Journal of Surgical Research最新文献

{"title":"Predictors of Academic Productivity in Cardiac Surgeons: Quality Over Quantity","authors":"Anirudha S. Chandrabhatla MD ,&nbsp;Adishesh K. Narahari MD, PhD ,&nbsp;Emily D. Fronk MD ,&nbsp;Aditya Singh BA ,&nbsp;Kennedy Gray BA ,&nbsp;Kevin T. Qiu BA ,&nbsp;Theodore Vasiliadis BA ,&nbsp;Joseph D. Nguyen BS ,&nbsp;Nicholas R. Teman MD ,&nbsp;John A. Kern MD ,&nbsp;Ourania A. Preventza MD, MBA ,&nbsp;J. Hunter Mehaffey MD, MSc ,&nbsp;Mark E. Roeser MD","doi":"10.1016/j.jss.2025.02.033","DOIUrl":"10.1016/j.jss.2025.02.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Building a successful academic career is challenging. It is unclear which metrics of academic productivity best predict future success for cardiac surgeons.</div></div><div><h3>Methods</h3><div>We collected academic cardiac surgeon profiles from the top 140 National Institutes of Health (NIH)-funded institutions. Publication information was obtained from Web of Science and the NIH <em>iCite</em> tool. Grant information was collected from NIH Research Portfolio Online Reporting Tools Expenditures and Results. Data were categorized into distinct time periods as follows for each surgeon: last 5 y of training (senior trainee), first 5 y as an attending (junior faculty), and after 5 y as an attending (established faculty). The primary outcomes of: (1) publications as established faculty and (2) receiving a K08 or R01 were analyzed using linear and logistic regression.</div></div><div><h3>Results</h3><div>We analyzed 972 academic cardiac surgeons. Total publications as established faculty were predicted by citations per year of papers published as a senior trainee (<em>P</em> = 0.015) but not the number of publications as a senior trainee (<em>P</em> = 0.14). The proportion of basic or translational research (<em>P</em> = 0.27) and first author publications as a senior trainee (<em>P</em> = 0.18) did not predict total publications as established faculty. Being awarded a K08 or R01 was predicted by the number of publications as junior faculty (<em>P</em> = 0.001; odds ratio (OR) 1.02) and whether the surgeon was awarded an F32 (<em>P</em> = 0.0004; OR 3.97) but not the number of publications as a senior trainee (<em>P</em> = 0.49; OR 1.01). Publishing a higher proportion of senior author papers as junior faculty also predicted being awarded a K08 or R01 (<em>P</em> &lt; 0.001; OR 17.15). The surgeons in the top quartile by publication volume varied substantially across career time points.</div></div><div><h3>Conclusions</h3><div>Research quality, not quantity, as a trainee predicts future academic productivity as an attending. Cardiac surgery trainees should prioritize learning how to conduct high-quality research and apply those skills as early attendings to position themselves for future academic success.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 216-223"},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685324","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":"Operative Outcomes of Patients With Recurrent Uncomplicated Appendicitis are Similar to Patients With Acute Uncomplicated Appendicitis","authors":"Amram Kupietzky MD ,&nbsp;Mika Gross BSc ,&nbsp;Roi Dover MD ,&nbsp;Ata Maden MD ,&nbsp;Shani Y. Parnasa MD ,&nbsp;Noam Shussman MD ,&nbsp;Haggi Mazeh MD ,&nbsp;Ido Mizrahi MD","doi":"10.1016/j.jss.2025.02.034","DOIUrl":"10.1016/j.jss.2025.02.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Nonoperative management (NOM) for uncomplicated acute appendicitis (AA) has been gaining popularity in recent years. As so, more patients present with recurrent AA after a successful past episode of NOM. The aim of this study is to assess the outcomes of patients who underwent appendectomy due to recurrent uncomplicated AA after a successful episode of NOM in the past, and to compare their operative and postoperative course to patients operated for uncomplicated AA during their index admission.</div></div><div><h3>Methods</h3><div>A retrospective analysis identified patients who underwent appendectomy in our institution between 2017 and 2022. The study group included all consecutive patients who underwent an appendectomy due to recurrent uncomplicated AA after NOM for uncomplicated AA in the past. Their course and outcomes were compared to a cohort of consecutive patients without any prior episodes of AA, who underwent an appendectomy during their index admission.</div></div><div><h3>Results</h3><div>During the study period, 102 patients underwent an appendectomy due to recurrent uncomplicated AA. This group was compared to 107 consecutive patients without prior episodes of AA, who underwent upfront surgery during their index admission. Analysis demonstrated no significant difference between the groups in the operative approach, resection-technique, overall postoperative complication rates, the use of peritoneal drains, and intraoperative findings. However, length of surgery was significantly shorter in the recurrent AA group than in the upfront appendectomy group (mean ± standard deviation, 34 ± 13.7 versus 50.7 ± 18 min; <em>P</em> &lt; 0.001). Pathology analysis revealed a normal appendix in 11.8% of patients presenting with recurrent AA compared to 1.9% of patients in the upfront surgery group (<em>P</em> = 0.007).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that surgery for recurrent uncomplicated AA after a successful episode of NOM appears to be safe and comparable to upfront surgery during the index admission for uncomplicated AA.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"308 ","pages":"Pages 209-215"},"PeriodicalIF":1.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685181","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":"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}