Journal of Surgical Research最新文献

{"title":"Can Concurrent Traumatic Hemopneumothorax be Safely Observed?","authors":"Abdul Hafiz Al Tannir, Morgan Tentis, Morgan Maring, Bryce Patin, Elise A Biesboer, Simin Golestani, Courtney J Pokrzywa, Jacob Peschman, Patrick B Murphy, Rachel S Morris, Thomas W Carver, Marc A de Moya","doi":"10.1016/j.jss.2024.09.085","DOIUrl":"10.1016/j.jss.2024.09.085","url":null,"abstract":"<p><strong>Introduction: </strong>The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX).</p><p><strong>Methods: </strong>We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure.</p><p><strong>Results: </strong>A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates.</p><p><strong>Conclusions: </strong>Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"400-407"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Gender Parity Among Vascular Surgeons: Progress and Attrition\" [Journal of Surgical Research, Volume 303 (2024) P281-286].","authors":"Elisa Bass, Scott Anderson, Braden C Hintze, Young Erben","doi":"10.1016/j.jss.2024.10.022","DOIUrl":"10.1016/j.jss.2024.10.022","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"410"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639308","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":"Gender Gap in Academic Surgery: Disparities in Early-Career Scholarly Productivity Sets the Stage for Unequal Academic Advancement","authors":"Gina Kim MD ,&nbsp;Emily Goodman MD ,&nbsp;Alexandra Adams MD ,&nbsp;John Skendelas MD ,&nbsp;Jessica Ward MD ,&nbsp;Fei Wang MD ,&nbsp;Shou-En Lu PhD ,&nbsp;Haejin In MD, MPH, MBA, FACS","doi":"10.1016/j.jss.2024.10.035","DOIUrl":"10.1016/j.jss.2024.10.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Gender disparities exist in academic surgery despite advances in the field. This study aimed to examine the extent of gender disparities in career advancement and promotion among academic faculty in surgery and understand the influence of academic productivity.</div></div><div><h3>Methods</h3><div>Cross-sectional study using publicly available information from online faculty profiles of 18 large academic US general surgery residency programs. Gender equality was examined overall and as subgroups by career stage (late-, mid-, and early-career) to account for differences over time. Logistic regression identified factors associated with gender disparities. Mediation analysis examined if the gender difference in academic advancement was mediated by academic productivity.</div></div><div><h3>Results</h3><div>Of the 1467 faculty members, 388 (26.4%) were women. Gender disparity in academic advancement was observed in the early-career cohort (33.4% <em>versus</em> 23.8%, <em>P</em> = 0.006). Women in the early-career cohort were nearly 40% less likely to achieve academic advancement (odds ratio 0.62 [95% confidence interval 0.44-0.88]) and more than 50% less likely to have &gt;30 publications (odds ratio 0.45 [95% confidence interval 0.32-0.63]) than men. The effect of gender was no longer significant once publication volume and fellowship training was incorporated into the model on multivariable regression. Mediation analysis showed that &gt;30 publications mediated nearly 67% of the effect of gender on academic advancement in the early-career cohort.</div></div><div><h3>Conclusions</h3><div>The gender gap in academic advancement for early-career faculty can partially be explained by the lower number of publications produced by women faculty. Institutions need to ensure that resources and support are designed to ensure equal opportunities regardless of gender.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 356-364"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744722","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 End-of-Life Care in Nonelderly Adults With Severe Traumatic Brain Injury","authors":"Morgan Tentis BA,&nbsp;Abdul Hafiz Al Tannir MD,&nbsp;Courtney J. Pokrzywa MD,&nbsp;Colleen Trevino PhD,&nbsp;Daniel N. Holena MD,&nbsp;Patrick B. Murphy MD,&nbsp;Thomas W. Carver MD,&nbsp;Jacob Peschman MD,&nbsp;Marc A. de Moya MD,&nbsp;Lewis B. Somberg MD,&nbsp;Rachel S. Morris MD","doi":"10.1016/j.jss.2024.10.046","DOIUrl":"10.1016/j.jss.2024.10.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Older age is a well-established risk factor for withdrawal of life-sustaining therapy (WDLST) and discharge to hospice (DH) in traumatic brain injury (TBI). However, a paucity of data exists in identifying factors associated with end-of-life (EoL) care in younger patients with TBI. We sought to identify hospital and patient factors associated with EoL care and timing of EoL care in younger adults with severe TBI.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of the National Trauma Databank (2019). Adults (18-65 y) with severe TBI (Glasgow coma scale &lt;9) were included in the analysis. Inclusion criteria included death, WDLST, or DH during the hospital stay. Exclusion criteria included Glasgow coma scale &gt;8, death in the emergency department, and missing WDLST status. The primary outcome was EoL Care defined as those who either underwent WDLST or DH. The secondary outcome was early EoL care defined as EoL care within 72 h of admission.</div></div><div><h3>Results</h3><div>A total of 1239 patients were included in the study, the median age was 43 y, and the majority were males (77%) and of white race (68%). A total of 667 (54%) patients underwent EoL Care. On multivariable analysis, increasing age (adjusted odd's ratio [aOR]: 1.02; 95% confidence interval [CI]: 1.01-1.03) and chronic alcoholism (aOR: 1.78; 95% CI: 1.05-3.03) were independently associated with EoL. Conversely, patients of Black race (aOR: 0.33; 95% CI: 0.22-0.49) and those admitted to university hospitals (odd's ratio 0.51 95% CI 0.33-0.74) and level II trauma centers (odd's ratio 0.57; 95% CI 0.37-0.88) were less likely to undergo EoL care. A total of 225 (34%) patients underwent early EoL Care. On multivariable analysis, presence of nonreactive pupils and absence of intracranial pressure monitor were independently associated with early EoL care.</div></div><div><h3>Conclusions</h3><div>Significant variation in EoL care exists in patients presenting with severe TBI. Better understanding of patient and hospital factors that influence these complex decisions may allow for targeted interventions to reduce variability in EoL practice in TBI across institutions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 348-355"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744720","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":"System-level Variability in Trauma Center Utilization for Seriously Injured Older Adults","authors":"Alexander J. Ordoobadi MD ,&nbsp;Manuel Castillo-Angeles MD, MPH ,&nbsp;Masami Tabata-Kelly MBA, MA ,&nbsp;Peter C. Jenkins MD, MSc ,&nbsp;Ula Hwang MD, MPH ,&nbsp;Zara Cooper MD, MSc ,&nbsp;Molly P. Jarman PhD, MPH","doi":"10.1016/j.jss.2024.10.047","DOIUrl":"10.1016/j.jss.2024.10.047","url":null,"abstract":"<div><h3>Introduction</h3><div>Many seriously injured older adults are not transported to trauma centers (TCs), a phenomenon known as undertriage. System-level factors that contribute to undertriage are poorly understood. One important system-level factor is the regional supply of TCs. We hypothesized that regions with greater supply of TCs would have higher rates of transport to a TC for seriously injured older adults.</div></div><div><h3>Methods</h3><div>In this retrospective cross-sectional study using Medicare data from 2014 to 2015, we measured the proportion of seriously injured (injury severity score &gt; 15) older adults (age ≥ 65 y) who were transported to a level I or level II TC within trauma service areas (TSAs), which consist of United States counties aggregated into contiguous geographic regions based on the most frequent hospital destinations for emergency conditions. Patients residing in rural regions were excluded. The primary outcome was transported to a level I or level II TC. The exposure was the supply of TCs within TSAs, grouped into terciles based on the number of TCs per capita. We performed a multivariable hierarchical logistic regression for the odds of TC transport with a random intercept for TSA and fixed effects for TC supply, patient demographics, and injury characteristics.</div></div><div><h3>Results</h3><div>Our study included 68,128 seriously injured older adults residing in 309 TSAs. The tercile of TSAs with the lowest supply of TCs had 1.13 TCs per 1,000,000 population, and 38.8% of seriously injured older adults were transported to a TC. In contrast, the tercile with the highest supply of TCs had 4.15 TCs per 1,000,000 population, and 68.5% were transported to a TC. On multivariable hierarchical logistic regression, TSAs with the highest supply of TCs had four times higher odds of transport to a TC compared to TSAs with the lowest supply of TCs (odds ratio 4.23; 95% confidence interval: 3.32-5.38; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Older adults with serious injuries are more likely to be transported to a TC in TSAs with greater supply of TCs. Ensuring an appropriate supply of TCs within TSA regions may help to reduce rates of undertriage for seriously injured older adults.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"Pages 10-18"},"PeriodicalIF":1.8,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747289","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":"Colorectal Surgery Outcomes and Healthcare Burden for Medicare Beneficiaries With Dementia","authors":"Clancy J. Clark MD, FACS ,&nbsp;Rachel Adler ScD, RD ,&nbsp;Lingwei Xiang MPH ,&nbsp;Samir K. Shah MD, MPH ,&nbsp;Zara Cooper MD, FACS ,&nbsp;Dae Hyun Kim MD, ScD ,&nbsp;Kueiyu Joshua Lin MD ,&nbsp;John Hsu MD ,&nbsp;Stuart Lipsitz MD ,&nbsp;Joel S. Weissman PhD","doi":"10.1016/j.jss.2024.10.029","DOIUrl":"10.1016/j.jss.2024.10.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with Alzheimer's disease and related dementias (ADRD) undergoing colorectal surgery have suboptimal postoperative outcomes, but the specific adverse outcomes and the context of these worse outcomes on a national level are not well understood.</div></div><div><h3>Methods</h3><div>Colorectal surgery patients with and without ADRD from January 1, 2017, to October 1, 2018, were identified using traditional, fee-for-service Medicare claims data. Unadjusted and adjusted analyses were performed to evaluate postoperative outcomes.</div></div><div><h3>Results</h3><div>123,324 Medicare beneficiaries (mean age 76.5, 59.3% female) underwent colorectal surgery in the study cohort with 8.3% (<em>n</em> = 10,254) having a preoperative diagnosis of ADRD. Colorectal surgery patients with ADRD were older (81 <em>versus</em> 76 y old, <em>P</em> &lt; 0.001), frail (42.8% <em>versus</em> 13.6%, <em>P</em> &lt; 0.001), and had more comorbidities (Elixhauser Score 19.6 <em>versus</em> 13.9, <em>P</em> &lt; 0.001) compared with those without an ADRD diagnosis. Patients with ADRD more often had open surgery (75.2% <em>versus</em> 65.7%, <em>P</em> &lt; 0.001) and emergency surgery (65.1% <em>versus</em> 37.8%, <em>P</em> &lt; 0.001). Unadjusted and adjusted analyses demonstrated that patients with ADRD have an increased risk of in-hospital, 30-d, and 90-day mortality, as well as postoperative complications. Patients with ADRD required more healthcare resources after colorectal surgery including increased length of stay (7 <em>versus</em> 5 days), discharge to a higher level of care (60.8% <em>versus</em> 25.8%, <em>P</em> &lt; 0.001), and discharge to a facility (54.0% <em>versus</em> 23.8%, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>For patients undergoing colorectal surgery, the diagnosis of ADRD is an independent risk factor for adverse postoperative outcomes and results in increased healthcare resource utilization both in hospital and after discharge.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"Pages 1-9"},"PeriodicalIF":1.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747290","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":"Presentation, Treatment, and Survival Among Asians With Gastric Cancer","authors":"Patrick L. Quinn MD ,&nbsp;Fode Tounkara PhD ,&nbsp;Kunika Chahal MPH ,&nbsp;Marcel Grau Rodríguez BS ,&nbsp;Alex Kim MD, PhD ,&nbsp;Aslam Ejaz MD, MPH","doi":"10.1016/j.jss.2024.10.049","DOIUrl":"10.1016/j.jss.2024.10.049","url":null,"abstract":"<div><h3>Introduction</h3><div>In aggregate, Asian patients have a higher incidence and mortality from gastric cancer (GC) than Non-Hispanic White (NHW) patients. However, there is a lack of data regarding outcomes among Asian-American subpopulations with GC.</div></div><div><h3>Methods</h3><div>The National Cancer Database was used to identify patients with GC between 2004 and 2020. Asian patients were disaggregated by region, with a further subanalysis of Eastern Asians. Outcomes of interest included the initial localized/regional presentation <em>versus</em> metastatic disease and cancer care measures including undergoing surgical excision or resection for stages I-III, receiving guideline-concordant care, receiving delayed treatment (&gt; 90 days for any treatment type), and overall survival. Outcomes were adjusted for patient/disease characteristics, treatment, and zip-code socioeconomic factors using logistic regression.</div></div><div><h3>Results</h3><div>Among 182,811 patients with GC, 7.2% (<em>n</em> = 13,051) were classified as Asian. More than one-half of the Asian cohort was categorized as East Asian (<em>n</em> = 6,762, 50.1%), with Chinese patients compromising 44.0% (<em>n</em> = 2972) of this subcohort. East Asian patients had greater odds of presenting with nonmetastatic disease (odds ratio [OR] 1.59; <em>P</em> &lt; 0.001), undergoing a curative-intent resection (OR 1.52; <em>P</em> &lt; 0.001), and receiving guideline-concordant care (OR 1.26; <em>P</em> &lt; 0.001) compared to NHW patients. Asians from outside of East, Southeast, and South Asia had increased odds of delayed treatment (OR 1.29, <em>P</em> = 0.024). Asians, in aggregate and by each subpopulation, had a lower mortality risk than NHW patients (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Asian patients with GC have improved outcomes in aggregate compared to NHW patients, largely driven by the East Asian subpopulation. All Asian subpopulations demonstrated improved survival in comparison with NHW patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 335-347"},"PeriodicalIF":1.8,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721680","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":"Sex Differences in Opioid-Sparing Regimen Prescribing Following Ventral Hernia Repair","authors":"Divyaam Satija BS ,&nbsp;Jennifer Dai MD ,&nbsp;Ramez Alzatari BA ,&nbsp;Justin Doble MD ,&nbsp;Molly Olson MS ,&nbsp;Benjamin Poulose MD, MPH, FACS ,&nbsp;Michael Reinhorn MD, FACS ,&nbsp;Savannah Renshaw MPH, MPA","doi":"10.1016/j.jss.2024.09.081","DOIUrl":"10.1016/j.jss.2024.09.081","url":null,"abstract":"<div><h3>Introduction</h3><div>While sex differences are known to have a clinically relevant impact on the response to pain therapy, current data are still largely equivocal on sex-specific postoperative pain management. The aim of this study is to determine whether sex predicts differences in pain management in patients undergoing ventral hernia repair (VHR).</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of prospectively collected data for VHR from the Abdominal Core Health Quality Collaborative. The study population included all opioid-naïve adults, undergoing nonemergent initial management of uncomplicated VHR. Multinominal logistic regression was used to explore if postoperative opioid regimens differed by patient sex.</div></div><div><h3>Results</h3><div>The final study population included 1325 males (mean age 54 y, 86.7% White, 62.9% open repairs, 75.9% mesh) and 827 females (mean age 51, 75.7% White, 52.5% open repairs, 69.5% mesh). Unadjusted analysis showed that an opioid sparing regimen was offered to 62.27% female patients and 66.34% male patients. Adjusted analysis demonstrated female patients were less likely to receive an opioid-sparing pain regimen when compared to male patients (odds ratio = 0.647, 95% confidence interval: (0.46-0.909), <em>P</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>Despite having a higher analgesic response than their male counterparts, as well as having a significantly lower morphine consumption postoperatively, female patients were less likely to receive an opioid-sparing regimen. These results show that there is a pressing need to educate clinicians on how sex-specific differences in pain and analgesia may affect opioid prescribing practices. Enhancing clinician awareness about sex-specific differences in pain and analgesia could potentially inform better prescribing practices and promote more equitable postoperative care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 329-334"},"PeriodicalIF":1.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698665","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":"Neonatal Airway Management and Outcomes Following Fetoscopic Endoluminal Tracheal Occlusion (FETO): A Single-Center Descriptive Analysis","authors":"Oluyinka O. Olutoye II MD, MPH ,&nbsp;Alexander Mina MD ,&nbsp;Sarah E. Peiffer MD, MPH ,&nbsp;Shannon M. Larabee MD ,&nbsp;Y. Deniz Sevilmis BSA ,&nbsp;Pamela Ketwaroo MD ,&nbsp;Timothy C. Lee MD ,&nbsp;Sundeep G. Keswani MD, MBA ,&nbsp;Adam Vogel MD ,&nbsp;Joseph Garcia-Prats MD ,&nbsp;Christopher Rhee MD ,&nbsp;Alice King MD","doi":"10.1016/j.jss.2024.10.038","DOIUrl":"10.1016/j.jss.2024.10.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital diaphragmatic hernia is a complex disease associated with pulmonary hypoplasia and hypertension. Fetoscopic endoluminal tracheal occlusion (FETO) has been shown to improve survival and pulmonary hypertension, however, is associated with tracheomegaly. We aim to describe neonatal tracheomegaly, airway management, and outcomes following FETO.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort review was performed for congenital diaphragmatic hernia patients who received FETO at our institution (4/12-6/22). Those with fetal demise, death at delivery, and those awaiting delivery were excluded. Demographics and perinatal outcomes were collected. Tracheal measurements were collected from initial postnatal chest x-ray by a single radiologist. Data were analyzed with descriptive analysis.</div></div><div><h3>Results</h3><div>34 patients underwent FETO with a median gestational age at a diagnosis of 23 wk [IQR 20-26] and at delivery of 36 wk [IQR 34-37]. Tracheomegaly was noted in 24 patients. The median maximum tracheal diameter was 9.9 mm [IQR 8.7-10.5]. All patients were intubated at birth. Ten (29%) eventually received a cuffed endotracheal tube (ETT), with 7/10 switched from an uncuffed ETT due to clinical concerns (i.e., large air leak) and 3/10 initially intubated with cuffed ETT. Nine (26%) patients underwent airway endoscopy, with two initially intubated with cuffed ETT compared to 7 with uncuffed ETT. A maximum of five endoscopies were performed on a single patient initially intubated with an uncuffed ETT, compared to 2 with cuffed ETT.</div></div><div><h3>Conclusions</h3><div>Given the need for multiple reintubations and use of airway endoscopies following FETO in patients with and without tracheomegaly, the placement of larger or cuffed ETT may be considered in initial resuscitation of FETO patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 322-328"},"PeriodicalIF":1.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698658","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":"A Comparison of Scoring Systems to Identify Patients at Increased Risk From Traumatic Rib Fractures","authors":"Jonathan Henglein PA-C ,&nbsp;Elysa Margiotta MD ,&nbsp;Isaac E. Wenger MD ,&nbsp;Yen-Hong Kuo PHD ,&nbsp;Paul Boland MBA, PA-C ,&nbsp;Nicholas Martella MS, PA-C ,&nbsp;Matthew Bank MD ,&nbsp;Manuel Beltran Del Rio PHD ,&nbsp;Alejandro Betancourt-Ramirez MD, MBA, FACS ,&nbsp;Shannon F.R. Small MD, FACS, CNSC","doi":"10.1016/j.jss.2024.10.030","DOIUrl":"10.1016/j.jss.2024.10.030","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Patients with rib fractures from traumatic injuries may suffer increased morbidity, an increased hospital stay, an increased length of time in the intensive care unit (ICU), pulmonary complications resulting in the need for mechanical ventilation, and increased mortality. Some studies have focused on developing specific scoring systems to triage and to help identify patients most at risk for the most severe complications. One such protocol is the RibScore. At our institution, we use and modified the Pain, Inspiratory Effort, Cough score (mPIC score) to help stratify patients most likely to require ICU admission. This study compared our protocol with the previously published and validated RibScore.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a retrospective review of patients with traumatic rib fractures presenting to our trauma center between 2018 and 2022. The primary outcomes evaluated were overall length of stay (LOS) and ICU LOS, with a secondary outcome of rates of intubation. We collected basic patient demographics, as well as data on methods to control analgesia, whether a nerve block was performed, and if the patient was mobilized. We calculated an mPIC score and a RibScore for these patients. We used an initial mPIC score of &lt;5 to indicate the need for ICU admission. Statistical analysis was performed with a value of a &lt;em&gt;P&lt;/em&gt; value of &lt;0.05 deemed statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Through Cox regression analysis we found that an mPIC score &lt;5 is associated with a doubling of both the risk to remain in ICU, and in hospital, compared to an mPIC score of ≥5. The overall LOS was also significantly higher in the former (median 4 d &lt;em&gt;versus&lt;/em&gt; 6 d, &lt;em&gt;P&lt;/em&gt; = 0.037). It was also associated with higher rates of intubation (14% &lt;em&gt;versus&lt;/em&gt; 2.3%, &lt;em&gt;P&lt;/em&gt; = 0.021) and ICU admission (82% &lt;em&gt;versus&lt;/em&gt; 51%, &lt;em&gt;P&lt;/em&gt; = 0.007). Similarly, a RibScore of 4-6 was associated with a statistically significant increase in the median overall LOS (2 d; &lt;em&gt;P&lt;/em&gt; = 0.008) and ICU LOS (2 d; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), as well as a statistically significant increase in the rates of intubation (14% &lt;em&gt;versus&lt;/em&gt; 2.1%, &lt;em&gt;P&lt;/em&gt; &lt; 0.006) and ICU admission (83% &lt;em&gt;versus&lt;/em&gt; 51%), when compared to a RibScore of 0-3.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients with rib fractures are at an increased risk of morbidity and mortality. The use of radiographic signs has been used to aid clinicians in accurately stratifying patients with traumatic rib fractures who are at increased risk. Here, we utilize two methods of stratifying patients, the previously described RibScore, which we used as our gold standard and our institutional mPIC score. As has been previously published, we found that a RibScore&gt;3 is associated with significant increases in the rates of intubation. We also found an increase in overall and ICU LOS; this correlates with our mPIC score of &lt;5. Comp","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 315-321"},"PeriodicalIF":1.8,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698659","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}