Journal of Surgical Research最新文献

{"title":"Normocalcemic Hyperparathyroidism: Bridging the Gap in Parathyroid Research","authors":"Jari Chen,&nbsp;Zhixing Song MD,&nbsp;Sanjana Balachandra MD,&nbsp;Andrea Gillis MD,&nbsp;Jessica Fazendin MD,&nbsp;Brenessa Lindeman MD,&nbsp;Herbert Chen MD","doi":"10.1016/j.jss.2025.04.024","DOIUrl":"10.1016/j.jss.2025.04.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Previous studies from single-institution cohorts have shown that patients with normocalcemic primary hyperparathyroidism (ncPHPT) are just as symptomatic as patients with classic PHPT. There is currently no large-scale database analysis of ncPHPT, so with the TriNetX database, a large international database, trends on ncPHPT can be studied over a large cohort of patients. The aim of this project is to characterize the diagnostic and treatment paradigm for ncPHPT in the TriNetX database.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective cohort study of patients with ncPHPT using the TriNetX Research Network, which includes patients from 52 healthcare organizations from 2007 to 2023. ncPHPT was defined as having parathyroid hormone (PTH) ≥66pg/mL and calcium between 8.4 and 10.4 mg/dL. We excluded patients with secondary, tertiary, and classic hyperparathyroidism and other hypercalcemia inducing factors.</div></div><div><h3>Results</h3><div>We found 5092 patients with ncPHPT; 78.2% were female, average age was 69 ± 13 y, and 78.9% were White. The average serum calcium was 9.7 ± 0.5 mg/dL, while the average serum PTH level was 97 ± 77.5 pg/mL. Of these, 2036 (40%) underwent a parathyroidectomy. Presurgery, calcium averaged 9.9 ± 0.1 mg/dL and PTH averaged 96 ± 152 pg/mL. Postsurgery, calcium averaged 9.3 ± 0.6 mg/dL, while PTH averaged 52 ± 33pg/mL.</div></div><div><h3>Conclusions</h3><div>In this large multi-institutional cohort, the minority of patients with ncPHPT underwent a parathyroidectomy. Education about the benefits of surgery for these patients to these providers is needed.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 137-142"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124562","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":"Long-term Efficacy of Pediatric Anti-reflux Surgery in Reduction of Acid-reducing Medication","authors":"Meagan Rosenberg MD ,&nbsp;Aixa Perez Coulter MS, MPH ,&nbsp;Victoria Pepper MD ,&nbsp;Gregory Banever MD, FAAP, FACS ,&nbsp;David Tashjian MD, FAAP, FACS ,&nbsp;Kevin Moriarty MD, FAAP, FACS ,&nbsp;Michael V. Tirabassi MD, FAAP, FACS","doi":"10.1016/j.jss.2025.04.020","DOIUrl":"10.1016/j.jss.2025.04.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Revision of anti-reflux procedures (ARPs) has contributed to a shift away from surgical management of pediatric gastroesophageal reflux disease. Long-term proton-pump inhibitor and H2 antagonist use, however, is associated with infection and micronutrient malabsorption. This study investigates long-term ARP efficacy in decreasing acid-reduction medication (ARMs) usage.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of pediatric patients undergoing ARP at a single institution was conducted from January 1, 2000 to December 31, 2017, allowing for at least a 6-y follow-up. Eligibility included patients less than 18 y undergoing index ARP. Age, weight, comorbidities, and ARM use were collected. Operative information included procedure type and hospital course. Postoperative information included complications, reoperation, postoperative symptoms, and postoperative ARMs. <em>t</em>-Tests compared continuous outcomes, while chi-square test compared frequency of categorical outcomes.</div></div><div><h3>Results</h3><div>In total, 305 patients were included with a mean (standard deviation) age of 7.2 (6.5) y. In total, 54.7% of patients were male; 70.7% were White, 23% Hispanic, and 5.7% Black. The procedure was laparoscopic for 99.3% and open for 0.7% (<em>n</em> = 2). The most common preoperative symptoms were regurgitation (53.4%) and retrosternal pain (9.2%). Postoperatively, regurgitation remained the most common at 30.8% (<em>n</em> = 94). The most common comorbidities were neurodevelopmental delay (42%, <em>n</em> = 128) and asthma (35.7%, <em>n</em> = 109). 11.8% (<em>n</em> = 33) underwent reoperation. Subsequently, 2.4% (<em>n</em> = 7) of the patients were within 90 d of operation, most commonly for wrap slippage (<em>n</em> = 11) or hiatal hernia (<em>n</em> = 9). AMRs were discontinued in 39.8% (<em>n</em> = 80) of the patients within 30 d and 57.4% (<em>n</em> = 156) at most recent follow-up. It appeared most efficacious for neurodevelopmental delay patients. The mean follow-up was 10 y.</div></div><div><h3>Conclusions</h3><div>More than half of the patients discontinued ARMs following ARP suggesting that surgery remains beneficial in reducing long-term medication use.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 112-117"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Morbidity and Mortality Conference for Education and Quality Improvement","authors":"Nina M. Clark MD, MS ,&nbsp;Denzel R. Woode MD ,&nbsp;Lauren L. Agoubi MD, MA ,&nbsp;Judy Y. Chen MD ,&nbsp;Lisa K. McIntyre MD ,&nbsp;Rebecca G. Maine MD, MPH","doi":"10.1016/j.jss.2025.04.022","DOIUrl":"10.1016/j.jss.2025.04.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite their long history, morbidity and mortality conferences (MMC) lack standardization and have not been shown to change behavior or improve outcomes. Our trauma center developed a database to record events discussed at acute care surgery MMC with the aim of improving the integration of MMC for education and quality improvement.</div></div><div><h3>Methods</h3><div>From May 2020 to November 2022, surgical trainees documented patient demographics, procedures performed, and details of adverse outcomes in a REDCap database. Using the institutionally developed Quality of Care Score (QCS) to standardize event reporting, trainees scored each event before MMC and consensus QCS was assigned after conference. We describe events presented at MMC and compare trainee to consensus scores.</div></div><div><h3>Results</h3><div>We included data from 679 patients who experienced 916 reported events. Sixty-five percent of the cohort was admitted for trauma. Exploratory laparotomy (31%) and incision and soft tissue debridement (15%) were the most common procedures performed. Comparison of trainee <em>versus</em> consensus QCS revealed identical scores in 84% of cases. Consensus scores were lower than trainee scores 12% of the time and higher 3% of the time. While patient deaths comprised the majority of reported events over the study period (47%), they made up a decreasing proportion of overall events reported over time.</div></div><div><h3>Conclusions</h3><div>Through the development of a standardized reporting platform for patient events and use of a numeric grading system, our program facilitates rapid quantitative analysis of surgical adverse events using a platform that can be easily adapted to different practice environments and systems. Discordance between trainee and consensus QCS highlights opportunities for trainee education about standards of care and disease processes, and ongoing data collection facilitates rapid identification of quality concerns.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 118-126"},"PeriodicalIF":1.8,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124564","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":"Comparative Analysis of the Accuracy of Microsoft Excel Macros in Retrospective Chart Review Studies","authors":"Justin Bauzon MD,&nbsp;Gustavo Romero-Velez MD,&nbsp;Ludovico Sehnem MD,&nbsp;Joyce Shin MD,&nbsp;Allan Siperstein MD,&nbsp;Judy Jin MD","doi":"10.1016/j.jss.2025.04.021","DOIUrl":"10.1016/j.jss.2025.04.021","url":null,"abstract":"<div><h3>Introduction</h3><div>While retrospective chart review is a useful methodology for clinical research, challenges still exist when abstracting data from the electronic health record. When collected manually, unstructured “free text” data are particularly tedious and can be susceptible to errors and biases. We aimed to evaluate the accuracy of Microsoft Excel macros to facilitate the data abstraction process.</div></div><div><h3>Methods</h3><div>One hundred pathology reports following surgery for thyroid cancer were retrospectively evaluated. Twenty variables of interest (tumor characteristics, invasive features, and lymph node counts) were manually abstracted by a physician reviewer. A macro (“ThyMAC”) was developed to extract the same variables. Abstraction error rates and speed were measured between manual and macro-assisted methods using a paired <em>t</em>-test. Accuracy, classification rates, and interrater reliability of ThyMAC were then analyzed. After identifying correctable errors, an ad hoc analysis of the optimized macro was then performed.</div></div><div><h3>Results</h3><div>Abstraction errors by physician reviewer were slightly lower relative to ThyMAC (3.8 <em>versus</em> 5.3% error rate, <em>P</em> = 0.03). By contrast, data collection time was 270 times faster via macro-assistance (65 <em>versus</em> 0.24 s per pathology report, <em>P</em> &lt; 0.001). Overall, ThyMAC performed with high rates of accuracy (87-100%) for all abstracted variables, with moderate-to-perfect agreement for 14 of 20 variables. Addressing correctable errors significantly decreased macro error rates compared to the physician abstractor (3.6 <em>versus</em> 0.5%, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Compared to a trained physician abstractor, macros can extract unstructured data in retrospective chart review studies with high accuracy at speeds superior to a manual approach. Macro errors are typically preventable, and the program can be modified to improve data extraction accuracy. Macros can serve as an efficient and versatile tool to assist researchers with chart review data collection, especially when large datasets are involved.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 92-97"},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114966","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":"Chest Wall Reconstruction Using Biologic Mesh to Cover Soft Tissue Defects: A Narrative Review","authors":"Jeffrey B. Velotta MD, FACS ,&nbsp;Jason Hammer MD ,&nbsp;Vivek Mukhatyar PhD","doi":"10.1016/j.jss.2025.04.023","DOIUrl":"10.1016/j.jss.2025.04.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Chest wall reconstruction (CWR) is used in functional and/or aesthetic impairments of the thoracic wall following resection. This review summarizes literature for soft tissue coverage with biologic mesh in CWR and reports use of a porcine-derived acellular dermal matrix in CWR.</div></div><div><h3>Methods</h3><div>A literature search identified studies that use biologic mesh in CWR, and expert opinion for the use of a porcine acellular dermal matrix and muscle flap reconstruction to repair large chest wall defects is provided.</div></div><div><h3>Results</h3><div>CWR with biologic mesh is used to provide soft tissue coverage for various medical conditions, including oncologic tumor resections, trauma, congenital malformations, and in complex procedures, such as large thoracic defects, presence of infection, and prior radiation of the chest wall. Compared with synthetic mesh, fewer overall complications, infections, and mesh explantations have been reported with biologic mesh in retrospective studies of patients who underwent CWR with surgical mesh. However, there are limited published data on the use of biologic mesh for CWR, and there are no published randomized controlled trials comparing synthetic <em>versus</em> biologic mesh in CWR. A case study for the use of a porcine acellular dermal matrix and muscle flap reconstruction to repair large chest wall defects demonstrates a successful outcome with more than 6 y of follow-up.</div></div><div><h3>Conclusions</h3><div>Use of biological mesh in CWR is supported by literature and expert opinion. However, more robust clinical data on risks and benefits of types of mesh are needed to aid surgeons in selecting mesh.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 98-105"},"PeriodicalIF":1.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114965","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":"Long-Term Opioid Use After Colon and Rectal Surgery","authors":"Kerri A. McKie MD ,&nbsp;Robert A. Malizia MD ,&nbsp;Adam C. Fields MD, MPH ,&nbsp;Liliana Bordeianou MD, MPH ,&nbsp;Marc Rubin MD ,&nbsp;Todd Francone MD ,&nbsp;Khawaja Fraz Ahmed MD, MPH ,&nbsp;Ronald Bleday MD","doi":"10.1016/j.jss.2025.04.019","DOIUrl":"10.1016/j.jss.2025.04.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The United States continues to struggle with the opioid epidemic. Enhanced recovery after surgery (ERAS) pathways aim to limit opioid use in the perioperative setting. The goal of this study was to examine whether standardized, nonnarcotic medications are associated with a decrease in long-term opioid use after colorectal surgery in opioid-naïve patients.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective cohort study from 2017 to 2020 with 1 y duration of follow-up. Data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program and Epic Systems Cooperation from five institutions in the Mass General Brigham Colorectal Surgery Collaborative. Opiate naïve patients undergoing colorectal surgery were selected using standardized Current Procedural Terminology codes. Between 2017 and 2020, a standardized ERAS protocol was developed at all five sites. The primary outcome was long-term opioid use after surgery defined as persistent opioid use at 6 and 12 mo.</div></div><div><h3>Results</h3><div>A total of 1363 opioid-naïve patients undergoing colorectal surgery were included in the study. From 2017 to 2020, nearly all patients were prescribed opioids. From 2017 to 2018, 16% and 11% of patients continued to use opioids at 6 and 12 mo, respectively, compared to 15% and 8% of patients from 2018 to 2019, and 11% and 4% of patients from 2019 to 2020, <em>P</em> &lt; 0.01.</div></div><div><h3>Conclusions</h3><div>Although a small proportion of opioid-naïve patients remain on opioids at 1 y postoperatively, we show a stepwise reduction from 2017 to 2020 after standardization of opioid-sparing strategies in ERAS pathways.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 86-91"},"PeriodicalIF":1.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114958","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":"Trimethylamine N-Oxide and Smoking Are Associated With the Progression of Thromboangiitis Obliterans","authors":"Song Wang PhD ,&nbsp;Hong Luo MS ,&nbsp;Zhong-hui Zou MS ,&nbsp;Mei-lan Su PhD ,&nbsp;Zhong-hui Pan BS ,&nbsp;Min Wang BS ,&nbsp;Wen-jing Zhang BS","doi":"10.1016/j.jss.2025.04.018","DOIUrl":"10.1016/j.jss.2025.04.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Thromboangiitis obliterans (TAO) is potentially associated with smoking, although its precise pathogenesis remains unclear. Trimethylamine N-oxide (TMAO) has been implicated in the induction of various cardiovascular and cerebrovascular diseases. However, the role of TMAO in TAO has not been reported. This study aimed to investigate the relationship between smoking, TMAO, and TAO.</div></div><div><h3>Materials and methods</h3><div>Thirty-three patients diagnosed with TAO and hospitalized for treatment between January 2018 and July 2024 were included in the study. Healthy smokers (<em>n</em> = 38) and nonsmokers (<em>n</em> = 35) were randomly recruited and matched for age, sex, and education level as controls. Subsequently, we analyzed their clinical characteristics, levels of TMAO, and immune and inflammatory markers.</div></div><div><h3>Results</h3><div>Patients with TAO exhibited significantly higher levels of TMAO, Toll-like receptor 4 (TLR4), receptor for advanced glycation end products, interleukin (IL)-1β, IL-18, tumor necrosis factor-alpha, high mobility group box 1, nuclear factor-κB (NF-κB), and phosphorylated NF-κB (pNF-κB) than those in the smoking and nonsmoking control groups (all <em>P</em> &lt; 0.05). The smoking control group also exhibited significantly higher levels of TMAO, TLR4, IL-1β, NF-κB, and pNF-κB (all <em>P</em> &lt; 0.05) than the nonsmoking control group. TMAO, IL-1β, and tumor necrosis factor-alpha levels were significantly higher in the underage smoking group (all <em>P</em> &lt; 0.05) than in the adult smoking group. The level of TMAO was significantly correlated with the Rutherford classification in patients with TAO, patients' smoking status (including total years of smoking and average daily cigarette consumption), and immune and inflammatory markers (all <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>These findings indicate that gut microbiota plays a significant role in the pathogenesis of TAO. TMAO is likely involved in the pathogenesis and progression of TAO, with smoking acting as a contributing factor. The underlying mechanism may involve the activation of immune-inflammatory pathways, specifically the high mobility group box 1–receptor for advanced glycation end products/TLR4-NF-κB pathway.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 78-85"},"PeriodicalIF":1.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107609","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":"Corrigendum to \"Reporting Minority Race and Ethnicity in Trauma & Critical Care\" [Journal of Surgical Research Volume 309 (2025) 166-173].","authors":"Shahenda Khedr, Andrew Geng, Xiaoyue Ma, Julie Hong, Elizabeth Zhao, Phillip Hwang, William Davis, Daithi S Heffernan, Jason M Sample, Konstantin Khariton, Steven Y Chao","doi":"10.1016/j.jss.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.jss.2025.04.017","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127902","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":"Relation of Malnutrition on Septic Older Adults in Emergency Gastrointestinal Surgery: A Modified Global Leadership Initiative on Malnutrition Analysis","authors":"Benjamin P. Nguyen MD ,&nbsp;Danielle Ruediger MD ,&nbsp;Paul Wischmeyer MD, FASPEN, FCCM ,&nbsp;Suresh Agarwal MD, FACS, FCCP ,&nbsp;Krista L. Haines DO, MABMH","doi":"10.1016/j.jss.2025.04.011","DOIUrl":"10.1016/j.jss.2025.04.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Malnutrition in older adults has significant ramifications for surgical outcomes. The incidence of malnutrition is up to 30% in emergent gastrointestinal surgery (EGS). This study aims to investigate malnutrition's correlation on outcomes of older adults with preoperative sepsis undergoing EGS.</div></div><div><h3>Methods</h3><div>Adults aged ≥ 65 y who had preoperative sepsis were included. The Global Leadership Initiative on Malnutrition (GLIM) introduced criteria to diagnose malnutrition. We used a modified GLIM (mGLIM) using the National Surgical Quality Improvement Project database. The mGLIM includes (1) body mass index ≤ 20 kg/m² for age ≤ 70 y and body mass index ≤ 22 kg/m² for age ≥ 71 y, (2) weight loss &gt;10% within the past 6 mo, (3) admission albumin ≤ 3.5 g/dL, and (4) EGS as an acute disease marker. Multivariate regression explored the relationship of malnutrition on mortality, length of stay, and complications.</div></div><div><h3>Results</h3><div>A total of 26,801 patients were included. Demographically, female patients included 58% (<em>n</em> = 15,501). African American patients consisted of 8.0% (<em>n</em> = 2133), and Caucasian patients accounted for 75.7% (<em>n</em> = 20,295) of the study population. Small bowel cases were 32.1% (<em>n</em> = 8609), and colorectal cases represented 76.5% (<em>n</em> = 20,490) of all cases. Malnourished patients made up of 1.8% (<em>n</em> = 481) of all patients. Multivariate regression revealed malnourished patients have higher chance of mortality for small bowel (<em>P</em> = 0.001, confidence interval [CI] 1.31-2.69) and colorectal (<em>P</em> &lt; 0.001, CI 1.47-2.39) procedures, and higher likelihood of complications for colorectal (<em>P</em> = 0.001, CI 1.31-2.65) cases.</div></div><div><h3>Conclusions</h3><div>Our analysis shows that malnutrition, as identified by mGLIM criteria, is associated with higher mortality and complication rates after EGS. The mGLIM criteria could be a prognostic tool for adverse outcomes in malnutrition-risk patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 70-77"},"PeriodicalIF":1.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107608","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":"Tourniquet in Place as Full Trauma Team Activation Criterion Maintains an Acceptable Overtriage Rate","authors":"Brown Christopher DO ,&nbsp;Coleman Kennith DO ,&nbsp;Bardes James MD ,&nbsp;Schroll Rebecca MD, FACS; PhD ,&nbsp;Alabaster Kelsey MD ,&nbsp;Schroeppel Thomas J MD, MS ,&nbsp;Stillman Zachery E MS ,&nbsp;Teicher Erik J MD ,&nbsp;Lita Elena BS ,&nbsp;Ferrada Paula MD ,&nbsp;Han Jinfeng CCRP ,&nbsp;Fullerton Robert D MS ,&nbsp;McNickle Allison G MD ,&nbsp;Fraser Douglas R MD ,&nbsp;Truitt Michael S MD ,&nbsp;Grossman Verner Heather M MS ,&nbsp;Todd S. Rob MD ,&nbsp;Turay David MD, PhD ,&nbsp;Pop Andrew BS ,&nbsp;Godat Laura N MD ,&nbsp;Smith Alison MD, PhD","doi":"10.1016/j.jss.2025.04.015","DOIUrl":"10.1016/j.jss.2025.04.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Prehospital tourniquet placement is not a required criterion for standard trauma team activation (TTA-S) as recommended by the American College of Surgeons Committee on Trauma. Educational campaigns such as STOP THE BLEED have led to an increase in tourniquet applications in the prehospital setting. We intend to evaluate if using extended trauma team activation (TTA-T) criteria, which includes tourniquet application, would lead to an acceptable amount of overtriage.</div></div><div><h3>Methods</h3><div>This was a multicenter retrospective analysis, utilizing the American Association for the Surgery of Trauma Major Extremity Trauma Tourniquet Database, comparing the overtriage rate of TTA-S criteria against the TTA-T criteria.</div></div><div><h3>Results</h3><div>A total of 1235 patients were included, with 687 meeting the TTA-S criteria and an additional 175 patients meeting the TTA-T criteria. The overtriage rate was calculated to be 21.2%, within the accepted over triage rate of 25%-35%.</div></div><div><h3>Conclusions</h3><div>Field tourniquet application for life-threatening hemorrhage, although not an American College of Surgeons Committee on Trauma criterion for TTA, should be considered for full TTA. Utilizing this as a criterion for TTA is associated with an acceptable rate of overtriage, while also having the benefit of rapid surgical team evaluation and intervention for possible life- or limb-threatening injuries.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 64-69"},"PeriodicalIF":1.8,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088703","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}