Journal of Surgical Research最新文献

{"title":"Impact of Surgical Experience on Burst Pressure of Hand-Sewn and Stapled Anastomoses","authors":"Thomas M.R. McKinley MD ,&nbsp;David Chow MD ,&nbsp;Jonathan B. Livezey MD ,&nbsp;Andrew Anklowitz MD ,&nbsp;Taylor M. Williams MD ,&nbsp;Tiffany Kippenberger DO ,&nbsp;Byron J. Faler MD ,&nbsp;Marcos C. Aranda MD","doi":"10.1016/j.jss.2025.03.063","DOIUrl":"10.1016/j.jss.2025.03.063","url":null,"abstract":"<div><h3>Introduction</h3><div>Both hand-sewn and stapled techniques for creating small bowel anastomoses are safe and have similar rates for leaks and stricture. Each technique comes with its own benefits and detriments, but a well-trained surgeon should be proficient in both anastomotic techniques. The understanding of tissue layers and meticulous technique needed to perform a proper hand-sewn anastomoses require greater skill and experience than a stapled anastomosis to achieve comparable results. This study is aimed to determine if there is a difference in anastomotic burst pressure between hand-sewn <em>versus</em> stapled anastomoses when they were performed by surgeons with differing years of experience.</div></div><div><h3>Methods</h3><div>Attending and resident surgeons with varying experience followed standardized instructions to create a hand-sewn and stapled anastomosis using segments of swine small intestine. Burst pressure was measured by inflating the intestine with air and using a manometer to record the pressure at which air leaked from the anastomosis.</div></div><div><h3>Results</h3><div>Thirteen participants with 1-11 y of experience took part in this study. Burst pressure ranged between 4 and 76 mmHg for hand-sewn and 9 to 40 mmHg for stapled anastomoses. The mean burst pressures of stapled anastomoses were equal between less (mean = 29.0 mmHg, standard deviation [SD] = 8.54) and more (mean 29.0 mmHg, SD = 12.36) experienced surgeons. The difference in mean burst pressure of hand-sewn anastomoses for less experienced surgeons (mean = 34.6 mmHg, SD = 21.8) and more experienced surgeons (mean = 24.8 mmHg, SD = 5.26) was not statistically significant (<em>P</em> = 0.09). However, there was a significant difference between the SDs of the hand-sewn anastomoses of less and more experienced surgeons (<em>P</em> = 0.01, F = 17.1, F Crit = 9.2). There was no significant difference in our secondary outcome, mean burst pressure between hand-sewn 30.5 mmHg (SD = 18.4) and stapled anastomoses 29.0 mmHg (SD = 11.07) (<em>P</em> = 0.81).</div></div><div><h3>Conclusions</h3><div>While unable to detect differences regarding the impact of surgical experience on mean burst pressure of anastomoses, there is a greater range of burst pressures in the hand sewn group. In addition, we feel that the model of anastomotic testing we present represents the value, at all levels of training, of refining and practice advanced surgical technical skills on animal models.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 122-127"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870363","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":"Patients’ Surgical History Profile and Its Association With Complexity in Major Emergency Abdominal Surgery","authors":"Lasse Rehné Jensen MD ,&nbsp;Klara Thorhauge MB ,&nbsp;Dunja Kokotovic MD, PhD ,&nbsp;Thomas Korgaard Jensen MD, PhD ,&nbsp;Jakob Burcharth MD, PhD","doi":"10.1016/j.jss.2025.03.051","DOIUrl":"10.1016/j.jss.2025.03.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency abdominal surgery often involves patients with a surgical history. Previous abdominal surgery can complicate new procedures. The correlation between surgical history and complexity in major emergency surgery has not been assessed. The purpose of this study was to profile patients undergoing emergency abdominal surgery, regarding quantity and type of previous abdominal procedures and to assess their association with intraoperative complexity. We hypothesized that a history of abdominal surgery would be associated with increased intraoperative complexity, defined as a composite outcome of complicating factors and intraoperative events.</div></div><div><h3>Materials and methods</h3><div>We conducted an exploratory analysis of 754 consecutive patients undergoing major emergency abdominal surgery at a single institution. While multiple procedure- and patient-related variables were prospectively recorded in our local database, data on patient history and previous abdominal surgeries were collected retrospectively. Intraoperative iatrogenic lesions (unintended lesions to intra-abdominal organs), prolonged procedural time (≥3 h), or excessive intraoperative bleeding (≥1 L) were established as indicative of a complex procedure (<em>‘complexity factor’</em>). Data were analyzed using multivariable logistic regression to identify significant preoperative risk factors for intraoperative complexity.</div></div><div><h3>Results</h3><div>A total of 754 patients were included, with a median age of 71 y (interquartile range: 58-79), and 51% of the cohort were female. Among them, 476 patients (61%) had a history of previous abdominal surgery. In 192 (25%) of the procedures, surgeons reported at least one complexity factor. Previous colonic or rectal resection was associated with intraoperative complexity (2.34 risk ratio, confidence interval 95: 1.01-5.41, <em>P</em> = 0.05). Other significant factors were prior laparotomy, severe intra-abdominal adhesions, previous intra-abdominal abscess, and prior small bowel obstruction.</div></div><div><h3>Conclusions</h3><div>This study profiles emergency surgical patients with a history of abdominal surgery and explores the associations between previous surgery and complexity in subsequent procedures. Awareness of factors associated with increased procedural complexity is valuable to the surgical and anesthesiologic team in the planning of the procedure.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 57-67"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864271","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":"Spleen Preservation in Solid Pseudopapillary Neoplasms of the Distal Pancreas: A Single-Center Experience","authors":"Tiffany M. Yue BS ,&nbsp;Beatrice J. Sun MD ,&nbsp;Daniel J. Delitto MD, PhD ,&nbsp;Monica M. Dua MD ,&nbsp;Jeffrey A. Norton MD ,&nbsp;George A. Poultsides MD ,&nbsp;Brendan C. Visser MD ,&nbsp;Byrne Lee MD","doi":"10.1016/j.jss.2025.03.062","DOIUrl":"10.1016/j.jss.2025.03.062","url":null,"abstract":"<div><h3>Introduction</h3><div>Solid pseudopapillary neoplasms (SPNs) are rare tumors of the pancreas that are typically low-grade but may carry malignant potential. While concurrent splenectomy is recommended for oncologic resection of malignant distal pancreas tumors, this is not well-described for SPN. This study evaluates the outcomes of spleen preservation for distal pancreas SPN.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted for adult patients with SPN who underwent surgical resection at a single tertiary center (2010-2023). Distal tumors were located within the pancreatic body or tail. Patient factors and outcomes were compared between those who underwent spleen-preserving (SP) <em>versus</em> nonspleen-preserving (NSP) distal pancreatectomy.</div></div><div><h3>Results</h3><div>In total, 52 patients underwent surgery for SPN. Thirty six had localized distal pancreatic tumors and underwent distal/subtotal pancreatectomy: 25 (69%) were SP and 11 (31%) were NSP. Overall, median age was 31 y, 86% were female, and 61% were symptomatic at diagnosis. Median tumor size (4.9 cm SP <em>versus</em> 6.0 cm NSP, <em>P</em> = 0.469) and number of lymph nodes examined (6 SP <em>versus</em> 11 NSP, <em>P</em> = 0.241) were similar. The majority of SP operations were completed minimally invasively via laparoscopic or robotic approaches (84% SP <em>versus</em> 36% NSP, <em>P</em> = 0.008). There was no difference in operative time, complications, length of stay, or readmission between groups. Neither cohort had recurrence of SPN at median follow-up of 3 y.</div></div><div><h3>Conclusions</h3><div>SP pancreatectomy can be performed safely for distal SPN with excellent long-term oncologic outcomes. This technique may be achieved minimally invasively and should be considered for localized SPN in the body or tail of the pancreas.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 17-21"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859816","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":"Oncology and Acute Care Surgery: Examining Outcomes in Cancer Patients Requiring Emergent Laparotomy","authors":"Grace M. Mallampalli MD ,&nbsp;Drayson B. Campbell BS ,&nbsp;Shruthi Srinivas MD, MPH ,&nbsp;Holly Baselice MPH ,&nbsp;Courtney M. Collins MD ,&nbsp;Megan Mansour MD ,&nbsp;Jordan M. Cloyd MD ,&nbsp;Jonathan Wisler MD","doi":"10.1016/j.jss.2025.03.015","DOIUrl":"10.1016/j.jss.2025.03.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients presenting with abdominal emergencies requiring emergent laparotomy are at high risk of morbidity and mortality. The impact of an active cancer diagnosis on the short-term outcomes of emergent laparotomy is not well described.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using an institutional database comprised of patients admitted from 2015 to 2019 who underwent exploratory laparotomy within 6 h of surgical consultation. The postoperative outcomes of patients with and without an active cancer diagnosis were compared using univariate and multivariable analysis with adjustment for clinical and demographic variables.</div></div><div><h3>Results</h3><div>Among 409 patients who met inclusion criteria, 320 (78.2%) were without an active cancer diagnosis and 89 (21.8%) had an active cancer diagnosis. Patients with cancer were older (median [interquartile range], 63 [56, 70] y <em>versus</em> 59 y [49, 69], <em>P</em> = 0.0001) and presented with higher number of acute severity measures (17.9% <em>versus</em> 13.1%, <em>P</em> = 0.017). Patients with cancer had higher odds of 90-d mortality (adjusted odds ratio: 12.0, 95% confidence interval: [4.9, 29.3]) and 90-d systemic complications (adjusted odds ratio 2.4, 95% confidence interval: [1.26, 4.50]). Patients with cancer who died during index hospitalization received more inpatient palliative care consultations (53.3% <em>versus</em> 25.7%, <em>P</em> = 0.0336) and experienced more systemic complications postoperatively (45.2% <em>versus</em> 17.0%, <em>P</em> = 0.0038).</div></div><div><h3>Conclusions</h3><div>An active cancer diagnosis is independently associated with worse postoperative outcomes following emergent laparotomy. These findings should inform individual and shared decision-making regarding the role of emergency surgery and are relevant for future patient-centered research in oncologic emergencies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 80-88"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864210","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":"Twenty Years in the Making: An Analysis of National Trends in ACGME Resident Breast Surgery Experiences","authors":"Kristen M. HoSang MD ,&nbsp;Terry P. Gao MD ,&nbsp;Austin D. Williams MD, MSEd ,&nbsp;Richard J. Bleicher MD ,&nbsp;Lindsay E. Kuo MD, MBA","doi":"10.1016/j.jss.2025.03.041","DOIUrl":"10.1016/j.jss.2025.03.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Breast surgery is a core component of general surgery; however, previous studies have shown that general surgery residents (GSRs) are performing fewer operations in this area. This study analyzes the 20-y trends in GSR breast surgery experience.</div></div><div><h3>Methods</h3><div>Case numbers were extracted from the Accreditation Council for Graduate Medical Education database from 2003 to 2023. Breast cases were categorized by sentinel lymph node biopsy, excisional biopsy (EB), simple mastectomy (SM), modified radical mastectomy, and radical mastectomy. Yearly average case numbers for total general and breast surgery cases were calculated. Surgical resident role (chief <em>versus</em> junior residents) was evaluated. Linear regression analyzed time trends.</div></div><div><h3>Results</h3><div>From 2003 to 2023, GSRs reported a 15% increase in average total cases performed (<em>P</em> &lt; 0.001), although there was a nonsignificant 8.1% decrease in total breast cases performed. Juniors performed 56.9-61.6 operations/year, where chiefs performed 9.2-10.3 breast operations/year. The annual number of chief-performed sentinel lymph node biopsies (1.8-0.8, <em>P</em> &lt; 0.001) and modified radical mastectomies (2.0-0.4 cases, <em>P</em> &lt; 0.001) decreased significantly over this time period, as did the number performed by juniors (4.0-3.7 cases [<em>P</em> &lt; 0.001] and 8.1-2.8 cases [<em>P</em> &lt; 0.001], respectively). Conversely, the number of chief-performed EBs (1.8-4.1 cases, <em>P</em> &lt; 0.001) and SMs (1.7-1.9 cases, <em>P</em> = 0.012), and junior-performed EBs (8.7-24.3, <em>P</em> &lt; 0.001) and SMs (7.1-9.4 cases, <em>P</em> &lt; 0.001), significantly increased during this time.</div></div><div><h3>Conclusions</h3><div>Although the number of breast surgeries performed by GSRs has not changed significantly, case mixes have shifted. Guideline changes are impacting the case composition for trainees and may affect comfort in practice, as opportunities to perform certain cases continue to decrease.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 49-56"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864270","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":"Readmission and Adoption of Early Discharge After Colectomy Using ACS-NSQIP: Is it Time for Widespread Adoption?","authors":"Racquel S. Gaetani MD,&nbsp;Michael M. Jonczyk MD, MSc,&nbsp;David A. Kleiman MD, MSc,&nbsp;Angela H. Kuhnen MD, MPH,&nbsp;Peter W. Marcello MD,&nbsp;Julia T. Saraidaridis MD, MMs,&nbsp;Jonathan S. Abelson MD, MS","doi":"10.1016/j.jss.2025.03.021","DOIUrl":"10.1016/j.jss.2025.03.021","url":null,"abstract":"<div><h3>Introduction</h3><div>The timing of post-operative discharge following colectomy procedures remains a subject of debate among colorectal surgeons. Prior studies have demonstrated the safety and adoption of early discharge within 24 h after elective colectomy in carefully selected patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilizing data from the American COllege of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2021. Adult patients undergoing elective partial colectomy with primary anastomosis and documented length of stay were included. Patients were stratified into early (&lt; 24) and non early (≥24 h) discharge groups. Propensity score matching was used to control for baseline demographics and non-modifiable risk factors. Primary outcomes included 30-day readmission rates and adoption trends of early discharge over time.</div></div><div><h3>Results</h3><div>A total of 282,037 patients met inclusion criteria of which 6364 (2.3%) were discharged within 24 h. On propensity score matching the early discharge cohort had a statistically significantly lower rate of readmission (5.5% <em>versus</em> 7.3%, <em>P</em> &lt; 0.001). Additionally, the early discharge group had a significantly reduced rate of anastomotic leak (1.0 <em>versus</em> 2.6%), ileus (2.0% <em>versus</em> 7.6%), and rate of reoperation (1.2% <em>versus</em> 4.0%) (<em>P</em> &lt; 0.001). The proportion of early discharge colectomies increased from 0.8% in 2012 to 3.6% in 2021 (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In carefully selected patients, early discharge after colectomy with primary anastomosis does not increase the risk of readmission, reoperation, or 30-d complication rates. Furthermore, the increasing trend in utilization of early discharge after colectomy suggests an increasing acceptance of this practice, though it remains a minority of all colectomies performed among institutions participating in ACS-NSQIP.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 242-248"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859177","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 of a Venous Thromboembolism Prophylaxis and Pain Medication Pathway in Thoracic Surgery Enhanced Recovery After Surgery Program","authors":"Bin Zhang MS,&nbsp;Jing Li MM,&nbsp;Jialin Sun PharmD,&nbsp;Miaomiao Han MS,&nbsp;Huaiqin Cang MS,&nbsp;Mingchen Cao MS,&nbsp;Xiaomin Xing MM","doi":"10.1016/j.jss.2025.03.044","DOIUrl":"10.1016/j.jss.2025.03.044","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the beneficial role of clinical pharmacists through a quality improvement project to incorporate a medication pathway into a thoracic surgery Enhanced Recovery After Surgery (ERAS) program.</div></div><div><h3>Methods</h3><div>The retrospective cohort study developed a venous thromboembolism (VTE) prophylaxis and pain medication pathway covering the different phases of the perioperative period in the thoracic surgery ERAS program, adhering to Lean management principles, within a multidisciplinary team framework. Outcome indicators related to VTE prophylaxis and pain management, adverse events, per capita drug cost, length of stay, and the total inpatient cost between the first 6 mos (preintervention, January 2023 to June 2023) and the second 6 mos (postintervention, July 2023 to December 2023) were collected and compared.</div></div><div><h3>Results</h3><div>A total of 1463 individuals were observed. Following the intervention, VTE risk assessment exceeded 95%, and the number of VTE cases notably decreased from 2 to 0. Pain relief was significantly enhanced (χ² = 4.423, <em>P</em> = 0.035) and the incidence of nausea and vomiting was significantly lower (χ² = 4.869, <em>P</em> = 0.027) when surgeons stopped using opioid agonist-antagonists. The per capita drug cost reduced from $639.04 to $479.39, the length of stay decreased from 13.68 ds to 12.23 ds, and the per capita total inpatient cost decreased from $6705.62 to $5460.81.</div></div><div><h3>Conclusions</h3><div>A medication pathway was significantly associated with improved outcome metrics related to VTE prophylaxis and pain management in thoracic surgery and can be incorporated into ERAS management programs. Further investigations using more current data are needed.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 41-48"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864273","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":"Communication After Emergent Surgery by English Proficiency: An Exploratory Qualitative Study","authors":"Kelsey Ogomori BA ,&nbsp;Julia K. Axelrod BA ,&nbsp;Emily Finlayson MD, MS ,&nbsp;Daniel Dohan PhD ,&nbsp;Christine Dehlendorf MD, MAS ,&nbsp;Tasce Bongiovanni MD, MPP, MHS","doi":"10.1016/j.jss.2025.03.022","DOIUrl":"10.1016/j.jss.2025.03.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Older adults with Limited English Proficiency (LEP) comprise a disproportionate number of trauma and emergency general surgery (EGS) patients. In other settings, this group experiences barriers to communication that are likely exacerbated by acute surgical admission. Despite their likely vulnerability, this topic remains understudied. We conducted an exploratory qualitative study to understand communication of older adults with English Proficiency (EP) and LEP hospitalized for trauma or EGS.</div></div><div><h3>Materials and methods</h3><div>Trauma/EGS service inpatients aged ≥65 with mild or no cognitive impairment were purposively sampled at a safety-net, level one trauma center. Semi-structured interviews were held with patients and family when present, using interpreters for LEP. Interviews transcripts were 20% triple-coded and thematically analyzed using modified grounded theory within an interpretivist paradigm. LEP transcripts were also examined for interpretation errors.</div></div><div><h3>Results</h3><div>Twenty-three patients enrolled, 8 with LEP (Spanish, Cantonese, Russian). Three themes emerged: 1. Lack of Information – both groups expressed limited knowledge of their care 2. Loss of Autonomy – both groups endorsed reliance on providers. 3. Feedback and Advocacy – Participants with EP and family members of LEP critiqued care and endorsed the importance of self-advocacy; participants with LEP were reluctant to offer critical feedback. All interviews with professional interpreters contained errors.</div></div><div><h3>Conclusions</h3><div>Differences in EP and LEP participants’ self-advocacy and critiques suggest that language proficiency and communication style contribute to communication barriers after trauma and EGS. Difficulties are likely compounded by professional interpreter errors. Our study generates foundational evidence for further exploration of these factors and their effects on patient outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 68-79"},"PeriodicalIF":1.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864272","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":"External Validation of CRASH Prognostic Model in an Urban Tertiary Care Public University Hospital","authors":"Asif Mulla MS ,&nbsp;Devi Bavishi MD ,&nbsp;Monty Khajanchi DNB ,&nbsp;Martin Gerdin Wärnberg MD, PhD","doi":"10.1016/j.jss.2025.03.040","DOIUrl":"10.1016/j.jss.2025.03.040","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma represents 9% of global mortality, where traumatic brain injuries are the leading cause in low-middle income countries, most commonly due to road traffic injuries. The multicenter randomized controlled trial CRASH (corticosteroid randomization after significant head injury) published a prediction model to estimate prognosis in traumatic brain injury patients. This prediction model was derived based on data from high-, low-, and middle-income countries. The external validity of this prediction model was not assessed in low and middle-income countries. To fill this gap, we aim to external validate the CRASH prediction model in traumatic brain injury (TBI) patients in India, a lower-middle-income country.</div></div><div><h3>Methods</h3><div>We conducted a prospective observational study at the General Surgery department of an urban tertiary care hospital in India. We collected data on the 14-d mortality and 6-mo unfavorable outcomes in patients with TBI. Calibration and discrimination of the CRASH models (basic and computed tomography [CT] model) comparing the observed and predicted outcomes using logistic regression, and area under the curve was analyzed to validate the model.</div></div><div><h3>Results</h3><div>In this study, 417 patients with the median age of 40 y and age range of 18-95 y were evaluated. There was no significant difference between the calibration of the models in prediction of a 14-d mortality (basic <em>P</em> = 0.082, CT <em>P</em> = 0.067) and 6-mo unfavorable outcome (basic <em>P</em> = 0.688, CT <em>P</em> = 0.204). The area under the receiver operating characteristic curve in basic and CT models in prediction of 14-d mortality were 0.885 and 0.885 respectively. In addition, the area under the receiver operating characteristic curve in basic and CT models in prediction of 6-mo unfavorable outcome were 0.901 and 0.896, respectively.</div></div><div><h3>Conclusions</h3><div>The results of this study showed that the CRASH basic and CT model both accurately predict 14 d mortality and 6 mo unfavorable outcomes of TBI patients in an urban tertiary care public university hospital in India.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 224-232"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859176","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":"Safety of an Unconventional Vertical Transumbilical Incision for Pediatric Umbilical Hernia Repair","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.2025.03.054","DOIUrl":"10.1016/j.jss.2025.03.054","url":null,"abstract":"<div><h3>Introduction</h3><div>Umbilical hernias are a common pediatric surgical problem, typically repaired at 4-5 y of age. Vertical transumbilical incision (VTUI) is a less common surgical approach associated with improved cosmetic outcomes. Our goal was to demonstrate the safety of this approach compared to the periumbilical incision (PUI).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 402 pediatric patients who underwent an index open umbilical hernia repair for any indication at a single institution from 2013 to 2023. Patient demographics, operative outcomes, narcotic use, and complications were compared by incision type. Data were stratified by age and weight. Analysis was performed using student's <em>t</em>-test.</div></div><div><h3>Results</h3><div>We analyzed 402 patients. Three hundred thirty-seven (83.8%) had PUI and 65 (16.2%) had VTUI. Mean (standard deviation) age was 5 (3.18) y, ranging 0-18 y. Females represented 55%. There was no difference in age based on incision type. PUI and VTUI room time (79.2 v 83.3 min, <em>P</em> = 0.10) and anesthetic time (37.8 v 33.2, <em>P</em> = 0.31) were not significantly different. Mean intraoperative morphine milliequivalents per kilogram (MME/kg) were not different between incision types (<em>P</em> = 0.99). Average postanesthesia care unit MME/kg showed no difference between PUI and VTUI (3.7 v. 7.6, <em>P</em> = 0.06). There were 6 (1.5%) complications with no difference based on incision: 4 recurrences (3 PUI, 1 VTUI), 1 hospital readmission (PUI), and 1 patient with uncontrolled pain requiring admission (PUI). Stratified by weight, there were no significant differences in complication rates based on incision type.</div></div><div><h3>Conclusions</h3><div>Our findings support VTUI as a safe alternative in the pediatric population without an increase in postoperative complications, anesthetic time, or MME/kg utilization.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 35-40"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859815","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}