thoracic Outlet Syndrome.","authors":"Behrad Ziapour, Keivan Ranjbar, Tina Tian, Robert W Thompson, Payam Salehi","doi":"10.1016/j.jss.2024.12.027","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.027","url":null,"abstract":"<p><strong>Introduction: </strong>There is currently no consensus on the optimal surgical approach for the treatment of venous thoracic outlet syndrome (vTOS). Surgical exposures for vTOS decompression include infraclavicular (IC), supraclavicular (SC), paraclavicular (PC), and transaxillary (AX) approaches. The purpose of this study is to provide a comprehensive review of the outcomes and major complications of these four surgical techniques.</p><p><strong>Methods: </strong>This meta-analysis was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We performed a systematic search in the Cochrane Library trials register, Scopus, PubMed, EMBASE, Google Scholar, and the US National Library of Medicine clinical trial databases for studies that evaluated the above four surgical exposures for vTOS and included them. Three independent reviewers assessed studies for inclusion, extracted data, and assessed quality and risk of bias. Primary outcomes of interest were clinical improvement and postoperative primary patency rate. Secondary outcomes included rates of nerve injury, hematoma, hemothorax, pneumothorax, and other complications. Pooled proportions with 95% confidence intervals (CIs) of various outcomes were calculated using a random-effects model. Subgroup analyses according to surgical approach were conducted.</p><p><strong>Results: </strong>A total of twenty-six studies were included in the final analysis. The cumulative number of studies by surgical approach was 8 IC, 5 SC, 6 PC, and 11 AX. Pooled results from these studies demonstrated a 0.94 clinical improvement following surgical intervention (95% CI, 0.87-1), with a rate of 1 (95% CI, 0.99-1) for IC, 0.84 (95% CI, 0.38-1) for SC, 0.97 (95% CI, 0.76-1) for PC, and 0.88 (95% CI, 0.78-0.96) for AX approach. Overall, postoperative patency rate was 0.92 (95% CI, 0.84-0.97), with rate of 0.95 (95% CI, 0.89-1) for IC, 0.95 (95% CI, 0.78-1) for SC, 1 (95% CI, 0.98-1) for PC, and 0.69 (95% CI, 0.54-0.82) for AX approach. Subgroup analysis demonstrated a significantly higher rate of clinical improvement (0.12) in the IC group compared to the AX group. Rates of postoperative primary patency were higher in the IC (0.26), SC (0.26), and PC (0.31) groups than the AX group.</p><p><strong>Conclusions: </strong>Our study highlights the importance of considering different surgical approaches for the decompression of vTOS. While the IC, SC, and PC methods demonstrate comparable postoperative primary patency and clinical improvement, the AX approach shows lower outcomes in these aspects. Surgeons should carefully weigh the benefits and limitations of each approach when determining the most suitable surgical technique for vTOS patients.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"306-316"},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Note Template Expedites Completion of Consults for Surgical Fetal Anomalies.","authors":"Michael B Gyimah, Sarah Peiffer, Shannon M Larabee, Timothy C Lee, Sundeep G Keswani, Alice King","doi":"10.1016/j.jss.2024.11.048","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.048","url":null,"abstract":"<p><strong>Introduction: </strong>We developed standardized electronic medical record templates (EMR-temp) for use in ambulatory prenatal surgical consultations for surgical fetal anomalies (SFAs). Our aim was to evaluate EMR-temp impact in provider documentation in prenatal care of SFA.</p><p><strong>Methods: </strong>Prenatal consultations for SFAs at a single institution were retrospectively reviewed (2019-2022). Disease-specific EMR-templates were developed. Note content and time to encounter closure (TEC) were collected. Descriptive statistics, chi-square, Fisher's Exact Test, and Wilcoxon rank sum tests were used.</p><p><strong>Results: </strong>Seven hundred twenty-four prenatal consultations were analyzed, with 131 consultations (18%) using EMR-temp for 55 (42%) congenital diaphragmatic hernia, 50 (38%) congenital lung malformations, 9 (7%) neural tube defects, 8 (6%) gastroschisis, and 9 (7%) heterotaxy. Overall median TEC was 23.9 hs [interquartile range (IQR) 1.3-128.6]. EMR-temp use decreases TEC from 28.4 hs [IQR 1.6-159.4] to 2.07 hs [IQR 0.85-76.2] (P < 0.001). The impact of EMR-temp varies depending on pathology. In congenital diaphragmatic hernia, EMR-temp decreased TEC 61%, from 52.0 [IQR 2.6-171.1] to 20.3 hs [IQR 1.5-55.5] (P = 0.01). In neural tube defect, EMR-temp decreased TEC 98% from 48.6 [IQR 2.6-157.1] to 1.02 hs [IQR 0.5-1.5] (P < 0.001). There were no differences in TEC with EMR-temp use in congenital lung malformation, gastroschisis and heterotaxy (P > 0.05). Across all diseases, EMR-temp had more comprehensive documentation of the following content: pathophysiology (92%), pregnancy planning (92%), delivery planning (84%), postnatal planning (95%), and long-term follow-up (90%) compared to nontemplates (P < 0.01).</p><p><strong>Conclusions: </strong>EMR templates in SFA consultations improves encounter closure with comprehensive documentation of disease-specific pathophysiology and plans. However, impact varies across pathology, suggesting other factors are also important.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"299-305"},"PeriodicalIF":1.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Rates of Visualization for Axillary Reverse Mapping Using Indocyanine Green Fluorescence Compared With Blue Dye.","authors":"Sydney A Jupitz, Christie Lin, Tisha Kawahara, Grace McKinney, Adam J Uselmann, Heather B Neuman","doi":"10.1016/j.jss.2024.11.043","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.043","url":null,"abstract":"<p><strong>Introduction: </strong>Successful axillary reverse mapping (ARM) during lymph node surgery for breast cancer has the potential to reduce risk of lymphedema. Standard of care uses blue dye for ARM; however, recent imaging advances with near-infrared indocyanine green (ICG) fluorescence has demonstrated potential to improve intraoperative ARM imaging. The objective was to determine the feasibility of using ICG fluorescence through the OnLume Avata System for ARM.</p><p><strong>Methods: </strong>Breast cancer patients undergoing axillary lymph node dissection and were to undergo ARM were enrolled. Lymphatic structures were visualized using ICG fluorescence and blue dye. Real-time fluorescence images were acquired with the OnLume Avata System preincision, intraoperatively, and post dissection during the ARM. Preincision images were quantitatively analyzed for lymphatic fluorescence signal in terms of contrast-to-noise ratio. Imaging data were evaluated in terms of binary visualization rates and signal-to-background ratio.</p><p><strong>Results: </strong>Lymph nodes, lymphatic vessels, and lymph pooling were observed with fluorescence more frequently than blue dye. For seven out of eight cases, at least one vessel was visualized near the axilla preincision. In all eight cases, ICG fluorescence was noted during the procedure with five cases visualizing intact lymphatics at the end of the procedure. The ambient-light compatibility of the imager allowed the surgeon to operate with image guidance throughout the ARM procedure.</p><p><strong>Conclusions: </strong>The Avata demonstrated superior identification and visualization with ICG when compared to blue dye for visualizing lymphatic structures in real time with minimal disruption to the clinical workflow.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"290-298"},"PeriodicalIF":1.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007374","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}