Journal of Surgical Research最新文献

{"title":"Comprehensive Rotation Analysis of Integrated Plastic Surgery Residency in the United States: Clarification of Rotation Metrics","authors":"Zachary A. Koenig MD,&nbsp;Niki K. Patel MD,&nbsp;Rebecca Norcini MD,&nbsp;Luis H. Quiroga MD, MPH,&nbsp;Kerri Woodberry MD, MPH","doi":"10.1016/j.jss.2025.06.069","DOIUrl":"10.1016/j.jss.2025.06.069","url":null,"abstract":"<div><h3>Introduction</h3><div>Plastic surgery training favors the integrated model, necessitating evaluation of all rotations to ensure comprehensive training. The American Board of Plastic Surgery and the American Council of Graduate Medical Education set rotation guidelines, yet programs adopt diverse curricula. This study examines trends in rotation blocks amid rising integrated programs.</div></div><div><h3>Methods</h3><div>Data from 2012 to 2023 from the National Resident Matching Program and the American Council of Educators in Plastic Surgery provided match statistics and the current program list. The study identified 89 accredited integrated plastic surgery programs, collecting rotation schedules via official websites or direct contact between January and March 2024. It analyzed rotations, categorizing them into plastic surgery or nonplastic surgery, with the latter divided into 18 specific categories.</div></div><div><h3>Results</h3><div>Over the decade, integrated programs increased by 68%, whereas independent programs decreased by 33%, with a 20% reduction in general surgery months. Analysis of 73 of 89 programs showed an average of 10.3 mo in general surgery rotations. Although not significant, departmental programs had fewer general surgery months than divisional programs. There were also no significant differences when stratified by association with an independent residency or incoming resident cohort sizes. Considerable variability in subspeciality rotations is noted.</div></div><div><h3>Conclusions</h3><div>The ideal combination of rotations is still being defined, reflecting the unique priorities of each program. This variability suggests ongoing experimentation with the structure and emphasis of rotations to find the most effective educational approach, with a general movement toward increasing early plastic surgery exposure and reducing nonplastic surgery rotations in the initial years.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 438-447"},"PeriodicalIF":1.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680192","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":"Impaired Diabetic Myocutaneous Wound Revascularization Is Associated With Reduced Transdermal H2S","authors":"Joseph Giacolone MD ,&nbsp;Deepali Kulkarni MD ,&nbsp;Carolyn Pace BS ,&nbsp;Benjamin Matheson PhD ,&nbsp;Nancy Kanagy PhD ,&nbsp;Ross M. Clark MD, MBA","doi":"10.1016/j.jss.2025.06.068","DOIUrl":"10.1016/j.jss.2025.06.068","url":null,"abstract":"<div><h3>Introduction</h3><div>As the prevalence of diabetes mellitus continues to rise, morbidity associated with nonhealing diabetic wounds is becoming more common. Hydrogen sulfide (H₂S) has been increasingly recognized as an important signaling molecule in wound healing and angiogenesis. Obesity and diabetes are associated with decreased levels of circulating and transdermal H₂S, but skin H₂S emissions during wound healing have not previously been established. This study aims to describe H₂S physiology during diabetic ischemic wound healing and revascularization.</div></div><div><h3>Materials and Methods</h3><div>Sprague Dawley and Zucker diabetic fatty (ZDF) rats underwent creation of full-thickness ischemic myocutaneous flap wounds. Revascularization was followed for 14 days by serial laser speckle contrast imaging and transdermal H₂S emissions during healing. The degree of ischemic tissue injury (panniculus carnosus thickness) and neovascularization (CD31 immunohistochemistry) were assessed histologically. Vascular endothelial growth factor was measured by Western immunoblot.</div></div><div><h3>Results</h3><div>ZDF rats were observed to have impaired skin perfusion at baseline and during flap engraftment [64 perfusion units (PU) versus 184 PU, <em>P</em> &lt; 0.01], which mirrored deficits in H₂S emissions of the healing flap wound (10 parts per billion [ppb] versus 28 ppb, <em>P</em> &lt; 0.01). Significantly worse tissue ischemic injury and neovascularization were noted in ZDF animals compared to Sprague Dawley (12 CD31⁺ vessels/mm² versus 20, <em>P</em> = 0.02), which correlated with a two-fold deficit in vascular endothelial growth factor expression compared to nondiabetic animals.</div></div><div><h3>Conclusions</h3><div>Impairments in transdermal H₂S emissions are present in diabetic ischemic wounds and are associated with deficits in wound revascularization, perfusion, maintenance of tissue architecture, neovascularization, and angiogenic signaling. H₂S therapies may be a viable novel option for this challenging clinical problem.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 457-464"},"PeriodicalIF":1.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687138","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":"Outcomes After ERAS Pathway in Open and Robotic Pancreatic Surgery: A Retrospective Cohort Study","authors":"Benjamin Lorié MD ,&nbsp;Kristine Kuchta MS ,&nbsp;Aram E. Rojas MD ,&nbsp;Sarah B. Hays MD ,&nbsp;Syed Abbas Mehdi MBBS ,&nbsp;Margaret Gurley BSN, MHA ,&nbsp;Rebecca Blumenthal MD ,&nbsp;Mark S. Talamonti MD ,&nbsp;Melissa E. Hogg MD","doi":"10.1016/j.jss.2025.06.059","DOIUrl":"10.1016/j.jss.2025.06.059","url":null,"abstract":"<div><h3>Introduction</h3><div>Enhanced recovery after surgery (ERAS) pathways improve outcomes for patients following open pancreaticoduodenectomy (PD). However, the impact of ERAS protocols following robotic pancreas surgery is less understood. This study aims to compare patient outcomes in open and robotic pancreas surgery, including PD and distal pancreatectomy (DP), following implementation of an ERAS pathway.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study was conducted from August 2018 to December 2022 and analyzed patients who underwent pancreatic surgery. Baseline characteristics, perioperative and postoperative outcomes, including postoperative morphine utilization, were compared between ERAS and non-ERAS cohorts. Univariate and multivariable analyses were performed.</div></div><div><h3>Results</h3><div>Of the 220 patients included in the study, average age was 68 y, 50.5% were female, 64.5% underwent PD, and a robotic approach was utilized in 68.6% of patients. The ERAS cohort required less postoperative opioids (58 <em>versus</em> 148 morphine milligram equivalents, <em>P</em> &lt; 0.0001), and had lower pain scores on postoperative day 0 (6 <em>versus</em> 8, <em>P</em> &lt; 0.0001) compared to the non-ERAS cohort. On multivariable analyses, the ERAS cohort was less likely to experience a complication overall (<em>P</em> &lt; 0.0001), and in the PD (<em>P</em> = 0.0004), DP (<em>P</em> = 0.0003), and robotic subgroups (<em>P</em> = 0.0002).</div></div><div><h3>Conclusions</h3><div>The utilization of an ERAS pathway following pancreatic surgery is associated with reduced postoperative opioid use, lower pain scores, and fewer complications, supporting its safety and feasibility for PD, DP, and use in a robotic approach.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 465-478"},"PeriodicalIF":1.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687280","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":"Preventable Transfers of Ingested Foreign Bodies in a Rural State","authors":"Savannah C. Walker MD ,&nbsp;Derek J. Krinock MD ,&nbsp;Chary Akmyradov PhD ,&nbsp;Deidre L. Wyrick MD ,&nbsp;Robert T. Maxson MD ,&nbsp;Melvin S. Dassinger MD ,&nbsp;Lindsey L. Wolf MD, MPH","doi":"10.1016/j.jss.2025.06.070","DOIUrl":"10.1016/j.jss.2025.06.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Unnecessary transfer of pediatric patients with ingested foreign bodies presents significant social and financial burdens for patients and families. We sought to assess patient factors associated with potentially avoidable interfacility transfers after foreign body ingestion in a rural state.</div></div><div><h3>Materials and methods</h3><div>This is a multisite retrospective cohort study including patients &lt; 18 y who were transferred to a tertiary pediatric hospital for surgical evaluation due to ingested foreign body between January 5, 2022, and April 30, 2024. Preventable transfer (PVT) was defined as any patient with an object below the gastroesophageal junction on pretransfer imaging not requiring surgical intervention or admission to any service for additional management of foreign body. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between patient factors and PVT.</div></div><div><h3>Results</h3><div>One hundred and seventy-one patients were included, with 26.3% (<em>n</em> = 45) identified as PVTs. No differences in demographic variables were seen between PVTs and nonpreventable transfers. Type of object was most commonly “other” in the preventable group and coin in the nonpreventable transfer group [60% <em>versus</em> 71%, <em>P</em> &lt; 0.001]. Surgical consults were ordered for 74.3% (<em>n</em> = 126) of all transferred patients and almost half (46.7%, <em>n</em> = 21) of PVTs, despite 97.8% of PVTs being ultimately discharged from the emergency department.</div></div><div><h3>Conclusions</h3><div>Interfacility transfers of patients with ingested foreign bodies were characterized as preventable in over one-quarter of patients. These findings suggest an opportunity for interfacility transfer guideline standardization or implementation of telemedicine consultation to decrease overtriage and improve efficiency of health care utilization associated with this common pediatric chief complaint.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 448-456"},"PeriodicalIF":1.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680191","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":"Efficacy of a Novel Hemostatic Material “Sodium Calcium Alginate’’ in a Porcine Acute Phase Model","authors":"Shoichiro Urabe MD ,&nbsp;Masahiro Sato PhD ,&nbsp;Yuto Kubo MD, PhD ,&nbsp;Sayaka Suzuki MS ,&nbsp;Takahiro Yoshihara MS ,&nbsp;Kousuke Yamauchi MS ,&nbsp;Tsuyoshi Hata MD, PhD ,&nbsp;Takayuki Ogino MD, PhD ,&nbsp;Norikatsu Miyoshi MD, PhD ,&nbsp;Mamoru Uemura MD, PhD ,&nbsp;Hirofumi Yamamoto MD, PhD ,&nbsp;Hidetoshi Eguchi MD, PhD ,&nbsp;Yuichiro Doki MD, PhD ,&nbsp;Kiyokazu Nakajima MD, PhD","doi":"10.1016/j.jss.2025.06.067","DOIUrl":"10.1016/j.jss.2025.06.067","url":null,"abstract":"<div><h3>Introduction</h3><div>Although biologically derived hemostatic materials have satisfactory performance, they involve the risk of infection. We have developed a novel hemostatic material, sodium calcium alginate (Na/Ca alginate), based on the nonbiological material sodium alginate. This study aimed to evaluate the hemostatic efficacy of our Na/Ca alginate compared with conventional nonbiological and biological agents.</div></div><div><h3>Methods</h3><div>We manufactured the Na/Ca alginate with optimized hemostatic properties according to our previous studies. We adopted microporous starch and oxidized cellulose as nonbiological existing hemostatic agents and fibrin glue as an existing biological hemostatic agent. Standardized punch-out wounds were created in porcine livers using a biopsy punch. Each hemostatic material was then applied, and hemostatic efficacy was evaluated at 2 and 5 min after application.</div></div><div><h3>Results</h3><div>The degree of bleeding was comparable at each group. Na/Ca alginate showed significantly higher hemostatic efficacy than microporous starch and oxidized cellulose at 2 min after application (Na/Ca alginate 90% <em>versus</em> microporous starch 0% <em>versus</em> oxidized cellulose 50%, <em>P</em> &lt; 0.01). The finding persisted at 5 min (86.7% <em>versus</em> 0% <em>versus</em> 43.3%, <em>P</em> &lt; 0.01). Na/Ca alginate also showed significantly higher hemostatic efficacy compared to fibrin glue at 2 min (Na/Ca alginate 94.1% <em>versus</em> fibrin glue 50.0%, <em>P</em> &lt; 0.01). At the 5-min evaluation, there was no statistically significant difference between Na/Ca alginate and fibrin glue (94.1% <em>versus</em> 85.3%, <em>P</em> = 0.427).</div></div><div><h3>Conclusions</h3><div>Our novel Na/Ca alginate demonstrated superior hemostatic efficacy compared to existing nonbiological hemostatic agents and achieved more rapid hemostasis than the existing biological hemostatic agent.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 389-396"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672351","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":"Assessing the Safety of Nonintensive Care Unit Admission for Select Grade III Blunt Splenic Trauma","authors":"Peter D. Nguyen MD ,&nbsp;Robert Painter MD ,&nbsp;Areg Grigorian MD ,&nbsp;Lourdes Swentek MD ,&nbsp;Alliya Qazi MD ,&nbsp;Cristobal Barrios MD ,&nbsp;Catherine Kuza MD, FASA ,&nbsp;Matthew Dolich MD ,&nbsp;Jeffry Nahmias MD, MHPE","doi":"10.1016/j.jss.2025.06.065","DOIUrl":"10.1016/j.jss.2025.06.065","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with grade III blunt splenic injuries (BSIs) may require splenectomy. Currently, there is practice variation for admission of these patients to an intensive care unit (ICU) or non-ICU floor. We hypothesized that select BSI patients may be admitted to non-ICU locations without increased complications, death, or need for splenectomy.</div></div><div><h3>Methods</h3><div>The 2017-2019 Trauma Quality Improvement Program database was queried for non-elderly adult (18-64 y-old) grade III BSIs. Patients with hypotension, heart rate &gt;90, respiratory rate &gt;22, abbreviated injury scale for the head/spine/thorax/upper or lower extremity &gt;2, or with cirrhosis, stroke, myocardial infarction, or chronic obstructive pulmonary disease were excluded as these patients might otherwise warrant ICU admission. ICU admissions were compared to non-ICU admissions. Multivariable logistic regression for mortality was performed.</div></div><div><h3>Results</h3><div>From 1899 patients included, 1000 (52.7%) were admitted to the ICU. There was similar demographics between cohorts (all <em>P</em> &gt; 0.05). There was a higher rate of colon injury in the ICU cohort (0.9% <em>versus</em> 0%, <em>P</em> = 0.004). ICU admissions had increased rates of splenectomy (4.8% <em>versus</em> 2.0%, <em>P</em> &lt; 0.001), major complications (1.8% <em>versus</em> 0.6%, <em>P</em> = 0.013) and length of stay (4.0 <em>versus</em> 3.0, <em>P</em> &lt; 0.001). However, there was no difference in the rate (0.3% <em>versus</em> 0.4%, <em>P</em> = 0.60) or associated risk of mortality (odds ratio 0.68, confidence interval 0.152-3.070, <em>P</em> = 0.62) between cohorts.</div></div><div><h3>Conclusions</h3><div>The rate of splenectomy, complications, and mortality was low overall and similar or better for nearly isolated grade III BSI patients admitted to non-ICU floors. This suggests there is a population of adult grade III BSI that can avoid ICU admission.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 397-402"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672479","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":"Firearm Owners’ Preferences for Secure Storage Devices: Insights From Product Reviews","authors":"Grayson Graham ,&nbsp;Colby Wilson ,&nbsp;Katelin Hoskins PhD ,&nbsp;M. Kit Delgado MD, MS ,&nbsp;Sunny Vespico Jackson MSN ,&nbsp;Athena Lee MA ,&nbsp;Anish Agarwal MD ,&nbsp;Elinore J. Kaufman MD, MSHP","doi":"10.1016/j.jss.2025.06.048","DOIUrl":"10.1016/j.jss.2025.06.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Securely storing firearms can prevent suicide, unintentional injury, and gun theft. However, fewer than half of the US firearm owners store all firearms securely. Ongoing efforts to promote secure storage by distributing locking devices could benefit from a robust understanding of how firearm owners' preferred qualities in storage devices. To gain insight into firearm owners’ priorities in evaluating a storage device, we conducted a qualitative analysis of Amazon product reviews of firearm locking devices.</div></div><div><h3>Methods</h3><div>We analyzed reviews for the top five rated products in five categories of storage devices: lock boxes, installed gun safes (handguns), installed gun safes (long gun), cable locks, and trigger locks. We collected the 5 “most helpful” positive and critical reviews, limited to reviews by verified purchasers. Review text and characteristics were extracted. Reviews were open-coded to identify what device features were most salient to purchasers. The codebook was refined iteratively. Disagreements were resolved by consensus. Coded data were summarized and key themes identified using content analysis.</div></div><div><h3>Results</h3><div>We analyzed 250 reviews of 25 products, yielding 13 themes. Overall, sturdiness, ease of access, reliability, and resistance to theft were prominent priorities for firearm storage device purchases across device types.</div></div><div><h3>Conclusions</h3><div>Firearm owners value secure storage devices that allow quick, easy access while remaining robust to theft or damage. Devices that are simple to set up and easy to operate were best received by consumers. Efforts to promote secure storage of firearms may be more effective by considering firearm owners’ preferences for storage devices.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 372-379"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672466","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":"Trends in the Management of Peripheral Arterial Injuries: A Five-Year National Analysis","authors":"Francisco Castillo-Diaz MD,&nbsp;Mohammad Al Ma'ani MD,&nbsp;Muhammad Haris Khurshid MD,&nbsp;Omar Hejazi MD,&nbsp;Christina Colosimo DO, MS, FACS,&nbsp;Adam Nelson MD, FACS,&nbsp;Audrey L. Spencer MD, FACS,&nbsp;Stanley E. Okosun MD, MS, FACS,&nbsp;Louis J. Magnotti MD, MS, FACS,&nbsp;Bellal Joseph MD, FACS","doi":"10.1016/j.jss.2025.06.076","DOIUrl":"10.1016/j.jss.2025.06.076","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral vascular injuries are rare with high rates of morbidity and long-term sequelae. The aim of this study is to study the trends in vascular injuries and management across American College of Surgeons–verified Level I trauma centers.</div></div><div><h3>Methods</h3><div>We performed a 5-y retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database for the years 2017-2021. We included all patients with peripheral arterial injuries (axillary, brachial, radial, ulnar, femoral, popliteal, and tibial arteries) that underwent open or endovascular repair. Trauma centers were stratified into tertiles based on the volume of these vascular injuries into low volume (LV), medium volume (MV), and high volume (HV) centers. The primary outcome was rates of open and endovascular repair. The secondary outcome was amputation. Descriptive statistics and trend analysis were performed.</div></div><div><h3>Results</h3><div>We identified a total of 22,057 patients with peripheral arterial injuries managed at 340 trauma centers (243 LV; 73 MV; 24 HV). Overall, the mean age was 36 (16) y; 83% were male. Nearly 30% sustained blunt injuries with a median injury severity score of 9 [3-13]. HV centers deal with an average of 27 cases/y. The rates of open and endovascular repairs were 63% and 13%, respectively. HV centers were more likely to perform endovascular repair (LV 11% <em>versus</em> MV 12% <em>versus</em> HV 14%, <em>P</em> &lt; 0.001). There was no clinically significant difference between the HV, MV, and LV centers in terms of amputations (HV: 2.9% <em>versus</em> MV: 3% <em>versus</em> LV: 2.5%). On linear regression analysis, the proportion of endovascular procedures has linearly increased from 12% in 2017 to 14% in 2021 (β = 0.013, 95% confidence interval = 0.010-0.016, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Peripheral arterial injuries remain a complex clinical challenge. Nearly one-third of the peripheral arterial injuries are due to blunt mechanisms. Open repair remains the most preferred method of management. However, the outcomes remain equivocal irrespective of volume. Current training programs need to identify ways to improve training in open repairs for vascular injuries.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 380-388"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Adjunctive Anesthesia Within an ERAS Protocol: A Retrospective Cohort Study","authors":"Justin Dourado MD ,&nbsp;Ariel Wolf MD ,&nbsp;Maria Herrera Rodriguez DO ,&nbsp;Shruti Agarwal BS ,&nbsp;Karin Blumofe MD ,&nbsp;Jordan Moseson DO ,&nbsp;Jose Yeguez MD ,&nbsp;Andrew Ross MD ,&nbsp;Avraham Belizon MD","doi":"10.1016/j.jss.2025.06.075","DOIUrl":"10.1016/j.jss.2025.06.075","url":null,"abstract":"<div><h3>Introduction</h3><div>There is increasing focus on adjunctive anesthesia to reduce complications and improve pain control among surgical patients. This study aims to investigate and compare if the type of anesthesia (spinal, transversus abdominis plane [TAP] block, or general anesthesia alone) used in patients undergoing colorectal surgery within an Enhanced Recovery After Surgery protocol is associated with improved patient outcomes.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study analyzed adult patients undergoing colorectal surgery at a Regional Hospital from December 2019 to October 2021. Data on demographics, operative details, complications, postoperative outcomes, and compliance were collected. The primary outcome was the association of adjunctive anesthesia on postoperative outcomes. After association analysis, variables yielding <em>P</em> &lt; 0.10 associated with the primary or secondary outcomes were chosen for regression analysis, with calculation of univariable odds ratios (ORs) and a significance set at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Among 225 patients, 70 received a TAP block, 100 spinal anesthesia, and 55 general anesthesia. There were no differences in length of stay (<em>P</em> = 0.746), readmission (<em>P</em> = 0.144), bowel function (0.778), complications (<em>P</em> = 0.24), or pain control (<em>P</em> = 0.686). Spinal anesthesia was associated with higher oral intake in postanesthesia recovery unit (OR 5.3750, <em>P</em> &lt; 0.001), lower narcotic use (OR 0.4303, <em>P</em> = 0.0213), and fewer discharges to skilled nursing facilities (OR 0.0303, <em>P</em> = 0.018).</div></div><div><h3>Conclusions</h3><div>Spinal anesthesia is associated with improved oral intake, reduced narcotic use, and less skilled nursing facility discharge in colorectal surgery patients compared to TAP blocks and general anesthesia.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 412-420"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672470","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":"Isoperistaltic Anastomosis Increases Neo-Terminal Ileum Intubation Rates in Crohn's Disease Patients","authors":"Tamar Thurm MD ,&nbsp;Galia Berman MD ,&nbsp;Ayal Hirsch MD ,&nbsp;Liat Deutsch MD ,&nbsp;Nathaniel Aviv Cohen MD ,&nbsp;Haim Leibovitzh MD ,&nbsp;Yulia Ron MD ,&nbsp;Nadav Dvir MD ,&nbsp;Eran Itzkovitz MD ,&nbsp;Hagit Tulchinsky MD ,&nbsp;Jonathan B. Yuval MD ,&nbsp;Yehuda Kariv MD ,&nbsp;Guy Lahat MD ,&nbsp;Nitsan Maharshak MD ,&nbsp;Meir Zemel MD","doi":"10.1016/j.jss.2025.06.082","DOIUrl":"10.1016/j.jss.2025.06.082","url":null,"abstract":"<div><h3>Introduction</h3><div>Side-to-side stapled ileocolonic anastomosis (ICA) is commonly used in Crohn's disease (CD). Antiperistaltic ICA (APICA) and isoperistaltic ICA (IPICA) alignments differ in ease of neo-terminal ileum (neo-TI) intubation, potentially impacting endoscopic follow-up. This study compares postsurgical neo-TI intubation feasibility between APICA and IPICA.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective analysis of CD patients (≥18 y) who underwent ileocolonic resection between 2010 and 2022 and completed ileocolonoscopy within 24 mo. Patients with non-APICA/IPICA anastomoses, ileostomy, and patients whose ileocolonoscopy report was unavailable were excluded.</div></div><div><h3>Results</h3><div>We included 148 patients, (76.4% APICA and 23.6% IPICA). Groups were comparable in demographics, surgical factors, and postsurgical outcomes. Anastomotic disease recurrence (Rutgeerts score Ri ≥ 2b) was similar: 37.6% APICA <em>versus</em> 37.1% IPICA (<em>P</em> = 0.563). Excluding patients with anastomotic strictures and poor preparation, neo-TI intubation was successful in 87.4% of APICA <em>versus</em> 100% of IPICA (<em>P</em> = 0.038).</div></div><div><h3>Conclusions</h3><div>APICA and IPICA have similar safety and endoscopic recurrence rates. IPICA allows for easier neo-TI intubation with no intubation failure, improving endoscopic surveillance and management of CD.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 421-430"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672475","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}