Journal of Surgical Research最新文献

{"title":"Sildenafil Attenuates Persistent Pulmonary Hypertension of the Newborn via Inhibiting the Growth and Migration of Pulmonary Artery Smooth Muscle Cells.","authors":"Lili Kang, Yujie Han, Chen Liu, Xianghong Liu, XiaoMei Li, Zilong Li, Xiaoying Li","doi":"10.1016/j.jss.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.013","url":null,"abstract":"<p><strong>Introduction: </strong>Sildenafil, a selective phosphodiesterase 5 inhibitor, modulates vascular dysfunction, with hypoxia-induced pulmonary artery smooth muscle cells (PASMCs) proliferation, migration, and invasion closely implicated in vascular remodeling in persistent pulmonary hypertension of the newborn (PPHN). This study aimed to assess sildenafil's protective effects against PPHN and elucidate underlying molecular pathways.</p><p><strong>Methods: </strong>Cell Counting Kit-8, wound healing, and Transwell assays evaluated rat PASMC proliferation, migration, and invasion under hypoxia. A rat PPHN model assessed sildenafil's impact on right ventricular systolic pressure (RVSP), right ventricular hypertrophy (RVH), and vascular remodeling. JAK2/STAT3 signaling was analyzed via Western blotting.</p><p><strong>Results: </strong>Sildenafil significantly inhibited hypoxia-induced PASMC proliferation, migration, and invasion. In addition, sildenafil reduced RVSP, RVH, and vascular remodeling in PPHN. Further, sildenafil decreased JAK2 and STAT3 phosphorylation in hypoxia-exposed PASMCs and the PPHN rat model. The JAK2/STAT3 pathway agonist colivelin reversed sildenafil's suppressive effects on PASMC proliferation, migration, invasion, as well as RVSP, RVH, and vascular remodeling in PPHN.</p><p><strong>Conclusions: </strong>Sildenafil protects against PPHN by inhibiting PASMC proliferation, migration, and invasion via suppression of JAK2/STAT3 signaling, indicating its potential as a therapeutic target for PPHN and contributing to a more comprehensive understanding of PPHN pathogenesis.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"249-256"},"PeriodicalIF":1.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Care Fragmentation on Overall Survival for Early Stage Breast Cancer.","authors":"Margaret Min, Kerri-Anne Crowell, Kristen Rhodin, Amanda Nash, Kendra J Modell Parrish, Hannah E Woriax, E Shelley Hwang","doi":"10.1016/j.jss.2024.11.044","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.044","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal treatment of stage I-III breast cancer requires multimodal therapies. Patients can receive these therapies at one or multiple facilities. Herein, we evaluated the association of receiving treatment at more than one facility and distance to that facility on overall survival.</p><p><strong>Methods: </strong>The 2004-2019 National Cancer Database was queried for patients with stage I-III breast cancer who received at least two modalities of treatment. \"Coordinated care\" was designated when a patient received all modalities of treatment at the same facility and \"fragmented care\" was designated when a patient received treatment at two or more facilities. Multivariable logistic regression was performed to identify factors associated with fragmented care. Overall survival was compared using Kaplan-Meier and Cox proportional hazards methods.</p><p><strong>Results: </strong>A total of 536,896 patients met the study criteria, of which 317,038 (59.1%) patients received coordinated care and 219,848 (40.9%) patients received fragmented care. Decreased mortality was seen with fragmented care in stage II and III patients (hazard ratio (HR): 0.92 and 0.94 respectively; 95% confidence interval (CI): 0.88-0.97, 0.89-0.99; P < 0.001), and receipt of care at an Academic/Research Program (HR: 0.89; 95% CI: 0.84-0.93). Unexpectedly, living greater than 50 miles away from the treating facility was also associated with decreased mortality (HR: 0.85; 95% CI: 0.81-0.90]), although this represented a small minority of patients (N = 30,290, 6.5%).</p><p><strong>Conclusions: </strong>For patients with early-stage breast cancer, receipt of fragmented care and greater distance to treating facility were not associated with worse outcomes. These results support patients' receipt of some care locally, underscoring the need for effective communication across the clinical care team.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"239-248"},"PeriodicalIF":1.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983803","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":"Clinical and Demographic Factors Associated Suicide Risk in Patients With Colorectal Cancer.","authors":"Annmarie Butare, M Drew Honaker, Sydney Taylor, Rebecca A Snyder, Alexander A Parikh","doi":"10.1016/j.jss.2024.12.026","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.026","url":null,"abstract":"<p><strong>Introduction: </strong>Mental health is adversely affected by a cancer diagnosis. As the incidence of colorectal cancer (CRC) is on the rise, data regarding mental health and suicide among CRC patients is lacking. The primary aim of this study is to investigate the incidence of suicide among CRC patients in comparison to the general population. The secondary aim is to identify factors that are associated with increased risk of suicide among patients with CRC.</p><p><strong>Methods: </strong>A cross-sectional study was conducted utilizing the Surveillance, Epidemiology, and End Results Program database from 2000 to 2018. Standardized Mortality Ratios (SMRs) were calculated for 5-y age groups. Cox's cause-specific hazards model was utilized to compare covariates that increased the risk of suicide.</p><p><strong>Results: </strong>A total of 530,711 patients were included. 289,363 (54%) were male. Overall, there were 782 (0.15%) suicides, of which 687 (88%) occurred in males. The SMR due to suicide was significantly higher in males (SMR 1.60, 95% confidence interval [CI] 1.481-1.722; P < 0.001) including ages 35-49 ys and over 60 ys, however, not in females (SMR 1.12, 95% CI 0.91-1.375; P = 0.276). Factors independently associated with increased suicide risk included distant disease (hazard ratio [HR] 2.57; CI 1.96, 3.39; P=<0.0001), radiation (HR 1.45; CI 1.16, 1.80; P = 0.0009), and increased age (HR 1.05 per 5-y increase; CI 1.02, 1.09; P = 0.0013). Factors associated with decreased risk of suicide included non-Hispanic Black race (HR 0.27; CI 0.18, 0.41; P= <0.0001), Hispanic race (HR 0.31; 95% CI 0.21, 0.45; P=<0.0001), being married (HR 0.56; CI 0.49, 0.65; P=<0.0001), living in metropolitan area (HR 0.74; CI 0.61, 0.90; P = 0.003), and receiving chemotherapy (HR 0.71; CI 0.58, 0.86; P = 0.0001).</p><p><strong>Conclusions: </strong>Male colorectal patients aged 35-49 ys and over 60 ys are at a higher risk of suicide than the general United States population. Understanding factors that increase a patient's risk for suicide will be important to develop strategies to mitigate this risk and improve overall mental health.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"217-223"},"PeriodicalIF":1.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971264","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":"Factors Contributing to Opioid Overprescribing at Surgical Discharge.","authors":"Lindsey E Dayer, Cheng Peng, Adrian J Williams, Lisa Luciani, Joshua Lowery, Brittany Butterfield, Jacob T Painter","doi":"10.1016/j.jss.2024.11.034","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.034","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids remain the gold standard for treating acute pain, whereas overprescribing occurs regularly in the postoperative setting with little clinical guidance. The objective of this study is to examine whether the length of surgery is an independent risk factor for opioid overprescribing at discharge.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study to determine if there is an association between the length of surgery and overprescribed opioids. The setting was an academic medical center located in the southern region of the United States - an adult level-one trauma center. It is a general medical and surgical facility and a teaching hospital. The study was determined not to be human subject research by the local institutional review board.</p><p><strong>Results: </strong>Our final sample consisted of 4367 patients that met the eligibility criteria. Of these patients, 1347 (30.84%) had been discharged on morphine equivalent daily dose (MEDD) greater than the previously administered 24-h MEDD. After adjusting for other covariates, the logistic regression analysis of the length of surgery showed that the risk of opioid overprescribing increased as the surgery lasted longer (adjusted odds ratio [AOR] 1.150, 95% confidence interval [CI] 1.099-1.202) and showed that older patients (AOR 1.010, 95% CI 1.006-1.015), males (AOR 1.168, 95% CI 1.006-1.356), non-White individuals (AOR 1.192, 95% CI 1.029-1.380), and patients who experienced lower average pain scores (AOR 0.789, 95% CI 0.757-0.823) had a significantly higher risk of opioid overprescribing.</p><p><strong>Conclusions: </strong>Overprescribing at discharge could result in unnecessary opioids in the community, which may, in turn, lead to opioid abuse, misuse, and diversion. Based on our study, opioid prescribing at discharge is often driven by factors other than inpatient opioid use. Therefore, considering patient-specific factors such as MEDD 24 h before discharge may be one of the most useful tools to help guide opioid prescribing.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"224-229"},"PeriodicalIF":1.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971420","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":"Factors Associated With Minority Patient Enrollment in a Gastric Cancer Biobank.","authors":"Morgan F Pettigrew, Amr I Al Abbas, Anida Southichack, Michelle R Ju, Suntrea T G Hammer, Yulun Liu, Matthew R Porembka, Sam C Wang","doi":"10.1016/j.jss.2024.12.002","DOIUrl":"10.1016/j.jss.2024.12.002","url":null,"abstract":"<p><strong>Introduction: </strong>Human tissue samples are essential for translational cancer research. However, less than 20% of current biobank and genomic samples were obtained from minority patients, which may lead to biased understanding of cancer biology. The objective of this study was to identify factors associated with patient enrollment in our institution's gastric cancer biobank.</p><p><strong>Methods: </strong>Patients with suspected or confirmed gastric or gastroesophageal junction cancer undergoing surgical procedures at our institution were invited to enroll in a prospective gastric cancer biobank. We retrospectively reviewed patients who were invited to enroll from 2017 to 2023 at our safety-net and university hospitals. We compared patients who enrolled to those who declined to identify factors that predict enrollment.</p><p><strong>Results: </strong>Hispanic patients had similar odds of enrollment as non-Hispanic White patients (odds ratio (OR): 1.22, 95% confidence interval (CI): 0.54-2.73, P = 0.63). Non-Hispanic minorities (Black/African Americans and Asians) were less likely to enroll when compared to non-Hispanic Whites (OR: 0.41, 95% CI: 0.18-0.95, P = 0.04). Minority patients treated at our safety-net hospital had higher odds of enrollment than those treated at our university hospital (OR: 2.62, 95% CI: 1.11-5.99, P = 0.02).</p><p><strong>Conclusions: </strong>Efforts to improve diversity in biomedical research cannot consider minority patients as a monolithic cohort. Instead, targeted interventions that address diverse cultural concerns and improve access to enrollment at safety-net centers are requisite.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"230-238"},"PeriodicalIF":1.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971409","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":"Preferences for Inguinal Hernia Repair in Infants: A Survey of the Eastern Pediatric Surgery Network.","authors":"Zane J Hellmann, J Leslie Knod, Afif N Kulaylat, Cornelia Griggs, Jennifer R DeFazio, Stefan Scholz, Hanna Alemayehu, Jamie R Robinson, Shaun M Kunisaki, Matthew A Hornick","doi":"10.1016/j.jss.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.012","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population.</p><p><strong>Methods: </strong>A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate.</p><p><strong>Results: </strong>Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10 ys of experience, 26 (27.1%) had 10-20 ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P < 0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference.</p><p><strong>Conclusions: </strong>The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"188-196"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965586","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":"Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls.","authors":"Brianna L Collie, Luciana Tito Bustillos, Shane L Collins, Nicole B Lyons, Walter A Ramsey, Christopher F O'Neil, Joyce I Kaufman, Jonathan P Meizoso, Kenneth G Proctor, Nicholas Namias","doi":"10.1016/j.jss.2024.12.016","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.016","url":null,"abstract":"<p><strong>Introduction: </strong>Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.</p><p><strong>Materials and methods: </strong>Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.</p><p><strong>Results: </strong>In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.</p><p><strong>Conclusions: </strong>In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"182-187"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Availability of Paternity Leave in US Surgical Residencies: A Study of Program Websites.","authors":"Coral Katave, Anusha Jayaram, Anam N Ehsan, Noelle Thompson, Hamaiyal Sana, Jonathan Gong, Zainab Alimohamed, Catherine A Wu, Raunak Goyal, Lydia Helliwell, Kavitha Ranganathan","doi":"10.1016/j.jss.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.jss.2024.12.022","url":null,"abstract":"<p><strong>Introduction: </strong>As family dynamics evolve, an increasing number of male residents are embracing parenthood during their training. Consequently, paternity leave has emerged as a crucial consideration. The aim of this study was to determine the gap in public availability of paternity leave policies in surgical residency programs across the United States.</p><p><strong>Methods: </strong>We evaluated publicly available information regarding paternity leave policies across both program-specific and Graduate Medical Education (GME) websites of 1242 surgical residency programs across eight surgical specialties. This information was further evaluated in relation to program size, program director gender, specialty type, and geographic location using logistic regression models.</p><p><strong>Results: </strong>Paternity leave policies were found on only 4.3% of program-specific websites and 18.8% of GME websites. Neurosurgery had the greatest number of programs that publicly advertised their policies-11.7% on program-specific websites and 82.5% on GME websites. Vascular surgery and ear, nose, and throat surgery had no policies available on program-specific websites, and general surgery had the least paternity leave policies publicly available as per the GME websites (7.9%). Programs in the northeast were significantly less likely to have paternal leave policies publicly available (odds ratio: 0.55; 95% confidence interval: 0.31-0.96; P = 0.034), whereas programs in the west were significantly more likely (odds ratio: 2.1; 95% confidence interval: 1.2-3.67; P = 0.009) compared to the midwest.</p><p><strong>Conclusions: </strong>This study highlights the pressing need for standardization and transparency across all surgical specialties regarding paternity leave policies. Addressing this gap is crucial for empowering applicants in family planning decisions and fostering a culture supportive of parental leave uptake.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"210-216"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965587","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":"Age-Related Vulnerability to Malnutrition-Related Mortality: Younger Patients are at Risk.","authors":"Lydia M Kersh, Gi J Shin, Sonal Swain, Trevor Sytsma, Scott Gallagher, Paul E Wischmeyer, Suresh Agarwal, Krista L Haines","doi":"10.1016/j.jss.2024.11.032","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.032","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition among older adults continues to be a prevalent health concern. While literature has highlighted an increased risk of malnutrition mortality for adults older than 65 y, the age threshold at which malnutrition effects survival and mortality remains unexplored.</p><p><strong>Methods: </strong>Annual crude and age-adjusted malnutrition-related mortality data from 2009 to 2018 was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. We compared crude rates by year, 10-y age groups (15 to 85+ y), and disposition among age groups 65+ y using analysis of variance. We examined crude rates, year, and 10-y age groups (15 to 85+ y) using multiple linear regression. A Welch two sample t-test was used to compare the 10-y age groups 55-64 and 65-74 by crude rate.</p><p><strong>Results: </strong>From 2009 to 2018, there were 275,282 older adult malnutrition-related mortalities. The differences in crude rates by year from 2009 to 2018 (P < 0.001) and all 10-y age groups were significant (P = 0.028). Differences in crude rates by disposition among age groups 65+ were not significant (P = 0.062). A multiple linear regression between crude rates between years 2009 and 2018 by all 10-y age groups showed a significant association (β = 0.06, 95% CI: 0.03, 0.09, P < 0.001). The difference between the annual crude rate for 10-y age groups 55-64 y and 65-74 y was significant (95% CI = 7.49, 13.41, P value <0.001).</p><p><strong>Conclusions: </strong>Increasing age correlates with higher rates of malnutrition mortality. While nourishment should be a priority for all patients, preventing malnutrition must be a priority for all care with the goal of survival and future research.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"203-209"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965503","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":"Prediction of Aneurysm Sac Shrinkage After Endovascular Aortic Repair Using Machine Learning-Based Decision Tree Analysis.","authors":"Toshiya Nishibe, Tsuyoshi Iwasa, Seiji Matsuda, Masaki Kano, Shinobu Akiyama, Shoji Fukuda, Jun Koizumi, Masayasu Nishibe, Alan Dardik","doi":"10.1016/j.jss.2024.11.049","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.049","url":null,"abstract":"<p><strong>Introduction: </strong>A simple risk stratification model to predict aneurysm sac shrinkagein patients undergoing endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA) was developed using machine learning-based decision tree analysis.</p><p><strong>Methods: </strong>One hundred nineteen patients with AAA who underwent elective EVAR at Tokyo Medical University Hospital between November 2013 and July 2019 were included in the study. Predictors of aneurysm sac shrinkage identified in univariable analysis (P < 0.05) were entered into the decision tree analysis.</p><p><strong>Results: </strong>Univariable analysis revealed significant differences between patients with and without aneurysm sac shrinkage in the variables of age (<75 y or ≥75 y), current smoking, operative type II endoleak, and preoperative pulse wave velocity (PWV) (<1800 cm/s or ≥1800 cm/s). The decision tree showed that preoperative PWV was the most relevant predictor, followed by operative type II endoleak and current smoking, and identified 6 terminal nodes with likelihoods of aneurysm sac shrinkage ranging from 5.6% to 63.6%.</p><p><strong>Conclusions: </strong>We established a decision tree model with 3 variables (preoperative PWV, operative type II endoleak, and current smoking) to predict aneurysm sac shrinkage in patients undergoing EVAR for AAA. This classification model may help identify patients with a high or low likelihood of aneurysm sac shrinkage.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"197-202"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965426","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}