Journal of Surgical Research最新文献

{"title":"Stitching the Story: Third-Y Clerkship Impact on Applicants to General Surgery Residency","authors":"Aaron L. Albuck BS ,&nbsp;Alison K. Mortemore BS, MS ,&nbsp;Ariel Kesick BS, MPP ,&nbsp;Jacquelyn Turner MD, FACS, FASCRS","doi":"10.1016/j.jss.2025.09.027","DOIUrl":"10.1016/j.jss.2025.09.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Medical students' clerkship experiences play a crucial role in shaping specialty interests. Factors such as mentorship, autonomy, and meaningful patient care contribute to clerkship quality and career decisions. Previous studies suggest that positive interactions with residents and attendings significantly influence students' likelihood of pursuing a specialty. This study evaluates key clerkship factors associated with students' interest in general surgery, focusing on mentorship, clinical exposure, and academic performance.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at a single medical school, analyzing data from students who completed their third-year surgical clerkship between May 2023 and December 2024. A deidentified survey assessed students' specialty preferences, clerkship timing, service assignments, team structures, and subjective factors influencing specialty choice. Performance data from the surgery shelf exam and clerkship grades were analyzed for associations.</div></div><div><h3>Results</h3><div>Among 144 respondents (27.6% response rate), 23.7% applied to general surgery. At the start of the third y, 18.0% were not interested in surgery, 39.6% were open-minded, 36.8% were interested, and 4.9% were committed. Notably, students exposed to postgraduate year-1 residents had a significantly higher likelihood of applying (odds ratio 1.887, <em>P</em> = 0.046). Direct participation in cases (60.6%), interactions with residents (56.7%), and faculty mentorship (52.0%) were key factors, whereas long work hours negatively impacted the interest.</div></div><div><h3>Conclusions</h3><div>This study highlights that direct clinical exposure, mentorship from junior residents, and active case participation strongly influence medical students' interest in general surgery. Although academic performance did not significantly impact specialty selection, subjective experiences and the quality of interactions played a pivotal role.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 400-406"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268562","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":"Presensitization Accelerates Antibody-Mediated Rejection in Mouse Intestinal Transplantation","authors":"Takuro Fujita MD,&nbsp;Hajime Matsushima MD, PhD,&nbsp;Taichiro Kosaka MD, PhD,&nbsp;Daisuke Miyamoto PhD,&nbsp;Akihiko Soyama MD, PhD,&nbsp;Takanobu Hara MD, PhD,&nbsp;Tomohiko Adachi MD, PhD,&nbsp;Kengo Kanetaka MD, PhD,&nbsp;Susumu Eguchi MD, PhD","doi":"10.1016/j.jss.2025.09.060","DOIUrl":"10.1016/j.jss.2025.09.060","url":null,"abstract":"<div><h3>Introduction</h3><div>The presence of donor-specific antibodies (DSAs) is a risk factor for antibody-mediated rejection (AMR) in the context of organ transplantation. However, the mechanisms and clinical characteristics of AMR in intestinal transplantation remain poorly understood, largely due to a lack of suitable animal models. In the present study, we performed intestinal transplantation in presensitized murine recipients as a model of AMR to better understand how this phenomenon contributes to graft rejection.</div></div><div><h3>Methods</h3><div>Skin from donor B6 mice was grafted onto the backs of recipient C3H mice. The presensitized C3H mice then received intestinal allografts from B6 mice 14 ds later. The presensitized and nonsensitized mice were compared in terms of their circulating DSAs levels and their intestinal allograft characteristics at various time points.</div></div><div><h3>Results</h3><div>Flow cytometric analysis showed that circulating DSA levels increased over time in the presensitized recipients. Moreover, the presensitized recipients exhibited more severe intestinal graft rejection at day 4 post-transplantation than the nonsensitized mice. Although immunostaining revealed no significant difference in the numbers of infiltrating CD4⁺ and CD8⁺ cells between the groups post-transplantation, the numbers of infiltrating CD20⁺ and CD68⁺ cells were significantly higher in the presensitized recipients. Furthermore, C3 and C4 deposition on the microvascular endothelium of intestinal allografts and capillaritis were observed after transplantation.</div></div><div><h3>Conclusions</h3><div>We successfully established a presensitized mouse model of AMR in the context of intestinal transplantation. Our model will be valuable in elucidating the mechanisms underlying AMR and exploring strategies for managing this phenomenon to improve the outcomes of intestinal transplantation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 390-399"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268070","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":"Under Pressure: Rapid Infusion of Stored Whole Blood Alters Coagulation Parameters","authors":"Ellen R. Becker MD,&nbsp;Ryan C. Chae MD,&nbsp;Adam D. Price MD,&nbsp;Lindsey J. Wattley MD,&nbsp;Rebecca M. Schuster MS,&nbsp;Michael D. Goodman MD,&nbsp;Timothy A. Pritts MD, PhD","doi":"10.1016/j.jss.2025.07.067","DOIUrl":"10.1016/j.jss.2025.07.067","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of normothermic rapid transfusers to deliver high volumes of warmed blood products to hemorrhaging patients is common practice. However, the effects of these transfusers on the coagulation profile of stored compared to fresh whole blood has not been studied.</div></div><div><h3>Methods</h3><div>Units of fresh whole blood and blood stored for 21 days were acquired from our local blood bank. Rapid infusion was simulated using a Level 1 H-1200 at 42°C and 300 mmHg of pressure. Samples were taken preinfusion and postinfusion and examined for cell counts, biochemical changes, viability, viscoelastic properties, and microvesicle concentrations.</div></div><div><h3>Results</h3><div>Fresh whole blood was unaffected by rapid infusion in all end points. In contrast, rapid infusion of stored whole blood resulted in significantly higher levels of free hemoglobin (63 ± 25 mg/mL preinfusion to 101 ± 41 mg/mL postinfusion, <em>P</em> = 0.0025), decreased platelet contribution to clot (73 ± 5% to 66 ± 6%, <em>P</em> = 0.0075), decreased platelet aggregation (10.1 ± 5.5 to 6.0 ± 3.7 area under the curve with arachidonic acid, <em>P</em> = 0.03), and increased platelet derived microvesicles (164 ± 151 to 260 ± 163 events/μL, <em>P</em> = 0.01). Platelet and platelet microvesicle concentrations expressing CD62 in stored whole blood remained unchanged postinfusion (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Infusion of stored whole blood via a rapid infuser resulted in hemolysis, platelet dysfunction, and increased platelet-derived microvesicles. We suspect that platelet destruction due to pressurized infusion leads to an increase in microvesicle concentration and a subsequently altered coagulation profile.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 381-389"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268966","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":"Response to \"Letter Regarding: The Performance of ChatGPT-4.0 and ChatGPT-4omni on Answering Thyroid Question: A Multicenter Study\".","authors":"Siyin Guo, Genpeng Li, Juxiang Gou, Yanping Gong, Wanjun Zhao, Zhiqiang Li, Xianwei Yang, Zhenni Liu, Zhihui Li, Jianyong Lei","doi":"10.1016/j.jss.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.jss.2025.09.030","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275013","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":"Quality of Life and Functional Outcomes After Watch-and-Wait for Locally Advanced Rectal Cancer: A Meta-Analysis","authors":"Racquel S. Gaetani MD, MSc,&nbsp;Sowmya Sharma MD,&nbsp;Tasneem Zaihra Rizvi PhD,&nbsp;Jonathan S. Abelson MD, MSc","doi":"10.1016/j.jss.2025.09.019","DOIUrl":"10.1016/j.jss.2025.09.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Watch-and-wait (W&amp;W), which involves total neoadjuvant therapy followed by close observation, has emerged as an alternative to total mesorectal excision for patients with locally advanced rectal cancer who achieve a clinical or near-complete response. This approach aims to preserve bowel function and avoid the morbidity associated with radical surgery.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. Eligible studies included randomized trials and observational studies of patients with locally advanced rectal cancer treated with total neoadjuvant therapy, followed by either W&amp;W or total mesorectal excision. The primary outcome was quality of life (QoL), assessed using validated instruments (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Quality of Life Questionnaire-CR29, Fecal Incontinence Quality of Life). Secondary outcomes included bowel function among patients without an ostomy, using validated measures such as Cleveland Clinic Florida Fecal Incontinence Scores, Vaizey, Memorial Sloan Kettering Cancer Center, and low anterior resection syndrome scores. A comprehensive search of PubMed, EMBASE, Medline, and Web of Science (Sept 2023-May 2025) was performed without language or date restrictions. Abstract/full-text screening, data extraction, and risk of bias assessments were conducted independently by two reviewers. Meta-analyses used inverse-variance weighting under a random-effects model. Data unsuitable for meta-analysis were synthesized narratively.</div></div><div><h3>Results</h3><div>Of 617 screened studies, 28 were reviewed in full and 9 met inclusion criteria (total 923 patients). Meta-analysis of five studies (<em>n</em> = 601) with no statistically significant difference in overall QoL between groups (pooled mean difference = 0.10, 95% confidence interval: −0.19 to 0.39, <em>P</em> = 0.49). However, pooled analysis of fecal incontinence scores from four studies (<em>n</em> = 384) showed a significant advantage for W&amp;W (pooled mean difference = −1.10, 95% confidence interval: −1.50 to −0.73, <em>P</em> &lt; 0.001). Qualitative synthesis of low anterior resections syndrome scores outcomes favored W&amp;W.</div></div><div><h3>Conclusions</h3><div>W&amp;W, offers a functional advantage without compromising QoL. The decision to pursue W&amp;W should be individualized, considering both the potential functional benefits and the oncological risks.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 362-375"},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268563","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":"Effects of Irrigation With Normal Saline on Traumatic Brain Injury Combined With Seawater Immersion in Rats.","authors":"Yang Yang, Li Chen, Pengwei Hou, Xia Yu, Tianshun Feng, Yuhui Chen, Yongjun Xu, Shousen Wang","doi":"10.1016/j.jss.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.jss.2025.09.017","url":null,"abstract":"<p><strong>Introduction: </strong>With the integrated development of the global economy, various economic activities in marine environments are also expanding, along with the number of offshore employees. However, the increased risk of accidental falling and collisions at sea may lead to traumatic brain injury (TBI) accompanied by seawater immersion (SI). The high permeability and alkalinity of seawater increase the risk of TBI and damage to the blood-brain barrier (BBB), which can indirectly result in excessive neuroinflammation, brain edema, and neuronal cell death.</p><p><strong>Methods: </strong>A well-characterized rat model of TBI + SI induced by controlled cortical impact combined with SI was established. After successful modeling, three different concentrations of sodium chloride (NaCl) solutions were used to irrigate the wound site to assess the effects on rats with early TBI complicated with SI.</p><p><strong>Results: </strong>The results showed that irrigation with 0.9% NaCl (normal saline [NS]) significantly reduced neurological dysfunction, reduced brain edema, and inhibited neuroinflammatory response in rats with TBI combined with SI. However, irrigation with 3% NaCl (3% hypertonic saline) aggravated the injury, whereas 0.45% NaCl (half-NS) had no obvious improvement. Irrigation with NS can neutralize the high alkalinity of seawater and prevent further damage to the BBB. Irrigation with NS caused fewer morphological changes to the neuronal mitochondria and prevented further damage, suggesting that NS was the most suitable rinse solution.</p><p><strong>Conclusions: </strong>SI can cause damage to the BBB, neuroinflammation, and neuronal cell death after TBI. Restoration of the injured BBB is a promising strategy for the treatment of TBI combined with SI.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Considerations for Patients With de Novo Metastatic Breast Cancer Based on Prognostic Group","authors":"Tori C. Nierenberg MS ,&nbsp;Samantha M. Thomas MS ,&nbsp;Victoria Rey BS ,&nbsp;Sara Kesan BS ,&nbsp;Ton Wang MD, MS ,&nbsp;Kendra J. Modell Parrish DO ,&nbsp;Akiko Chiba MD ,&nbsp;Astrid Botty van den Bruele MD ,&nbsp;Laura H. Rosenberger MD, MS ,&nbsp;Jennifer K. Plichta MD, MS","doi":"10.1016/j.jss.2025.08.020","DOIUrl":"10.1016/j.jss.2025.08.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Advances in systemic therapy for de novo metastatic breast cancer (dnMBC) led to the development of a novel staging system (IVA-D), which stratifies patients into prognostic subgroups based on tumor characteristics and metastatic extent. Overall survival (OS) varies between subgroups; therefore, different treatment approaches may be considered. This study explores the association of surgery of the primary tumor with OS among prognostic subgroups.</div></div><div><h3>Methods</h3><div>Patients with dnMBC (2010-2020) receiving systemic therapy were selected from the National Cancer Database (NCDB) and stratified by prognostic stage group (IVA-D). A landmark analysis was employed with OS defined as the time from diagnosis, plus 12 mo, to death due to any cause. Kaplan–Meier methods, log-rank tests, and adjusted Cox models evaluated OS differences and associations.</div></div><div><h3>Results</h3><div>Among 42,824 patients, subgroups included IVA 7.3%, IVB 55.7%, IVC 27.4%, and IVD 9.5%. Surgery receipt varied by subgroups: IVA 34.5%, IVB 23.7%, IVC 21.5%, and IVD 29.8% (<em>P</em> &lt; 0.001). After adjustment, surgery was associated with younger age, fewer comorbidities, and private insurance (all <em>P</em> &lt; 0.05). Median OS varied: IVA 84.5 mo, IVB 49.4 mo, IVC 30.8 mo, and IVD 15.3 mo. Among those with IVA disease, surgery patients had better unadjusted 5-y OS (77.5% <em>versus</em> 49.7%, log rank <em>P</em> &lt; 0.001). Despite lower absolute survival in advanced stages (IVB-D), surgery remained associated with significantly higher OS. Adjusted analysis confirmed surgery's association with improved OS (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.57-0.63).</div></div><div><h3>Conclusions</h3><div>Surgery of the primary tumor may be associated with better survival for selected patients with dnMBC, and future prospective studies may consider exploring this association using prognostic subgroups.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 348-361"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268579","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":"Robot-assisted Interval Cholecystectomy is not Inferior to Laparoscopic Interval Cholecystectomy in Advanced Cholecystitis","authors":"Ikemsinachi C. Nzenwa MBChB, MSc ,&nbsp;Ritwik Sanyal BS ,&nbsp;Yasmin Arda MD ,&nbsp;Vahe S. Panossian MD ,&nbsp;Dias Argandykov MD ,&nbsp;Michael P. DeWane MD ,&nbsp;Matthew A. Bartek MD, MPH ,&nbsp;Joshua S. Ng-Kamstra MD, MPH ,&nbsp;John O. Hwabejire MD, MPH ,&nbsp;George C. Velmahos MD, PhD ,&nbsp;Haytham M.A. Kaafarani MD, MPH ,&nbsp;Charudutt N. Paranjape MD","doi":"10.1016/j.jss.2025.09.040","DOIUrl":"10.1016/j.jss.2025.09.040","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted cholecystectomy has been recently associated with increased bile duct injury and biliary interventions. Careful patient selection is key to maximizing the benefits of robot-assisted surgery. We used a national dataset to compare complication rates and healthcare utilization between laparoscopic and robot-assisted interval cholecystectomy (IC) after percutaneous cholecystostomy (PCT).</div></div><div><h3>Methods</h3><div>We analyzed the 2016-2019 Nationwide Readmissions Database (NRD) to identify adult patients who underwent percutaneous cholecystostomy during an index admission for cholecystitis and later received either laparoscopic or robot-assisted IC on readmission within the same calendar year. The primary outcome was a composite measure of mortality and morbidity. We performed a 2:1 propensity-matched analysis to adjust for clinically relevant confounders. A subgroup analysis of patients treated at high-volume centers was conducted.</div></div><div><h3>Results</h3><div>A total of 3179 patients undergoing IC were identified, with 209 (6.6%) receiving robot-assisted surgery. The median age was 72 y and 41.4% were female. After matching, 376 and 188 patients were in the laparoscopic IC and robot-assisted cohorts, respectively. Adjusted analyses revealed no significant difference in the composite mortality-morbidity rate between robot-assisted and laparoscopic IC (37.8% <em>versus</em> 34.3%, <em>P</em> = 0.42). Additionally, there were no significant differences in length of stay and nonroutine discharge rates between the two groups. However, robot-assisted IC was associated with significantly higher hospital costs ($17,077 <em>versus</em> $13,531, <em>P</em> &lt; 0.001). In the subgroup analysis, there were still no significant differences in adverse outcomes between the two surgical approaches, though the cost of hospitalization remained higher for the robot-assisted group ($16,470 <em>versus</em> $14,463, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Even after accounting for center volume, robot-assisted and laparoscopic IC yielded comparable outcomes in patients with difficult gallbladders or advanced cholecystitis. While robot-assisted IC does not increase the risk of adverse outcomes, it is associated with higher healthcare costs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 313-323"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268454","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 of Well-being Measures With Suicidal Ideation in Surgeons","authors":"Reagan A. Collins MD ,&nbsp;Jessica A. Gold MD, MS ,&nbsp;Colin P. West MD, PhD ,&nbsp;Nathaniel D. Mercaldo PhD ,&nbsp;Carrie E. Cunningham MD, MPH","doi":"10.1016/j.jss.2025.09.042","DOIUrl":"10.1016/j.jss.2025.09.042","url":null,"abstract":"<div><h3>Introduction</h3><div>In a 2023 national survey of surgeons, nearly one out of 7 surgeons reported thoughts of suicide in the past year. This study aimed to assess the relationship between potentially modifiable personal and professional well-being measures (professional fulfillment, self-valuation, resilience, and loneliness) and suicidal ideation.</div></div><div><h3>Methods</h3><div>An anonymous survey developed by a group of surgeons, psychiatrists, survey scientists, and statisticians was distributed to members of several national surgical societies. Suicidal ideation was assessed using a single item, and the well-being instruments included the Stanford Professional Fulfillment Index, Stanford Self-Valuation Scale, Brief Resilient Coping Scale, and the De Jong Gierveld Isolation Scale. Multivariable logistic regression was used to assess the association between well-being scores with suicidal ideation.</div></div><div><h3>Results</h3><div>A total of 622 students, trainees, and surgeons completed the survey (51% female). On multivariable analysis adjusted for sex, training level, and prior mental health disorder diagnosis, respondents with higher scores in professional fulfillment (adjusted odds ratio: 0.51 (95% confidence interval: 0.38-0.70), <em>P</em> &lt; 0.001), higher resilience (0.82 [0.73-0.92], <em>P</em> = 0.001), and higher self-valuation (0.83 [0.75-0.91], <em>P</em> &lt; 0.001) had lower odds of reporting suicidal ideation in the previous 12 months, whereas those with higher loneliness scores (1.45 [1.25-1.67], <em>P</em> &lt; 0.001) had higher odds of reporting suicidal ideation in the previous 12 months.</div></div><div><h3>Conclusions</h3><div>Higher professional fulfillment, resilience, and self-valuation scores were associated with decreased odds of suicidal ideation while higher loneliness scores were associated with increased suicidal ideation. Institutional or professional society-directed initiatives aimed at improving these factors may be potential targets for reducing suicidal ideation among the surgical community.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 324-330"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268072","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":"Overnight Decision-Making for Equivocal Appendicitis Often Involves Unnecessary Hospital Admissions","authors":"Daniel R. Liesman MD ,&nbsp;Steven T. Papastefan MD ,&nbsp;Sara Ungerleider BA ,&nbsp;Michela Carter MD ,&nbsp;J. Benjamin Pitt MD ,&nbsp;Kathryn L. McElhinney MD ,&nbsp;Julia E. Grabowski MD ,&nbsp;Sriram Ramgopal MD ,&nbsp;Seth D. Goldstein MD, MPhil","doi":"10.1016/j.jss.2025.09.035","DOIUrl":"10.1016/j.jss.2025.09.035","url":null,"abstract":"<div><h3>Background</h3><div>After-hours surgical consultations for equivocal appendicitis are common in children's hospitals. When surgery is not clearly indicated, disposition options include hospital admission with serial examinations (ASE) or discharge with return precautions. In our hospital, ASE occurs exclusively after-hours. The purpose of this study is to characterize the benefits and harms of overnight ASE for equivocal appendicitis.</div></div><div><h3>Materials and methods</h3><div>We conducted a single-institution retrospective review of patients less than 18 ys old evaluated overnight for suspected appendicitis from July 2021 to July 2023. The definition of equivocal appendicitis was considered to be nondefinitive imaging as determined by the attending radiologist and overnight surgical resident. Analyzed groups included ASE <em>versus</em> discharged patients.</div></div><div><h3>Results</h3><div>There were 43 (54%) patients in the ASE group and 36 (46%) discharged patients. Ten ASE patients underwent appendectomy with 3 (30%) showing no inflammation on pathology (negative appendectomy). One (3%) discharged patient represented ultimately undergoing a negative appendectomy. ASE patients without appendicitis had higher Alvarado scores compared to discharged patients (4.0 <em>versus</em> 3.0, <em>P</em> value = 0.004). An Alvarado score less than 5 ruled out appendicitis in 100% of cases; however, 44% of these patients were admitted.</div></div><div><h3>Conclusions</h3><div>Children with equivocal appendicitis presenting after-hours are often admitted to the hospital, despite low Alvarado scores. Children in this study offered ASEs for equivocal appendicitis have unexpectedly high negative appendectomy rates. Conversely, patients with low Alvarado scores who are discharged rarely present for subsequent intervention. Discharging patients with equivocal appendicitis and low Alvarado score may reduce resource utilization without increasing risks of missed diagnosis.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 338-347"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268465","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}