Journal of Surgical Research最新文献

{"title":"Improving Medical Student Surgery Notes Through Near-Peer Targeted Education: A Qualitative Analysis","authors":"Ariana Naaseh MD, MPHS,&nbsp;Rachel Kalbfell BS,&nbsp;Carla Koberna,&nbsp;Kerri A. Ohman MD,&nbsp;Lindsay M. Kranker MD,&nbsp;Bethany C. Sacks MD, MEd","doi":"10.1016/j.jss.2025.02.035","DOIUrl":"10.1016/j.jss.2025.02.035","url":null,"abstract":"<div><h3>Introduction</h3><div>It is necessary for medical students (MSs) to develop proficiency in medical documentation before residency; however, there is limited education focused on this task. We conducted a qualitative analysis of surgical clerkship note evaluations to create an intervention to improve note writing skills and utilized post-intervention assessments to determine the effect on the quality of clerkship student notes.</div></div><div><h3>Methods</h3><div>An intervention consisting of an in-person senior MS led lecture during the surgery clerkship orientation focused on Subjective-Objective-Assessment-Plan (SOAP) notes was introduced to MS with limited prior note writing education. Examples of complete and accurate surgical SOAP notes were discussed in-person and shared online. Reports from note assessments were analyzed for four clerkship cycles (2 pre-intervention and 2 post-intervention). Descriptive statistics and Fisher's exact tests were performed to compare assessment responses pre-intervention and post-intervention. Thematic analysis was performed on open-ended responses focused on areas for improvement from the anonymized evaluations.</div></div><div><h3>Results</h3><div>One hundred seventy-one total note assessments were evaluated (85 pre-intervention and 86 post-intervention). Pre-intervention, MS struggled with note organization and lack of inclusion of patient-centered language within their documentation. Post-intervention, students struggled less frequently with flow and chronology of notes but had continued opportunities to improve in concise and organized presentation of information. Students improved in their ability to provide a one-liner, prioritize a differential diagnosis, and organize and structure their notes effectively. Feedback focused on advanced skills including plan specificity, discharge details and parameters, or advanced physical exam finding documentation.</div></div><div><h3>Conclusions</h3><div>MS improved their SOAP format note writing skills in response to a targeted near-peer led educational intervention. Remaining growth opportunities in note writing skills appear more connected to evolving clinical reasoning and surgery-specific knowledge which can evolve with ongoing exposure and further education.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 224-232"},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Readmissions Following Left Ventricular Assist Device Implantation","authors":"John B. Eisenga MD ,&nbsp;Kyle A. McCullough MD ,&nbsp;Aasim Afzal MD ,&nbsp;J. Michael DiMaio MD ,&nbsp;Ghadi Moubarak MD ,&nbsp;Greg Milligan MD ,&nbsp;Nitin Kabra MD ,&nbsp;Akash Rusia MD ,&nbsp;David A. Rawitscher MD ,&nbsp;Timothy J. George MD","doi":"10.1016/j.jss.2025.02.009","DOIUrl":"10.1016/j.jss.2025.02.009","url":null,"abstract":"<div><h3>Introduction</h3><div>While left ventricular device implantation has been shown to improve both survival and quality of life in patients with end stage heart failure, these patients have a high rate of readmissions to the hospital. The incidence and factors associated with readmission are poorly characterized in the destination therapy population.</div></div><div><h3>Methods</h3><div>All patients who underwent HeartMate III left ventricular assist device therapy (LVAD) implantation at our facility from 2017 to 2023 were identified. Patients undergoing primary LVAD implantation were included. Primary outcome was readmission for any reason. Multivariable linear regression was utilized to identify predictors of readmissions.</div></div><div><h3>Results</h3><div>From 2017 to 2023, 151 primary LVAD implantations were performed with 12 (8.0%) perioperative moralities (defined as index implant hospitalization mortality). The 139 remaining patients suffered 456 separate readmissions with a median follow-up of 590 (303-1002) ds and a total follow-up of 270.7 patient-ys for a rate of 1.7 readmissions per patient-y. The most common cause of readmission was heart failure exacerbation (27.0%), major infection (17.8%), and major bleeding (13.6%). Patients who were readmitted within 6 mos were more likely to have New York Heart Association class III or IV symptoms compared to those who had not been readmitted 39.1% <em>versus</em> 11.8% <em>versus</em> 15%, <em>P</em> = 0.0008. On multivariable linear regression, increasing body mass index (<em>P</em> = 0.02), increased preoperative bilirubin (<em>P</em> = 0.04), and increased follow-up time (<em>P</em> &lt; 0.01) were predictive of the need for readmissions.</div></div><div><h3>Conclusions</h3><div>Following LVAD implantation, readmissions within 6 mos of surgery are associated with worse functional status at 6 mos and 1 y postoperatively. Increased body mass index and preoperative bilirubin were associated with more frequent readmissions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 202-208"},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685323","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 Radial Artery Use in Coronary Bypass Grafting: A Multi-institutional Cohort Study","authors":"Sean W.W. Noona MD ,&nbsp;Steven D. Young MD ,&nbsp;Andrew M. Young MD ,&nbsp;Raymond J. Strobel MD, MS ,&nbsp;Matthew P. Weber MD ,&nbsp;Ebun Ajadi MD ,&nbsp;Mohammed Quader MD ,&nbsp;Mark Joseph MD ,&nbsp;Leora T. Yarboro MD ,&nbsp;Kenan Yount MD ,&nbsp;Nicholas R. Teman MD ,&nbsp;Jared P. Beller MD","doi":"10.1016/j.jss.2025.02.026","DOIUrl":"10.1016/j.jss.2025.02.026","url":null,"abstract":"<div><h3>Introduction</h3><div>To explore trends and analyze clinical and angiographic predictors of radial utilization in patients undergoing isolated coronary artery bypass grafting (CABG).</div></div><div><h3>Methods</h3><div>We analyzed data from 17,352 patients undergoing isolated CABG (January 1, 2017, to December 31, 2022) in a regional Society of Thoracic Surgeons Adult Cardiac Surgery Database linked with the National Cardiovascular Data Registry CathPCI registry. Multivariable logistic regression assessed predictors of radial artery (RA) use.</div></div><div><h3>Results</h3><div>Radial artery grafts (RAGs) were used in 1745 patients (10.0%). Utilization increased from 3.34% (2017) to 14.24% (2022) (<em>P</em> &lt; 0.001). Patients receiving RAGs were younger (60 [53-67] <em>versus</em> 67 [60-73] y, <em>P</em> &lt; 0.001), had lower predicted risk of morbidity or mortality (6% <em>versus</em> 9%, <em>P</em> &lt; 0.001), and lower incidence of heart failure (25% <em>versus</em> 32%, <em>P</em> &lt; 0.001). Predictors of RA use included higher preoperative ejection fraction (odds ratio [OR] 1.18 [1.10-1.27], <em>P</em> &lt; 0.001), male sex (OR 1.72 [1.44-2.05], <em>P</em> &lt; 0.001), and increasing surgery year (OR 1.38 [1.33-1.44], <em>P</em> &lt; 0.001). Conversely, severe chronic kidney disease (OR 0.30 [0.18-0.49], <em>P</em> &lt; 0.001), older age (OR 0.56 [0.52-0.60], <em>P</em> &lt; 0.001), and higher predicted risk of morbidity or mortality (OR 0.79 [0.71-0.89], <em>P</em> &lt; 0.001) decreased likelihood of receiving a RAG. Critical lesion stenosis (≥90%) did not predict RA use (OR 1.06 [0.78-1.44], <em>P</em> = 0.70).</div></div><div><h3>Conclusions</h3><div>RA use in CABG remains limited, predominantly in younger, healthier patients. These findings suggest surgeons likely consider clinical and potential long-term benefits in choosing radial grafting. Understanding relative predictors of radial grafting could enhance CABG outcomes across patient demographics.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 193-201"},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631789","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":"Incidental Thyroid Cancer in Patients With Graves’ Disease: Not as Rare as We Previously Believed","authors":"Shaidy Moronta DO ,&nbsp;Lauren Slattery MD, MS ,&nbsp;Rongzhi Wang MD, MSPH ,&nbsp;Fiemu Nwariaku MD, MBA ,&nbsp;Jessica Liu McMullin MD, MS","doi":"10.1016/j.jss.2025.02.024","DOIUrl":"10.1016/j.jss.2025.02.024","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of thyroid cancer in Graves' disease (GD) patients remains unclear due to the limitations of previous studies which mostly include small, single-institution cohorts. We used the large, multi-institutional National Surgical Quality Improvement Program's Procedure Targeted Thyroidectomy dataset to explore the rate of incidental thyroid cancer in Graves' patients undergoing total thyroidectomy.</div></div><div><h3>Methods</h3><div>We identified patients who underwent total thyroidectomy for GD in the National Surgical Quality Improvement Program's Procedure Targeted Thyroidectomy between 2013 and 2021. Surgical pathology reports were reviewed for coexisting thyroid cancer, excluding occult or microconfined cases. Demographic and postoperative outcomes were compared for patients with and without incidental cancer.</div></div><div><h3>Results</h3><div>Of 3193 GD patients treated surgically, 406 (12.7%) had incidental thyroid cancer on final pathology. Among those with cancer, 387 (95.3%) had papillary thyroid carcinoma, 14 (3.4%) had follicular cancer, and 1.3% had Hürthle cell cancer or metastasis from other primaries. On pathology, 343 (84.5%) had T1 disease, 23 (5.7%) T2, and 16 (3.9%) T3, while 26 patients (6.4%) had N1 disease. Most cancers were solitary and unilateral (61.6%), however, 12.6% had multifocal unilateral disease, and 19.2% had multifocal bilateral disease. Graves’ patients with cancer were older (median age 47.0 <em>versus</em> 42.0, <em>P</em> &lt; 0.01) and had a higher body mass index (median body mass index 28.9 <em>versus</em> 27.8, <em>P</em> &lt; 0.01) at the time of surgery, with no difference in postoperative outcomes.</div></div><div><h3>Conclusions</h3><div>Thyroid cancer was incidentally found in 12.7% of patients undergoing thyroidectomy for GD. This risk should be considered when counseling patients on definitive management of GD.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 122-128"},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631785","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":"Incident Food Insecurity and Associated Risk Factors After Surgical Trauma","authors":"Annabelle Jones MD, MPH ,&nbsp;Anam N. Ehsan MBBS ,&nbsp;Shivangi Saha MCh ,&nbsp;Chuan-Chin Huang DSc, MS ,&nbsp;Nivedha Pillai MBBS ,&nbsp;Preet Hathi MBBS ,&nbsp;Srinivasan Vengadassalapathy MBBS, MD ,&nbsp;Keerthana Bhat MBBS ,&nbsp;Praveen Ganesh MDS ,&nbsp;Shashank Chauhan MS, MCh ,&nbsp;Maneesh Singhal MCh ,&nbsp;S. Raja Sabapathy MS, MCh, DNB ,&nbsp;Seth A. Berkowitz MD, MPH ,&nbsp;Kavitha Ranganathan MD","doi":"10.1016/j.jss.2025.02.008","DOIUrl":"10.1016/j.jss.2025.02.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Food insecurity, defined as a lack of access to adequate nutrition, impacts approximately 30% of the global population. Despite clear evidence regarding the benefit of proper nutrition on clinical outcomes, the burden of incident food insecurity after surgical intervention in previously food secure patients is unknown. The goal of the study was to quantify incident food insecurity post operatively and to identify associated risk factors.</div></div><div><h3>Methods</h3><div>A multicenter, prospective, longitudinal study was conducted among adult surgical trauma patients at tertiary care public and private hospitals in India. The primary outcome was new food insecurity from initial admission for traumatic injury to 6 mo post operatively. Cox proportional hazards models were used to evaluate associations between clinical and sociodemographic variables and incident food insecurity.</div></div><div><h3>Results</h3><div>Of 774 patients enrolled, 20% were food insecure at baseline. During the follow-up period, 21% of patients who were food secure at baseline experienced new food insecurity. Incident food insecurity was associated with longer length of stay (hazard ratio (HR): 3.76, 95% confidence interval (CI): 1.62-8.74; <em>P</em> = 0.002), intensive care unit admission (HR: 1.87, 95% CI: 1.05-3.31; <em>P</em> = 0.032), receiving welfare support (HR: 2.00, 95% CI: 1.00-3.98; <em>P</em> = 0.049) and daily wage, rather than salaried, employment (HR: 2.95, 95% CI: 1.24-7.06; <em>P</em> = 0.015). Higher total household income was associated with maintaining food security (HR: 0.24, 95% CI: 0.13-0.44; <em>P</em> &lt; 0.001). Hospitalization-related financial toxicity was significantly associated with incident food insecurity (HR: 3.07, 95% CI: 2.09-4.50; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>High levels of incident food insecurity were observed among surgical trauma patients. This highlights the need for serial food insecurity assessment post discharge. In lieu of serial follow-up, risk factors associated with incident food insecurity can be used to identify high-risk patients prior to discharge to facilitate connection to food insecurity interventions such as food prescription programs, monetary support, and nutritional welfare policies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 174-182"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628806","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":"Development and Validation of a Discharge Disposition Prediction Model in Injured Adults","authors":"Liling Lu MS,&nbsp;David Silver MD, MPH,&nbsp;Jamison Beiriger BS,&nbsp;Sebastian M. Boland MD,&nbsp;Tamara J. Byrd MD,&nbsp;Joshua B. Brown MD, MSc","doi":"10.1016/j.jss.2025.02.017","DOIUrl":"10.1016/j.jss.2025.02.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Early prediction of posthospital disposition is crucial for counseling and planning, particularly for adults away from age extremes, given the greater uncertainty about returning home or requiring postacute care among these patients. We aimed to create a prediction model for discharge disposition using data from the first 24 h of admission.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the National Trauma Data Bank encompassing patients treated from 2007 to 2016, focusing on individuals aged 35-70, categorized by discharge disposition. Our objective was to predict discharge outcomes – home, rehabilitation, skilled nursing facility, or mortality – employing machine learning techniques based on patient factors, including demographics, comorbidities, injuries, and early resource utilization. Each base model underwent training and parameter tuning to optimize the F1 score and was then evaluated on unseen data. The top three base models were chosen to build a stack ensemble model, and performance was assessed using area under the receiver operating characteristics (AUC), F1, recall, and precision metrics through the one-<em>versus</em>-rest approach, comparing each class. External validation was conducted using data from the Pennsylvania Trauma Outcomes Study.</div></div><div><h3>Results</h3><div>A total of 2,342,703 patients were included. A stack ensemble model was built using the three top performers, which yielded AUCs from 0.73 to 0.97 for each class on held out National Trauma Data Bank data. This stacked model demonstrates strong generalizability across Pennsylvania Trauma Outcomes Study, with AUCs spanning from 0.71 to 0.97.</div></div><div><h3>Conclusions</h3><div>We created a stacked ensemble model that predicts discharge disposition for adults outside of the extremes of age with injuries within 24 h of admission. Further validation is warranted to show the potential benefits of this model for planning and patient and family guidance.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 129-140"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reoperative Laparoscopic Liver Resection for Hepatolithiasis Patients With a History of Biliary Surgery: A Cohort Study.","authors":"Yuan-Lin Yu, Jie Fu, Zhi-Wen Feng, Wei-Dong Zhang, Da-Fei Dai, Min-Tuo Wang, Yun-Feng Zhou, Xiao-Peng Chen","doi":"10.1016/j.jss.2025.02.028","DOIUrl":"https://doi.org/10.1016/j.jss.2025.02.028","url":null,"abstract":"<p><strong>Introduction: </strong>It is unclear whether laparoscopic hepatectomy for hepatolithiasis patients with a history of biliary surgery achieves favorable clinical outcomes. This study aimed to evaluate the safety and feasibility of reoperative laparoscopic hepatectomy (rLH).</p><p><strong>Methods: </strong>Patients who underwent anatomical liver resection for hepatolithiasis between 2015 and 2022 were included in the study. The clinical outcomes of rLH were compared with those of reoperative open hepatectomy (rOH) and initial laparoscopic hepatectomy (iLH). To ensure balanced baseline characteristics, propensity score matching was performed.</p><p><strong>Results: </strong>A total of 311 patients undergoing anatomical hepatectomy combined with biliary exploration for hepatolithiasis were studied, which included 84 rOH, 101 rLH, and 127 iLH. Propensity score matching resulted in 86 patients in both iLH (miLH) and rLH (mrLH) groups. Compared with the miLH group, the mrLH group had a higher conversion rate (14.0% versus 3.5%, P < 0.001), a higher 90-d complication rate (52.3% versus 34.9%, P = 0.035), and a lower stone clearance rate (initial, 76.2% versus 89.9%, P = 0.024; final, 81.0% versus 93.7%, P = 0.021). However, when compared with the rOH group, the rLH group required a lower blood transfusion rate (20.8% versus 39.3%, P = 0.006), a shorter median postoperative hospital stay (8.0 versus 11.0 d, P < 0.001), and a lower stone recurrence rate (4.9% versus 25.8%, P < 0.001), except for a longer median operation duration (300.0 versus 240.0 min, P < 0.001). No significant differences were found in other clinical outcomes.</p><p><strong>Conclusions: </strong>rLH is a safe and feasible option for selected patients with hepatolithiasis who have previously undergone biliary surgery, although its overall clinical benefit is inferior to that of iLH. It should be carefully performed by surgeons with rich experience in laparoscopic liver resection in large medical centers.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639586","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":"Impact and Measurement of Mechanical Tension in Bowel Anastomosis: A Scoping Review of the Current Literature","authors":"Muhammad Usman Khalid MBBS ,&nbsp;Danish Ali MBBS ,&nbsp;Jie Ying Wu PhD ,&nbsp;Hanjoo Lee MD ,&nbsp;Aimal Khan MD, FACS","doi":"10.1016/j.jss.2025.02.011","DOIUrl":"10.1016/j.jss.2025.02.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Creating a “tension-free anastomosis” is a fundamental principle in safe bowel surgery. This review aims to summarize the current literature regarding the measurement and impact of tension on bowel anastomoses.</div></div><div><h3>Methods</h3><div>This scoping review was conducted using a systematic literature search in the PubMed, SCOPUS, and EMBASE databases. Data were synthesized in tables and summarized paragraphically, with studies assessed using the Newcastle-Ottawa scale.</div></div><div><h3>Results</h3><div>Out of the 350 studies identified in the initial literature review, 25 were included in this study. Several studies indicated that anastomotic leak and tension are strongly associated, with the presence of tension making leaks up to 10 times more likely. However, no objective and clinically available methods exist to measure tension on bowel anastomosis in humans. Freedom from tension has traditionally been measured via surrogate measures of adequate bowel mobilization and subjective assessment by operating surgeons. Animal and cadaveric studies have been the frontier for objective measurement of wall tension. These studies use tensiometers to measure tension and automated machines or pulley and ratcheting systems to increase tension at specified intervals. However, these methods are universally destructive due to their design of measuring maximal tensile load and are not readily adaptable to the operating room.</div></div><div><h3>Conclusions</h3><div>The current literature does not address the objective measurement of bowel tension in live human subjects. Given the importance of tension, developing an objective, safe, intraoperative method to measure bowel wall tension would be a valuable surgical tool.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 161-173"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyvinyl Alcohol Sponges Reduce Intraperitoneal Adhesions After Abdominal Surgery","authors":"Donna C. Koo MD ,&nbsp;P. Nina Scalise MD ,&nbsp;Claire A. Ostertag-Hill MD ,&nbsp;Abbie E. Naus MD ,&nbsp;Jonathan M. Durgin MD ,&nbsp;Megan Z. Chiu MD ,&nbsp;Melissa Mejia Bautista MD ,&nbsp;Kamila Moskowitzova MD ,&nbsp;Steven J. Staffa MS ,&nbsp;Gabriel Ramos Gonzalez MD ,&nbsp;Alyaa Al-Ibraheemi MD ,&nbsp;Eliza J. Lee MD ,&nbsp;Farokh R. Demehri MD ,&nbsp;Heung Bae Kim MD","doi":"10.1016/j.jss.2025.02.005","DOIUrl":"10.1016/j.jss.2025.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of cotton sponges in the operating room has been linked to intraperitoneal adhesion formation. Inert, nonlinting polyvinyl alcohol (PVA) sponges have been used as an alternative to reduce intraoperative tissue trauma and particle remnants in other surgical fields. We investigate the effect of PVA sponges on reducing postoperative intraperitoneal adhesions in a murine model.</div></div><div><h3>Methods and methods</h3><div>In total, 189 C57BL/6 mice were randomly divided into three groups by abdominal packing intervention. Following laparotomy on day 0, the abdominal cavity was packed with cotton gauze (<em>n</em> = 53), PVA wipe (<em>n</em> = 54), or no packing (sham; <em>n</em> = 58) for three rounds of 10 min each before packing was removed. Mice were euthanized, and necropsies were performed between postoperative days 13-15. Adhesions were graded by two blinded observers using a validated system composed of adhesion extent, tenacity, and density. Adhesion scores were compared between the three groups.</div></div><div><h3>Results</h3><div>Compared to adhesions in gauze-packed mice, adhesions in PVA-packed mice were significantly less extensive, less tenacious, and less dense (<em>P</em> &lt; 0.001 for all), which equated to lower total adhesion scores in PVA-packed mice (0 [0, 3] <em>versus</em> 5 [2, 7], <em>P</em> &lt; 0.001). The adhesion scores for sham group mice were significantly lower than PVA and gauze mice in all categories.</div></div><div><h3>Conclusions</h3><div>This is the first study to directly compare postoperative intra-abdominal adhesion formation following the use of gauze and PVA sponges in an animal model. PVA sponges significantly reduce postoperative adhesions when compared to standard cotton gauze sponges. PVA should be further explored as a useful alternative to reduce postoperative adhesion-related morbidity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 183-192"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628805","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 COVID-19 Pandemic and Delays in Melanoma Treatment: A National Cancer Database Study","authors":"Sophie H. Chung MD,&nbsp;Jacob L. Leung BA,&nbsp;Kelsey S. Romatoski MD,&nbsp;Gordana Rasic MD, MS,&nbsp;Anna J. Kobzeva-Herzog MD,&nbsp;Jennifer F. Tseng MD, MPH, FACS,&nbsp;Kelly Kenzik MS, PhD,&nbsp;Teviah E. Sachs MD, MPH, FACS","doi":"10.1016/j.jss.2025.02.018","DOIUrl":"10.1016/j.jss.2025.02.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Timely treatment for patients with melanoma is critical. This study evaluated associations between the COVID-19 pandemic and time to treatment for patients with melanoma and delineated factors associated with delayed treatment.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database, patients with cutaneous melanoma were categorized using year of diagnosis: COVID era (2020) versus pre-COVID era (2018-2019). Multivariable logistic regression was used to estimate the odds of delayed time to surgery (DTS) and/or chemoimmunotherapy (DTC), defined as &gt;30 d.</div></div><div><h3>Results</h3><div>Among 72,590 patients with melanoma, 71.2% were diagnosed in the pre-COVID era (25,210 in 2018; 26,471 in 2019) compared to 28.8% diagnosed in the 2020 COVID era. Of the COVID era patients, 40.4% received COVID-19 testing, with 5.7% having a positive result. COVID era patients were diagnosed at a later stage (3 and 4), 7.4% <em>versus</em> 6.6%. While overall DTS decreased for COVID era patients, a higher proportion of patients tested for COVID experienced longer DTS. In multivariable logistic analysis, male sex, Black race, Hispanic ethnicity, uninsured or underinsured status, less education, stage &gt; 1, and treatment locations in the Northeast, West, and South were associated with DTS. COVID era diagnosis was not associated with DTC; however, uninsured or underinsured status and treatment in the South were associated with DTC.</div></div><div><h3>Conclusions</h3><div>The pandemic was not associated with overall delays in treatment for melanoma; however, vulnerable populations and certain geographic areas experienced disproportionate differences in treatment timing. The potential long-term associations between delayed treatment and outcomes warrant further investigation, especially for marginalized populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 141-152"},"PeriodicalIF":1.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628807","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}