Journal of Surgical Research最新文献

{"title":"A Multifactorial Analysis of Trauma Outcomes: Comorbidities, Race, and Socioeconomic Status","authors":"Andrew Tian-Yang Yu BA, MHS,&nbsp;Anika Gnaedinger BS,&nbsp;Braylee Grisel BS,&nbsp;Manuel Castillo-Angeles MD, MPH,&nbsp;Joseph Fernandez-Moure MD, MS,&nbsp;Suresh Agarwal MD,&nbsp;Krista L. Haines DO, MA","doi":"10.1016/j.jss.2024.09.075","DOIUrl":"10.1016/j.jss.2024.09.075","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma patients with comorbid conditions are known to have poorer outcomes. We hypothesize that these outcomes are further influenced by race or ethnicity and socioeconomic status.</div></div><div><h3>Methods</h3><div>We queried patient records in the Trauma Quality Improvement Program database from 2017 to 2019 and assessed those with selected comorbidities: chronic kidney disease (CKD), diabetes, cardiac comorbidities (angina pectoris, congestive heart failure, myocardial infarct, and hypertension), and chronic obstructive pulmonary disease (COPD). We used multivariate logistic and linear regression models to investigate the interaction of race or ethnicity and insurance status in trauma patients with the above comorbidities, adjusting for injury severity, demographic factors, and other comorbidities.</div></div><div><h3>Results</h3><div>We identified 44,388 patients with CKD, 357,008 with diabetes, 947,980 with cardiac comorbidities, and 205,525 with COPD from a total of 2,493,327 records. Patients were mostly White and non-Hispanic, with Medicare as a payor; patients with diabetes and CKD were male, while patients with cardiac comorbidities and COPD were female. Minority patients had increased hospital mortality and longer hospital stays; length of stay was associated with differences in payor and with increases or decreases observed across different payor-comorbidity interactions. Discharge dispositions were also associated with differences in race or ethnicity and payor.</div></div><div><h3>Conclusions</h3><div>In an analysis of trauma patients with specific comorbidities, racial or ethnic background and socioeconomic status were associated with differences in outcomes, even after adjusting for injury severity and other factors. These results indicate that comorbidity indices alone are insufficient for optimal patient care, necessitating the inclusion of social determinants in treatment and discharge planning.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 41-51"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604690","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 of Gastroschisis and Omphalocele Treated at Children’s Surgery Verified Centers in Texas","authors":"Sarah Peiffer MD, MPH ,&nbsp;Alexander Mina MD ,&nbsp;Paulina Powell BS ,&nbsp;Mike Gyimah MD ,&nbsp;Alice King MD","doi":"10.1016/j.jss.2024.10.001","DOIUrl":"10.1016/j.jss.2024.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior abdominal wall defects (AWDs), such as gastroschisis or omphalocele, are often diagnosed prenatally and counseled to deliver at facilities with resources capable of managing their AWD and complex-associated anomalies. The American College of Surgeons instituted their Children’s Surgery Verification (CSV) program to identify facilities with the optimal resources for pediatric surgical care. We aimed to evaluate the impact of CSV status on the outcomes of AWD and potential health disparities in the care of AWD in the first year of life in Texas.</div></div><div><h3>Materials and Methods</h3><div>We performed a multicenter epidemiological cohort study of infants &lt;1 y of age at discharge with AWD from 2013 to 2021. Data were extracted from the Texas Health Care Information Council Public Use Data File. Patients who were transferred were excluded to avoid systematic double counting.</div></div><div><h3>Results</h3><div>We identified 2282 AWD patients with 26% treated at CSV centers and 68% undergoing surgical abdominal wall repair. The majority (70%) had gastroschisis. CSV center care recipients were more likely to be non-Hispanic (64% <em>versus</em> 58%, <em>P</em> = 0.018), reside in urban counties (92% <em>versus</em> 82%, <em>P</em> &lt; 0.001), or counties not along the Mexican border (98% <em>versus</em> 81%, <em>P</em> &lt; 0.001) when compared with non-CSV patients. While non-CSV admissions had lower costs per day ($9316 <em>versus</em> $10,109, <em>P</em> = 0.003), CSV centers had slightly lower mortality although this was not statistically significant (8% <em>versus</em> 10%, <em>P</em> = 0.153) despite higher illness severity scores (extreme illness severity: 51% <em>versus</em> 44%, <em>P</em> = 0.019). However, it is notable that non-CSV centers had higher rates of prematurity (62% <em>versus</em> 55%, <em>P</em> = 0.003). Multivariable logistic regression analysis for mortality revealed that treatment at CSV centers (adjusted odds ratio 0.562, <em>P</em> = 0.005) was protective. Predictive modeling revealed that CSV centers have lower predicted mortality across all illness severity levels as compared with non-CSV centers.</div></div><div><h3>Conclusions</h3><div>AWD treated at CSV centers have superior outcomes with improved mortality despite increased patient complexity and illness severity. Disparities in care at CSV centers exist based on race and geographic residency. Ongoing quality efforts are needed to improve quality universally and recognize facilities providing high-quality care while also ensuring equitable access to high-quality pediatric surgical care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 28-35"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564251","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":"Sequential Fasciotomies for Managing Abdominal Compartment Syndrome: Porcine Experimental Study","authors":"Javier Lopez-Monclus MD, PhD, FACS ,&nbsp;Amparo Gómez-Cruz MD, PhD ,&nbsp;Joaquin M. Munoz-Rodriguez MD, PhD, FACS ,&nbsp;Sandra Catalina García-Perrote MD ,&nbsp;Laura Román García de León MD ,&nbsp;Luis A. Blazquez-Hernando MD, PhD ,&nbsp;Álvaro Robin Valle De Lersundi MD, PhD ,&nbsp;Martin Santos-González DVM, PhD ,&nbsp;José Luis Lucena de la Poza MD, PhD ,&nbsp;Miguel A. Garcia-Urena MD, PhD, FACS","doi":"10.1016/j.jss.2024.09.072","DOIUrl":"10.1016/j.jss.2024.09.072","url":null,"abstract":"<div><h3>Introduction</h3><div>Abdominal compartment syndrome (ACS) poses a significant clinical challenge, with high morbidity and mortality rates. Conventional treatment via decompressive laparotomy with open abdomen and temporary closure presents significant drawbacks. This experimental study evaluates the efficacy of open minimally invasive sequential fasciotomy in managing simulated ACS in a porcine model.</div></div><div><h3>Methods</h3><div>Ten adult pigs were included in this prospective experimental investigation, wherein a mechanical model of abdominal hypertension was induced by pneumoperitoneum via a Veres needle. Open minimally invasive sequential fasciotomy, involving bilateral external oblique muscles (EOMs) and <em>linea alba (LA)</em>, was performed. Physiological parameters were recorded preprocedure and postprocedure.</div></div><div><h3>Results</h3><div>In our study, 70% of pigs completed the fasciotomy sequence. Unilateral EOM fasciotomy significantly reduced intravesical pressure and femoral venous pressure by 18% and 16%, respectively. Bilateral EOM fasciotomies led to a 35.7% decrease in both parameters. Following re-establishment of intra-abdominal pressure to 20 mmHg, <em>LA</em> fasciotomy resulted in a 47% drop in intravesical pressure and femoral venous pressure. Significant increases in tidal volume and abdominal perimeter were observed after each fasciotomy.</div></div><div><h3>Conclusions</h3><div>This study establishes that open minimally invasive sequential fasciotomy of bilateral EOM and <em>LA</em> is an effective strategy for managing simulated ACS in a porcine model. Each fasciotomy resulted in a significant reduction in intra-abdominal pressure. These findings suggest that sequential fasciotomy techniques offer a promising alternative to decompressive laparotomy in ACS management. Further research is essential to validate these outcomes in human subjects.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 761-771"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546106","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":"Vascular Graft Infections Treated With Bioabsorbable Antibiotic Beads","authors":"Aaron Litvak BA ,&nbsp;Joshua T. Geiger MD ,&nbsp;Joel Kruger MD ,&nbsp;Benjamin Ford MD ,&nbsp;Roan Glocker MD, MPH ,&nbsp;Michael Stoner MD","doi":"10.1016/j.jss.2024.09.079","DOIUrl":"10.1016/j.jss.2024.09.079","url":null,"abstract":"<div><h3>Introduction</h3><div>Inguinal vascular surgical site infections (VSSI) and infected prosthetic grafts remain a critical problem in vascular surgery. Prior clinical reports suggest antibiotic-impregnated beads may be used to attempt salvage of the graft and improve outcomes, especially if explant would result in major amputation or mortality. Described is our institutional experience managing inguinal VSSI using bioabsorbable, antibiotic-impregnated beads compared to inguinal VSSI managed with debridement alone.</div></div><div><h3>Methods</h3><div>Patients with VSSIs after lower-extremity procedures were identified through the institutional database and departmental registries from 2014 to 2023. Cases were excluded if they did not involve an inguinal wound infection or an operation for VSSI management. Outcomes, including amputation-free survival, reinfection, and re-operation for infection were recorded, along with microbial isolates. Basic descriptive statistics, Kaplan–Meier, and Multiple variable Cox proportional hazards analyses were performed.</div></div><div><h3>Results</h3><div>There were 43 patients identified (23 with intravenous antibiotics and debridement alone, and 20 treated with intravenous antibiotics, debridement, and antibiotic beads). The two groups differed significantly in their Szilagyi classification, with thirteen patients (65%) with class III infections in the antibiotic bead group compared with one (7%) in the debridement alone group. There was no significant difference in amputation-free survival for those cases that received debridement and antibiotic beads <em>versus</em> debridement alone (<em>P</em> = 0.20) or amputation-free survival between Szilagyi classifications (<em>P</em> = 0.47) despite a higher representation of Szilagyi III cases in the antibiotic bead group (<em>P</em> = 0.0001). Patients with graft infections treated with beads experienced similar survival outcomes to patients with subcutaneous infections treated with debridement alone (<em>P</em> = 0.21).</div></div><div><h3>Conclusions</h3><div>The efficacy of bioabsorbable antibiotic beads in VSSIs remains controversial. While this cohort study demonstrated an increased risk of re-infection, this is confounded by the antibiotic bead group having a higher frequency of graft infections. Antibiotic beads appear to be safe for use in patients with vascular graft infections and may help achieve outcomes comparable to patients without graft involvement. Further studies with larger patient populations and similar infection severity between groups are needed.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 772-779"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546107","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":"Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery","authors":"Lisa P. Doshi MHS, DrPH ,&nbsp;Richard Nudotor MD, MPH ,&nbsp;Gina Lynn Adrales MD, MPH ,&nbsp;David Chin MD, MBA ,&nbsp;Matt Austin PhD, MS ,&nbsp;Conan Dickson PhD, MPH ,&nbsp;Lilly D. Engineer MD, DrPH, MHA","doi":"10.1016/j.jss.2024.09.082","DOIUrl":"10.1016/j.jss.2024.09.082","url":null,"abstract":"<div><h3>Introduction</h3><div>While the adoption of ERAS protocols in bariatric surgery has increased, variability exists across centers, reflecting a spectrum of implementation stages. The objective of this study is to understand and increase awareness of the effectiveness of enhanced recovery after surgery (ERAS) protocols in bariatric surgery, given the specific perioperative difficulties and risks for this population. We aimed to study the association between implementation of the ERAS program in bariatric surgery and specific outcomes.</div></div><div><h3>Methods</h3><div>Primary bariatric patients (≥18 y old) at a single academic institution were divided into pre-ERAS and post-ERAS groups. Poisson and quantile regressions were used to examine the association between the ERAS protocol and length of stay and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-d readmissions.</div></div><div><h3>Results</h3><div>A total of 680 procedures were performed in the pre-ERAS cohort, compared to 1124 procedures post-ERAS. The median length of hospital stay was shorter, and median cost of surgery was lower for post-ERAS patients compared to pre-ERAS patients by 1 d (<em>P</em> = 0.001) and $2000, respectively. A higher proportion of patients in the pre-ERAS period had one or more unplanned readmissions compared to the post-ERAS period (<em>P</em> &lt; 0.001). The ERAS protocol was associated with decreased length of stay (incidence rate ratio = 0.72, <em>P</em> &lt; 0.001), decreased median cost (−$2230, <em>P</em> &lt; 0.001), and lower risk of 30-d unplanned readmissions (odds ratio = 0.48, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>This study highlights the value of an enhanced recovery program in bariatric surgery, benefiting both patients and health systems.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 19-27"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564250","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":"Rodent Model of Cardiopulmonary Bypass Demonstrates Systemic Inflammation and NeuroMarker Changes","authors":"Aimee Zhang MD ,&nbsp;Nathan S. Haywood MD ,&nbsp;Dustin T. Money RRT-ACCS ,&nbsp;Matthew R. Byler MD, MBA ,&nbsp;Hari P. Osuru PhD ,&nbsp;Navya Atluri PhD ,&nbsp;Victor E. Laubach PhD ,&nbsp;J. Hunter Mehaffey MD, MSc ,&nbsp;Jennifer R. Charlton MD ,&nbsp;Nadia Lunardi MD, PhD ,&nbsp;Irving L. Kron MD ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.jss.2024.09.041","DOIUrl":"10.1016/j.jss.2024.09.041","url":null,"abstract":"<div><h3>Introduction</h3><div>The physiologic derangements imposed by cardiopulmonary bypass (CPB) can result in complications such as postoperative delirium. We aim to validate a rodent survival model of CPB demonstrating a systemic inflammatory response and hypothesize that this contributes to post-CPB delirium.</div></div><div><h3>Methods</h3><div>Adult Sprague–Dawley rats were randomized to three groups: 1) Sham peripheral surgical cannulation, 2) CPB followed by acute phase harvest, or 3) CPB followed by 24-h survival. CPB was carried out for 60 min before decannulation and weaning from mechanical ventilation. Physiological and biochemical endpoints were compared between groups. Gene expression analysis of hippocampal tissue was performed using quantitative RT-PCR panels and protein expression levels were confirmed with Western blot.</div></div><div><h3>Results</h3><div>Sixteen animals underwent cannulation and were successfully decannulated without transfusion requirement or inotrope use with one procedure-related mortality. Serum acute phase proinflammatory chemokines cytokine-induced neutrophil chemoattractant 1, cytokine-induced neutrophil chemoattractant 3, fractalkine, and lipopolysaccharide-induced CXC chemokine as well as interleukin (IL)-10 were increased 1 h following CPB compared to sham (<em>P</em> &lt; 0.05). Significant changes in hippocampal expression of biomarkers apolipoprotein 1, vascular epithelial growth factor A, and synapsin 1 were demonstrated following CPB.</div></div><div><h3>Conclusions</h3><div>This study validated a model of CPB that captures the resultant systemic inflammatory response, and identified differentially expressed proteins that may be associated with brain injury. Modulation of the CPB-induced inflammatory response may be a promising therapeutic target to attenuate post-CPB delirium, and this survival rat model of CPB with low surgical attrition will allow for more comprehensive evaluations of the short- and long-term effects of both CPB and potential therapeutic interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 780-787"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546105","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 Surgical Management in Gallbladder Cancer—A Surveillance, Epidemiology, and End Results Medicare–Based Study","authors":"Kelsey S. Romatoski MD ,&nbsp;Sophie H. Chung MD ,&nbsp;Veer Sawhney BA ,&nbsp;Marianna V. Papageorge MD, MPH ,&nbsp;Susanna W.L. de Geus MD, PhD ,&nbsp;Sing Chau Ng MS ,&nbsp;Kelly Kenzik MS, PhD ,&nbsp;Jennifer F. Tseng MD, MPH ,&nbsp;Teviah E. Sachs MD, MPH","doi":"10.1016/j.jss.2024.09.084","DOIUrl":"10.1016/j.jss.2024.09.084","url":null,"abstract":"<div><h3>Introduction</h3><div>Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.</div></div><div><h3>Materials and methods</h3><div>SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% <em>versus</em> 65.6%; <em>P</em> = 0.0104), ≥80 y old (48.2% <em>versus</em> 22.4%; <em>P</em> &lt; 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> &lt; 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> &lt; 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> &lt; 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> &lt; 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% <em>versus</em> 47.2%; <em>P</em> &lt; 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> &lt; 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 9-18"},"PeriodicalIF":1.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554640","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":"Antibiotic Prophylaxis and Spinal Infection After Gunshot Wounds to the Spine: A Retrospective Study","authors":"Jaclyn A. Gellings MD,&nbsp;Kathryn Haberman MD ,&nbsp;Abdul Hafiz Al Tannir MD,&nbsp;Thomas Carver MD,&nbsp;Jacob Peschman MD","doi":"10.1016/j.jss.2024.09.083","DOIUrl":"10.1016/j.jss.2024.09.083","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal and paraspinal infections (SPIs) are a potential complication following traumatic spinal column injury, and we sought to determine the association of antibiotic prophylaxis on SPI development following a spinal gunshot wound (GSW).</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed.</div></div><div><h3>Results</h3><div>A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% <em>versus</em> 23.1%, <em>P</em> &lt; 0.001), primarily colon injuries (55.6% <em>versus</em> 12.5%, <em>P</em> &lt; 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% <em>versus</em> 2%; <em>P</em> = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (<em>P</em> = 0.49).</div></div><div><h3>Conclusions</h3><div>Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 1-8"},"PeriodicalIF":1.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546108","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":"Resident Race and Operative Experience in General Surgery Residency: A Mixed-Methods Study","authors":"Nicole Panzica MD ,&nbsp;Alexander R. Cortez MD ,&nbsp;Chukwuma Eruchalu MD ,&nbsp;Kenneth Lynch PhD ,&nbsp;Andrea Gillis MD ,&nbsp;Brenessa Lindeman MD, MEHP ,&nbsp;Herbert Chen MD ,&nbsp;Jessica Fazendin MD ,&nbsp;Polina Zmijewski MD, MA","doi":"10.1016/j.jss.2024.09.049","DOIUrl":"10.1016/j.jss.2024.09.049","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent multi-institutional quantitative work has found that Black general surgery residents perform fewer operations during training. Further mixed-methods research exploring the reasons for this phenomenon is needed to address this inequity for residents who are underrepresented in medicine (URiM).</div></div><div><h3>Material and methods</h3><div>Data were collected through open response and Likert scale questions that were distributed electronically to residents at 21 accredited US general surgery programs within the US Resident Operative Experience Consortium. Questions focused on what barriers prevent residents from going to the operating room and potential solutions. Free text was analyzed by three qualitative reviewers.</div></div><div><h3>Results</h3><div>The online survey was completed by 96 general surgery residents representing a 12% overall response rate from the 21 US Resident Operative Experience Consortium programs. Eight (<em>n</em> = 8/13, 62%) of the URiM residents endorsed that they experienced barriers in obtaining case numbers compared to 13% of non-URiM residents (<em>P</em> &lt; 0.05). A similar proportion of both groups agreed that their quality of training was affected by their race or ethnicity (<em>n</em> = 6/13, 46% <em>versus n</em> = 34/49, 41%; <em>P</em> = 0.77). Floor work and clinical tasks were the most common qualitative themes regarding operative barriers (75 responses). Racial bias (<em>n</em> = 22) was frequently referenced as a barrier specifically experienced by URiM residents. Suggestions to improve the operative experience of URiM residents included increasing mentorship at the attending level (<em>n</em> = 25) and setting objective standards for resident operating room participation (<em>n</em> = 30).</div></div><div><h3>Conclusions</h3><div>Nearly five times as many URiM residents reported experiencing barriers in obtaining case numbers compared to non-URiM residents. Qualitative analysis suggests that clear expectations for resident participation in cases and increasing mentorship at the attending level may be ways to achieve parity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 756-760"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539642","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 Qualitative Study of Electronic Patient-Reported Outcome Symptom Monitoring After Thoracic Surgery","authors":"Alix Boisson-Walsh PhD ,&nbsp;Chase Cox MD, MS ,&nbsp;Meghan O'Leary PhD ,&nbsp;Sachita Shrestha MPH ,&nbsp;Philip Carr MPH ,&nbsp;Amanda L. Gentry MPH ,&nbsp;Lauren Hill PhD ,&nbsp;Bernice Newsome AGNP ,&nbsp;Jason Long MD, MPH ,&nbsp;Benjamin Haithcock MD ,&nbsp;Angela M. Stover PhD ,&nbsp;Ethan Basch MD, MSc ,&nbsp;Jennifer Leeman DrPH, MPH, MDiv ,&nbsp;Gita N. Mody MD, MPH, FACS","doi":"10.1016/j.jss.2024.09.051","DOIUrl":"10.1016/j.jss.2024.09.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital health systems can facilitate remote postoperative symptom management yet obstacles persist in their routine clinical adoption. This study aimed to identify patient-perceived barriers and facilitators to using an electronic patient-reported outcome (ePRO) monitoring platform specially designed to detect complications from thoracic surgery postdischarge.</div></div><div><h3>Methods</h3><div>Patients (<em>n</em> = 16) who underwent thoracic surgery and participated in an ePRO parent study completed semistructured interviews, which were analyzed using thematic content analysis and iterative team-based coding. Themes were mapped onto the three domains of the Capability, Opportunity, and Motivation Model of behavior framework to inform ePRO design and implementation improvements.</div></div><div><h3>Results</h3><div>Analysis demonstrated seven dominant themes, including barriers (1. postoperative patient physical and mental health, 2. lack of access to email and poor internet connectivity, 3. lack of clarity on ePRO use in routine clinical care, and 4. symptom item redundancy) as well as facilitators (5. ease of the ePRO assessment completion, 6. engagement with the surgical care team on ePRO use, and 7. increased awareness of symptom experience through ePRO use). Suggested ePRO improvements included offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient education on ePROs for perioperative care.</div></div><div><h3>Conclusions</h3><div>Addressable barriers and facilitators to implementation of ePRO symptom monitoring in the thoracic surgical patient population postdischarge have been identified. Future work will test the impact of design improvements on implementation outcomes of feasibility and acceptability.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 744-755"},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502689","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}