Journal of Surgical Research最新文献

{"title":"Assessing the Safety of Nonintensive Care Unit Admission for Select Grade III Blunt Splenic Trauma","authors":"Peter D. Nguyen MD ,&nbsp;Robert Painter MD ,&nbsp;Areg Grigorian MD ,&nbsp;Lourdes Swentek MD ,&nbsp;Alliya Qazi MD ,&nbsp;Cristobal Barrios MD ,&nbsp;Catherine Kuza MD, FASA ,&nbsp;Matthew Dolich MD ,&nbsp;Jeffry Nahmias MD, MHPE","doi":"10.1016/j.jss.2025.06.065","DOIUrl":"10.1016/j.jss.2025.06.065","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with grade III blunt splenic injuries (BSIs) may require splenectomy. Currently, there is practice variation for admission of these patients to an intensive care unit (ICU) or non-ICU floor. We hypothesized that select BSI patients may be admitted to non-ICU locations without increased complications, death, or need for splenectomy.</div></div><div><h3>Methods</h3><div>The 2017-2019 Trauma Quality Improvement Program database was queried for non-elderly adult (18-64 y-old) grade III BSIs. Patients with hypotension, heart rate &gt;90, respiratory rate &gt;22, abbreviated injury scale for the head/spine/thorax/upper or lower extremity &gt;2, or with cirrhosis, stroke, myocardial infarction, or chronic obstructive pulmonary disease were excluded as these patients might otherwise warrant ICU admission. ICU admissions were compared to non-ICU admissions. Multivariable logistic regression for mortality was performed.</div></div><div><h3>Results</h3><div>From 1899 patients included, 1000 (52.7%) were admitted to the ICU. There was similar demographics between cohorts (all <em>P</em> &gt; 0.05). There was a higher rate of colon injury in the ICU cohort (0.9% <em>versus</em> 0%, <em>P</em> = 0.004). ICU admissions had increased rates of splenectomy (4.8% <em>versus</em> 2.0%, <em>P</em> &lt; 0.001), major complications (1.8% <em>versus</em> 0.6%, <em>P</em> = 0.013) and length of stay (4.0 <em>versus</em> 3.0, <em>P</em> &lt; 0.001). However, there was no difference in the rate (0.3% <em>versus</em> 0.4%, <em>P</em> = 0.60) or associated risk of mortality (odds ratio 0.68, confidence interval 0.152-3.070, <em>P</em> = 0.62) between cohorts.</div></div><div><h3>Conclusions</h3><div>The rate of splenectomy, complications, and mortality was low overall and similar or better for nearly isolated grade III BSI patients admitted to non-ICU floors. This suggests there is a population of adult grade III BSI that can avoid ICU admission.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 397-402"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Firearm Owners’ Preferences for Secure Storage Devices: Insights From Product Reviews","authors":"Grayson Graham ,&nbsp;Colby Wilson ,&nbsp;Katelin Hoskins PhD ,&nbsp;M. Kit Delgado MD, MS ,&nbsp;Sunny Vespico Jackson MSN ,&nbsp;Athena Lee MA ,&nbsp;Anish Agarwal MD ,&nbsp;Elinore J. Kaufman MD, MSHP","doi":"10.1016/j.jss.2025.06.048","DOIUrl":"10.1016/j.jss.2025.06.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Securely storing firearms can prevent suicide, unintentional injury, and gun theft. However, fewer than half of the US firearm owners store all firearms securely. Ongoing efforts to promote secure storage by distributing locking devices could benefit from a robust understanding of how firearm owners' preferred qualities in storage devices. To gain insight into firearm owners’ priorities in evaluating a storage device, we conducted a qualitative analysis of Amazon product reviews of firearm locking devices.</div></div><div><h3>Methods</h3><div>We analyzed reviews for the top five rated products in five categories of storage devices: lock boxes, installed gun safes (handguns), installed gun safes (long gun), cable locks, and trigger locks. We collected the 5 “most helpful” positive and critical reviews, limited to reviews by verified purchasers. Review text and characteristics were extracted. Reviews were open-coded to identify what device features were most salient to purchasers. The codebook was refined iteratively. Disagreements were resolved by consensus. Coded data were summarized and key themes identified using content analysis.</div></div><div><h3>Results</h3><div>We analyzed 250 reviews of 25 products, yielding 13 themes. Overall, sturdiness, ease of access, reliability, and resistance to theft were prominent priorities for firearm storage device purchases across device types.</div></div><div><h3>Conclusions</h3><div>Firearm owners value secure storage devices that allow quick, easy access while remaining robust to theft or damage. Devices that are simple to set up and easy to operate were best received by consumers. Efforts to promote secure storage of firearms may be more effective by considering firearm owners’ preferences for storage devices.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 372-379"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Management of Peripheral Arterial Injuries: A Five-Year National Analysis","authors":"Francisco Castillo-Diaz MD,&nbsp;Mohammad Al Ma'ani MD,&nbsp;Muhammad Haris Khurshid MD,&nbsp;Omar Hejazi MD,&nbsp;Christina Colosimo DO, MS, FACS,&nbsp;Adam Nelson MD, FACS,&nbsp;Audrey L. Spencer MD, FACS,&nbsp;Stanley E. Okosun MD, MS, FACS,&nbsp;Louis J. Magnotti MD, MS, FACS,&nbsp;Bellal Joseph MD, FACS","doi":"10.1016/j.jss.2025.06.076","DOIUrl":"10.1016/j.jss.2025.06.076","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral vascular injuries are rare with high rates of morbidity and long-term sequelae. The aim of this study is to study the trends in vascular injuries and management across American College of Surgeons–verified Level I trauma centers.</div></div><div><h3>Methods</h3><div>We performed a 5-y retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database for the years 2017-2021. We included all patients with peripheral arterial injuries (axillary, brachial, radial, ulnar, femoral, popliteal, and tibial arteries) that underwent open or endovascular repair. Trauma centers were stratified into tertiles based on the volume of these vascular injuries into low volume (LV), medium volume (MV), and high volume (HV) centers. The primary outcome was rates of open and endovascular repair. The secondary outcome was amputation. Descriptive statistics and trend analysis were performed.</div></div><div><h3>Results</h3><div>We identified a total of 22,057 patients with peripheral arterial injuries managed at 340 trauma centers (243 LV; 73 MV; 24 HV). Overall, the mean age was 36 (16) y; 83% were male. Nearly 30% sustained blunt injuries with a median injury severity score of 9 [3-13]. HV centers deal with an average of 27 cases/y. The rates of open and endovascular repairs were 63% and 13%, respectively. HV centers were more likely to perform endovascular repair (LV 11% <em>versus</em> MV 12% <em>versus</em> HV 14%, <em>P</em> &lt; 0.001). There was no clinically significant difference between the HV, MV, and LV centers in terms of amputations (HV: 2.9% <em>versus</em> MV: 3% <em>versus</em> LV: 2.5%). On linear regression analysis, the proportion of endovascular procedures has linearly increased from 12% in 2017 to 14% in 2021 (β = 0.013, 95% confidence interval = 0.010-0.016, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Peripheral arterial injuries remain a complex clinical challenge. Nearly one-third of the peripheral arterial injuries are due to blunt mechanisms. Open repair remains the most preferred method of management. However, the outcomes remain equivocal irrespective of volume. Current training programs need to identify ways to improve training in open repairs for vascular injuries.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 380-388"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Adjunctive Anesthesia Within an ERAS Protocol: A Retrospective Cohort Study","authors":"Justin Dourado MD ,&nbsp;Ariel Wolf MD ,&nbsp;Maria Herrera Rodriguez DO ,&nbsp;Shruti Agarwal BS ,&nbsp;Karin Blumofe MD ,&nbsp;Jordan Moseson DO ,&nbsp;Jose Yeguez MD ,&nbsp;Andrew Ross MD ,&nbsp;Avraham Belizon MD","doi":"10.1016/j.jss.2025.06.075","DOIUrl":"10.1016/j.jss.2025.06.075","url":null,"abstract":"<div><h3>Introduction</h3><div>There is increasing focus on adjunctive anesthesia to reduce complications and improve pain control among surgical patients. This study aims to investigate and compare if the type of anesthesia (spinal, transversus abdominis plane [TAP] block, or general anesthesia alone) used in patients undergoing colorectal surgery within an Enhanced Recovery After Surgery protocol is associated with improved patient outcomes.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study analyzed adult patients undergoing colorectal surgery at a Regional Hospital from December 2019 to October 2021. Data on demographics, operative details, complications, postoperative outcomes, and compliance were collected. The primary outcome was the association of adjunctive anesthesia on postoperative outcomes. After association analysis, variables yielding <em>P</em> &lt; 0.10 associated with the primary or secondary outcomes were chosen for regression analysis, with calculation of univariable odds ratios (ORs) and a significance set at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Among 225 patients, 70 received a TAP block, 100 spinal anesthesia, and 55 general anesthesia. There were no differences in length of stay (<em>P</em> = 0.746), readmission (<em>P</em> = 0.144), bowel function (0.778), complications (<em>P</em> = 0.24), or pain control (<em>P</em> = 0.686). Spinal anesthesia was associated with higher oral intake in postanesthesia recovery unit (OR 5.3750, <em>P</em> &lt; 0.001), lower narcotic use (OR 0.4303, <em>P</em> = 0.0213), and fewer discharges to skilled nursing facilities (OR 0.0303, <em>P</em> = 0.018).</div></div><div><h3>Conclusions</h3><div>Spinal anesthesia is associated with improved oral intake, reduced narcotic use, and less skilled nursing facility discharge in colorectal surgery patients compared to TAP blocks and general anesthesia.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 412-420"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isoperistaltic Anastomosis Increases Neo-Terminal Ileum Intubation Rates in Crohn's Disease Patients","authors":"Tamar Thurm MD ,&nbsp;Galia Berman MD ,&nbsp;Ayal Hirsch MD ,&nbsp;Liat Deutsch MD ,&nbsp;Nathaniel Aviv Cohen MD ,&nbsp;Haim Leibovitzh MD ,&nbsp;Yulia Ron MD ,&nbsp;Nadav Dvir MD ,&nbsp;Eran Itzkovitz MD ,&nbsp;Hagit Tulchinsky MD ,&nbsp;Jonathan B. Yuval MD ,&nbsp;Yehuda Kariv MD ,&nbsp;Guy Lahat MD ,&nbsp;Nitsan Maharshak MD ,&nbsp;Meir Zemel MD","doi":"10.1016/j.jss.2025.06.082","DOIUrl":"10.1016/j.jss.2025.06.082","url":null,"abstract":"<div><h3>Introduction</h3><div>Side-to-side stapled ileocolonic anastomosis (ICA) is commonly used in Crohn's disease (CD). Antiperistaltic ICA (APICA) and isoperistaltic ICA (IPICA) alignments differ in ease of neo-terminal ileum (neo-TI) intubation, potentially impacting endoscopic follow-up. This study compares postsurgical neo-TI intubation feasibility between APICA and IPICA.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective analysis of CD patients (≥18 y) who underwent ileocolonic resection between 2010 and 2022 and completed ileocolonoscopy within 24 mo. Patients with non-APICA/IPICA anastomoses, ileostomy, and patients whose ileocolonoscopy report was unavailable were excluded.</div></div><div><h3>Results</h3><div>We included 148 patients, (76.4% APICA and 23.6% IPICA). Groups were comparable in demographics, surgical factors, and postsurgical outcomes. Anastomotic disease recurrence (Rutgeerts score Ri ≥ 2b) was similar: 37.6% APICA <em>versus</em> 37.1% IPICA (<em>P</em> = 0.563). Excluding patients with anastomotic strictures and poor preparation, neo-TI intubation was successful in 87.4% of APICA <em>versus</em> 100% of IPICA (<em>P</em> = 0.038).</div></div><div><h3>Conclusions</h3><div>APICA and IPICA have similar safety and endoscopic recurrence rates. IPICA allows for easier neo-TI intubation with no intubation failure, improving endoscopic surveillance and management of CD.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 421-430"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skin Color Representation in Thyroid Textbooks: Lack of Imaging Diversity","authors":"Eddy P. Lincango MD, MSc ,&nbsp;Cristina Arias Cortez MD ,&nbsp;Mateo Montalvo MD ,&nbsp;Jose Villamarin MD ,&nbsp;Jessica Hidalgo MD ,&nbsp;Kimberly M. Ramonell MD ,&nbsp;Andrea Gillis MD ,&nbsp;Juan P. Brito MD ,&nbsp;Sophie Dream MD, MPH","doi":"10.1016/j.jss.2025.06.077","DOIUrl":"10.1016/j.jss.2025.06.077","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial and ethnic disparities in the diagnosis and treatment of thyroid disease have been identified with various contributing factors, including delays in diagnosis and care, limited access to health care, and potential underlying provider bias. Individuals from racially and ethnically diverse backgrounds, particularly those with darker skin tones, have been historically underrepresented in medical textbooks; this underrepresentation contributes to the development of inherent racial biases in medical trainees when considering certain diagnoses. The potential impact that educational resources have on provider bias related to thyroid disease is limited. This study aims to assess the representation of thyroid disease in textbooks, specifically focusing on the depiction of various skin tones.</div></div><div><h3>Methods</h3><div>We conducted a review analyzing skin color in thyroid images from the latest editions of major textbooks with sections on thyroid disease. There were no restrictions based on language, country of publication, or patient age. We excluded images depicting thyroid trauma, black-and-white images, and illustrations. Skin color was assessed using the Fitzpatrick constitutive scale.</div></div><div><h3>Results</h3><div>We analyzed 139 pictures from 22 textbooks. Most images depicted adults (95%) with benign noninfectious thyroid conditions such as goiter, hypothyroidism, and Graves’ disease (46.7%). The Fitzpatrick constitutive scale depicted a predominance of lighter skin tones across all textbooks. Overall, 88% of the images depicted lighter skin tones, while only 12% showed darker skin tones. Notably, darker skin color images were absent from internal medicine books.</div></div><div><h3>Conclusions</h3><div>The underrepresentation of patients with darker skin tones in thyroid disease images is prevalent across various medical textbooks. The relative absence of depicting patients with darker skin tones in educational resources potentially contributes to provider bias in their understanding of thyroid disease. To address this disparity, we recommend a more diverse range of patient skin tones in textbook images. This approach may help mitigate disparities in the diagnosis and treatment of thyroid disease by lessening implicit bias that may develop during training.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 431-437"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680190","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 Significance of CEA Levels Normalization After Neoadjuvant Therapy in Patients With Initially Resectable Colorectal Liver Metastases","authors":"Bin Zhou MD ,&nbsp;Bo Zhang MS ,&nbsp;Yin-Chen Gu BS ,&nbsp;Sen-Feng Ying BS ,&nbsp;Bao-Rui Tao MS ,&nbsp;Yi-Tong Li MS ,&nbsp;Zhen-Mei Chen MS ,&nbsp;Rong-Quan Sun MS ,&nbsp;Chen-He Yi MD, PhD ,&nbsp;Yan Geng MS ,&nbsp;Rui Zhang MD ,&nbsp;Xiang-Yu Wang MD, PhD ,&nbsp;Jin-Hong Chen MD, PhD","doi":"10.1016/j.jss.2025.06.023","DOIUrl":"10.1016/j.jss.2025.06.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Although the prognostic role of carcinoembryonic antigen (CEA) in colorectal liver metastases (CRLM) is well established, it remains unclear whether the normalization of CEA levels following neoadjuvant therapy (NAT) is associated with improved outcomes after CRLM resection.</div></div><div><h3>Methods</h3><div>We retrospectively collected the clinical data of patients with CRLM who underwent NAT and hepatectomy between 2013 and 2023. Using a CEA threshold of 5 ng/ml as the normal value, patients were divided into three groups: normal group (normal CEA levels before and after NAT), normalized group (elevated CEA levels before NAT but decreased to normal levels afterward), and nonnormalized group (elevated CEA levels before and after NAT or normal CEA levels before NAT but elevated CEA levels after NAT). Overall survival (OS) and disease-free survival (DFS) were the primary end points. The Cox regression model and Kaplan-Meier method were used to clarify the clinicopathological factors influencing survival.</div></div><div><h3>Results</h3><div>We included 146 CRLM patients who underwent NAT and subsequent resection. Survival analyses showed the normalized CEA group had a significantly better prognosis than the nonnormalized group (OS, <em>P</em> = 0.001; DFS, <em>P</em> = 0.037); however, the prognosis was comparable to that of the normal group (OS, <em>P</em> = 0. 604; DFS: <em>P</em> = 0.722). After excluding patients with initial CEA levels &gt; 200 ng/mL and elevated CEA levels after NAT, patients with normalized CEA levels still experienced significantly prolonged OS (<em>P</em> = 0.003) and DFS (<em>P</em> = 0.045) compared to those with nonnormalized CEA levels. Multivariate analysis revealed that CEA normalization after NAT (<em>P</em> = 0.007) and RAS/BRAF gene mutations (<em>P</em> = 0.017) were independent predictors of OS, whereas CEA normalization after NAT (<em>P</em> = 0.036), number of liver metastases (<em>P</em> = 0.008), and presence of extrahepatic metastases (<em>P</em> = 0.020) were independent predictors of DFS.</div></div><div><h3>Conclusions</h3><div>Normalization of CEA level after NAT is a reliable biomarker for predicting postoperative survival in patients with CRLM. It could serve as a promising tool to determine the timing of surgery during NAT in patients with initially resectable CRLM.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 403-411"},"PeriodicalIF":1.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672477","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":"Response Regarding: \"Comparison of Risk Assessment Tools' Prediction of Outcomes for Penetrating Trauma\".","authors":"Jeffrey Santos, Catherine M Kuza, Areg Grigorian, Jeffry Nahmias","doi":"10.1016/j.jss.2025.06.047","DOIUrl":"https://doi.org/10.1016/j.jss.2025.06.047","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667902","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":"Statewide Analysis of Pediatric Appendicitis Outcomes by Pediatric Surgeon Availability","authors":"Erin West DO ,&nbsp;Ben Havko DO ,&nbsp;Alyssa N. Carroll MPH ,&nbsp;Utsav M. Patwardhan MD ,&nbsp;Margaret Y.N. Mericle MD ,&nbsp;Alexandrea S. Rooney MPH ,&nbsp;Vishal Bansal MD ,&nbsp;Michael J. Krzyzaniak MD ,&nbsp;Andrea Krzyzaniak MA ,&nbsp;Pamela M. Choi MD","doi":"10.1016/j.jss.2025.06.062","DOIUrl":"10.1016/j.jss.2025.06.062","url":null,"abstract":"<div><h3>Introduction</h3><div>Appendicitis is common in children, treated by both pediatric and general surgeons at hospitals with varying specialization levels of pediatric care. We evaluated differences in treatment and outcomes by pediatric surgeon coverage using California's Department of Health Care Access and Information Database.</div></div><div><h3>Methods</h3><div>Children (≤17 y) with acute appendicitis (2019-2021) were identified. Those with significant comorbidities or could not be followed longitudinally were excluded. Hospitals were categorized as exclusively free-standing children's hospitals (ECH), other hospitals with pediatric surgeon coverage (WPS) or no pediatric surgeon coverage (NPS). Outcomes of initial intervention (appendectomy/drainage/nonoperative), readmissions, and complications were analyzed and stratified by appendicitis type (simple <em>versus</em> complicated).</div></div><div><h3>Results</h3><div>Of 7059 included patients, 33% were treated at ECH, 28% at WPS, and 39% at NPS. There were no differences in any outcomes for patients with simple appendicitis. Complicated appendicitis (<em>n</em> = 2755) was treated in greater proportions at ECH (43% ECH <em>versus</em> 38% WPS <em>versus</em> 37% NPS, <em>P</em> &lt; 0.01). In complicated appendicitis, initial drain management was rare (<em>n</em> = 179) but more common in patients at ECH (9.1% ECH <em>versus</em> 5.2% WPS <em>versus</em> 4.9% NPS, <em>P</em> &lt; 0.01). Readmissions were also rare (<em>n</em> = 181) but higher at ECH (8.4% <em>versus</em> 5% at NPS and WPS). Overall complication rates for complicated appendicitis did not differ by hospital type.</div></div><div><h3>Conclusions</h3><div>Although treatment strategies for appendicitis differed by hospital type, complication rates were equivalent regardless of surgeon coverage by hospital type. These results demonstrate that children with appendicitis in California overwhelmingly have positive outcomes regardless of the hospital's level of specialization in pediatric care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 345-350"},"PeriodicalIF":1.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654763","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":"Extent of Lymphadenectomy and Development of Delayed Gastric Emptying After Gastric Cancer Resection","authors":"Emma Bradley MD, MPH ,&nbsp;Marissa Kuo MD ,&nbsp;Julia Brickey MD ,&nbsp;Emily Swafford MD ,&nbsp;Jean Mok BS ,&nbsp;Deepa Magge MD, FACS","doi":"10.1016/j.jss.2025.06.027","DOIUrl":"10.1016/j.jss.2025.06.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Delayed gastric emptying (DGE) has been related to quality of life and clinical outcomes for gastric cancer patients. The role of lymphadenectomy in postoperative mechanics of gastric emptying remains undefined. This study aims to evaluate the association of D1 <em>versus</em> D2 lymphadenectomy with development of postgastrectomy DGE.</div></div><div><h3>Materials and methods</h3><div>This institutional retrospective study is comprised of clinicopathologic data from patients who underwent gastrectomy between 1994 and 2023. Development of DGE was compared between patients who underwent D1 <em>versus</em> D2 lymphadenectomy in univariate and multivariate analyses, adjusting for other patient-specific and operative characteristics.</div></div><div><h3>Results</h3><div>Of the 302 gastrectomy patients reviewed, 114 underwent distal or subtotal gastrectomy for gastric adenocarcinoma. Thirty of these patients (26.3%) developed DGE. Incidence of DGE was higher among patients who received a D2 (32%) <em>versus</em> D1 lymphadenectomy (15.4%). Adjusted for other covariates, D2 lymphadenectomy was independently associated with an increased likelihood of developing DGE (adjusted odds ratio 3.63, 95% confidence interval 1.12-11.8, <em>P</em> = 0.032). Additional risk factors for DGE identified in multivariate analysis included older age and postoperative complications. While patients with DGE experienced longer postoperative hospitalizations and more frequent 30-d readmissions, there was no difference in 30-d mortality, reoperation, overall survival, or progression-free survival.</div></div><div><h3>Conclusions</h3><div>In this retrospective study, D2 lymphadenectomy was identified as a risk factor for the development of postgastrectomy DGE in gastric cancer patients. However, long-term outcomes such as survival and cancer progression did not differ based on the development of DGE.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 326-334"},"PeriodicalIF":1.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654836","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}