Journal of Surgical Research最新文献

{"title":"Hospital Outcomes of Spinal Injuries Associated With Aquatic Activities","authors":"Mohsen Zakaib MNE ,&nbsp;Em Long-Mills MA ,&nbsp;Dmitry Tumin PhD ,&nbsp;Erika Greene MSN, RN ,&nbsp;Shannon W. Longshore MD","doi":"10.1016/j.jss.2025.09.039","DOIUrl":"10.1016/j.jss.2025.09.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal injuries (SIs) that occur during aquatic activities, including swimming, surfing, or engaging with high-energy breaking waves, pose a significant public health concern. This study analyzed hospital outcomes for SIs sustained during aquatic activities, evaluating factors such as mortality, complications, length of stay (LOS), and trauma intervention.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the American College of Surgeons Trauma Quality Improvement Program registry (2017-2022). Patients included sustained SIs related to aquatic activities, identified using International Classification of Diseases, Tenth Revision codes for drowning-related mechanisms. Transport-related drownings were defined as those involving watercraft or personal watercraft. Eligible cases had documented SIs, and primary outcomes included in-hospital mortality, hospital complications, LOS, and need for surgical intervention.</div></div><div><h3>Results</h3><div>In addition, 960 patients were analyzed: 87% sustained injuries from transport-related drownings, 10% from nontransport-related unintentional drownings, and 3% from intentional or undetermined drownings. Fractures were the most common injury type (85%). Nontransport-related and intentional drownings were associated with higher odds of in-hospital mortality (odds ratio: 6.74, 8.50, respectively) and prolonged LOS (incidence rate ratio: 1.19, 1.47, respectively). Intentional drownings had higher odds of in-hospital complications (odds ratio: 3.46). Alcohol consumption was linked to intentional drownings, while protective device use correlated with reduced injury severity and shorter LOS.</div></div><div><h3>Conclusions</h3><div>Optimizing fracture management, timely transfers to specialized SI centers, and promoting protective device use may improve patient outcomes. Public health initiatives discouraging alcohol consumption and enhancing aquatic safety education could reduce injury severity. Future research should address swimming ability, time to intervention, and protective device effectiveness.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 306-312"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268071","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 Atypical Presentation and Delayed Timing of Anastomotic Leak in Patients Who Undergo Cytoreducation and Hyperthermic Intraperitoneal Chemotherapy","authors":"Colin J. Rog MD ,&nbsp;Riom Kwakman MD ,&nbsp;Charlotte van Schooten MD ,&nbsp;Chloe Hanson MD ,&nbsp;Elizabeth J. Olecki MD ,&nbsp;Richard A. Erali MD ,&nbsp;Joy Sarkar MD ,&nbsp;Erek Nelson MD ,&nbsp;Matthew G.K. Benesch MD, PhD ,&nbsp;Shalana O'Brien MD ,&nbsp;Gary Mann MD ,&nbsp;Joseph Skitzki MD ,&nbsp;Mohamed Alassas MD ,&nbsp;Evan S. Ong MD","doi":"10.1016/j.jss.2025.09.037","DOIUrl":"10.1016/j.jss.2025.09.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Anastomotic leak (AL) can be a disproportionately devastating complication following cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) due to its effect on both perioperative and oncologic outcomes. Anecdotally, patients who underwent CRS/HIPEC present in an atypically fashion compared to those who undergo non-CRS/HIPEC gastrointestinal surgery, but this has never been rigorously studied.</div></div><div><h3>Methods</h3><div>The records for all consecutive patients who underwent CRS/HIPEC with curative intent from prospectively maintained databases at two high-volume centers were retrospectively reviewed. Those who experienced AL were identified and dichotomized into early (&lt;POD10) and late (≥ POD 10) AL. Groups were analyzed using chi-squared, Fisher exact tests, and analysis of variance for categorical data and Mann–Whitney U or Kruskall–Wallis for continuous data.</div></div><div><h3>Results</h3><div>On median postoperative day (POD) 15, 6.1% of patients experienced AL . Demographics, disease histology, risk factors for AL, receipt of neoadjuvant therapy, and extent of surgery were well-balanced. A higher proportion of small bowel anastomoses leaked in &lt;POD10, whereas a higher proportion of ileocolonic and colorectal anastomoses leaked ≥ POD10. Patients in the late group were also significantly less likely to present with fever, tachycardia, and hypotension compared to patients in the early group, and patients in both cohorts were unlikely to present with peritonitis or leukocytosis.</div></div><div><h3>Conclusions</h3><div>Patients who experience AL after CRS/HIPEC often present in an atypical manner compared to those who undergo non-CRS/HIPEC gastrointestinal surgery. These findings are important to any practitioner who encounters CRS/HIPEC patients given that early recognition of AL is crucial to mitigating subsequent sequelae that can negatively impact both short-term perioperative and long-term oncologic outcomes in this uniquely challenging population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 331-337"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268578","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":"Prolonged Antibiotic Duration is Not Associated With Reduced Surgical Site Infection After Lower Extremity Bypass Surgery","authors":"Hana S. Shafique BS, BA ,&nbsp;Christina L. Cui MD, MAS ,&nbsp;Anthony N. Eze MD ,&nbsp;Adam P. Johnson MD, MPH ,&nbsp;Young Kim MD, MS","doi":"10.1016/j.jss.2025.09.038","DOIUrl":"10.1016/j.jss.2025.09.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical site infection (SSI) is among the most common complications following infrainguinal bypass surgery, despite being considered a preventable complication. The timing and selection of perioperative antibiotic prophylaxis are a key measure in SSI prevention efforts. Current practice guidelines recommend a prophylactic antibiotic duration of less than 24 h; however, there are limited data on the efficacy of prolonged antibiotic duration after lower extremity bypass (LEB) surgery.</div></div><div><h3>Methods</h3><div>In this national cohort study, the Vascular Quality Initiative (VQI) database was retrospectively reviewed for all infrainguinal bypass operations performed from January 2014 to December 2023. The primary outcome of interest was postoperative SSI. Perioperative antibiotics included first- and second-generation cephalosporins. Standard duration was defined as discontinuation of perioperative antibiotics within 24 h of surgical end time; and prolonged duration was defined as any extension beyond 24 h.</div></div><div><h3>Results</h3><div>Over the 10-y study period, 21,647 infrainguinal bypasses were performed and had complete antibiotic-related data. A total of 461 cases (2.1%) developed a postoperative SSI. All patients received preoperative antibiotics. The majority of patients (97.7%) received antibiotic within 1 h preoperatively, with no difference between patients with SSI and no SSI (97.7% <em>versus</em> 96.8%, <em>P</em> = 0.186). Prolonged antibiotics were reported in 6.6% of cases. After adjusting for patient, perioperative, and antibiotic-related factors, prolonged duration was associated with an increased SSI occurrence compared with standard duration (adjusted odds ratio [aOR] 2.01; 95% confidence interval [CI], 1.52-2.67; <em>P</em> &lt; 0.001). Other risk factors included diabetes mellitus (aOR 1.24; 95% CI, 1.03-1.51; <em>P</em> = 0.027), end stage renal disease (ESRD) (aOR 1.86; 95% CI, 1.33-2.61; <em>P</em> &lt; 0.001), and longitudinal groin incision configuration compared with a transverse incision (aOR 1.65; 95% CI, 1.23-2.20; <em>P</em> &lt; 0.001). Preoperative chlorhexidine showers or wipes were associated with fewer SSI events (aOR 0.48; 95% CI, 0.29-0.78; <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>In this large multi-institutional study, prolonged duration of perioperative antibiotic prophylaxis was not associated with a reduction in SSI after infrainguinal bypass surgery. These findings support antimicrobial stewardship efforts in limiting perioperative antibiotic course within 24 h of surgery.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 291-297"},"PeriodicalIF":1.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258293","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":"Crossing Lines: Expiration of Title 42 and the Injury Landscape at the US-Mexico Border","authors":"Parisa Oviedo MD ,&nbsp;John R. Austin MD ,&nbsp;Louis Perkins MD ,&nbsp;Alan H. Tyroch MD ,&nbsp;Ira Swinney MD ,&nbsp;Jamila Boukari BA ,&nbsp;Andrea Krzyzaniak MA ,&nbsp;Vishal Bansal MD ,&nbsp;Erika Brigmon MD ,&nbsp;Samantha Murphy MD ,&nbsp;Benjamin A. Keller MD ,&nbsp;Romeo C. Ignacio MD ,&nbsp;Allison E. Berndtson MD","doi":"10.1016/j.jss.2025.09.015","DOIUrl":"10.1016/j.jss.2025.09.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Title 42 is an emergency public health mandate reenacted in 2020 during the SARS-CoV-2 pandemic, allowing expulsion of migrants entering the United States. This policy ended on May 11, 2023. We hypothesized that border crossing injuries would continue to increase despite expiration.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of data from five US trauma centers along the US–Mexico border. Included patients were adults injured while crossing the border from November 10, 2022-November 12, 2023; the time periods 6 mo before (Title 42 Era) and after (Post 42 Era) expiration were compared. Data collected included demographics, injuries, need for surgery, and hospital outcomes and charges.</div></div><div><h3>Results</h3><div>There were 531 patients in the Title 42 Era and 493 in the Post 42 Era. During Title 42, there was an upward trend in monthly injuries which ceased after Title 42 expired. There were less Central Americans (<em>P</em> = 0.004) and more South Americans in the Post 42 Era (<em>P</em> &lt; 0.001). More patients Post 42 were discharged to law enforcement (<em>P</em> = 0.02). Median hospital charges per patient increased from $95,740 [$64,630-$179,773] to $104,678 [$70,775-$219,394] after Title 42 ended. Cohort was not associated with age, sex, Spanish language, intensive care unit or ventilator days, mortality, injury mechanism or severity, number of operations, or type of operation.</div></div><div><h3>Conclusions</h3><div>The increasing numbers of monthly border-related injuries during the Title 42 Era flattened in the Post 42 Era, indicating that Title 42's expiration was not correlated with a rise in patient injuries. We did note differences in patient demographics, discharge location, and hospital charges per patient between eras.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 284-290"},"PeriodicalIF":1.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258326","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":"Understanding Human Leukocyte Antigens in Vascularized Composite Allotransplantation","authors":"Faisal A.A. Shurafa BS ,&nbsp;Kevin M. Klifto DO, PharmD ,&nbsp;Stephen J. Kovach MD ,&nbsp;L. Scott Levin MD ,&nbsp;Saïd C. Azoury MD","doi":"10.1016/j.jss.2025.09.021","DOIUrl":"10.1016/j.jss.2025.09.021","url":null,"abstract":"<div><div>Vascularized composite allotransplantation (VCA) has all the immunogenic risks of solid organ transplantation, while including the complexity and immunogenicity of the skin. This review provides an overview of the human leukocyte antigens (HLAs) system and its current role in VCA. HLA are cell surface glycoproteins critical for immune system surveillance. Their physiological function is to present self-recognized and foreign peptides to inhibit or initiate an immune response through induction, regulation of immune responses, and the selection of T-cells. The HLA system provides targets for stimulation during graft versus host disease, donor-specific HLA antibodies, and allograft rejection. HLA matching, identifying and using acceptable mismatches, and desensitization strategies may increase the immunologic compatibility of the HLA system between a donor and recipient in VCA.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 298-305"},"PeriodicalIF":1.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258300","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":"Perioperative Interprofessional Communication Between Urology and Palliative Care: A Qualitative Analysis","authors":"Alekhya Gunturi MD ,&nbsp;Bhagvat J. Maheta MD ,&nbsp;Monica Bodd MD ,&nbsp;Jonathan Bergman MD, MPH ,&nbsp;John T. Leppert MD, MS ,&nbsp;Karl A. Lorenz MD, MSHS ,&nbsp;Isabella G. Raspi BA ,&nbsp;Nainwant K. Singh MD ,&nbsp;Karleen F. Giannitrapani PhD, MPH","doi":"10.1016/j.jss.2025.09.013","DOIUrl":"10.1016/j.jss.2025.09.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Good-quality care for patients with a serious illness often requires interdisciplinary expertise. In the urologic perioperative period, this can include urologists and Palliative Care (PC). Our objective is to understand how to improve perioperative coordination between urologists and PC providers in the context of urologic serious illness.</div></div><div><h3>Materials and methods</h3><div>We interviewed 38 providers: urologists (13), PC physicians (12), and clinical team members (13) in phase I of this study. From these interviews, there were 96 examples of interdisciplinary communication that were analyzed using qualitative content analysis with dual review in phase II of this study.</div></div><div><h3>Results</h3><div>Two key themes emerged regarding communication between urology and PC teams. First, effective collaboration is often hindered by logistical challenges, such as surgeons’ limited availability due to time spent in surgery and difficulties coordinating in-person meetings. Fostering bidirectional, timely communication through asynchronous communication and structured meetings improves alignment within the clinical team before patient interactions. Second, hierarchical structures within medical teams can discourage open dialogue, with nonsurgeons sometimes feeling hesitant to share input. Promoting mutual respect is essential to creating a more balanced and collaborative environment. Together, these themes highlight the need for systemic changes that support accessibility, respect, and communication in interdisciplinary care.</div></div><div><h3>Conclusions</h3><div>Future directions include implementing an evidence-based intervention with structures and processes to improve interdisciplinary collaboration among urologists and PC.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 275-283"},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251673","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":"Extracellular Matrix Hydrogel Reduces Anastomotic Leaks in a Rodent Model of Rectal Anastomosis","authors":"Vincent Antonelli MD ,&nbsp;Charles Patterson BS ,&nbsp;Catalina Pineda Molina PhD ,&nbsp;Scott A. Johnson MSc ,&nbsp;Michael Hu BS ,&nbsp;George S. Hussey PhD ,&nbsp;David S. Medich MD ,&nbsp;Stephen F. Badylak DVM, PhD, MD","doi":"10.1016/j.jss.2025.09.008","DOIUrl":"10.1016/j.jss.2025.09.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Anastomotic leaks remain a significant source of morbidity following rectal resections. Despite advances in technique, the incidence of leaks remains high, often necessitating temporary fecal diversion which carries its own risks and requires additional surgery for restoration of intestinal continuity. Reducing leak rates could minimize the need for prophylactic diversion. Extracellular matrix (ECM)–based surgical devices have shown potential to support gastrointestinal healing. Urinary bladder matrix (UBM), a versatile, acellular ECM material that promotes constructive tissue remodeling, has not been extensively studied in colorectal anastomoses. A lack of reliable small animal models has limited progress in this field.</div></div><div><h3>Methods</h3><div>A reproducible rat model of low rectal anastomosis was developed to evaluate ECM-based interventions. Female Sprague–Dawley rats underwent standardized distal colonic resection and sutured anastomosis below the peritoneal reflection. Rats were randomized to receive no adjunct, UBM extraluminal wraps, or UBM hydrogel applied directly to the anastomosis. Healing was assessed using a multimodal evaluation strategy.</div></div><div><h3>Results</h3><div>Control animals demonstrated a 46% anastomotic leak rate, while UBM hydrogel treatment significantly reduced leak rates to 8%. Extraluminal wraps did not confer a protective effect. Rats treated with hydrogel also exhibited fewer perianastomotic adhesions. Histological analysis showed improved composite healing scores in the hydrogel group.</div></div><div><h3>Conclusions</h3><div>This reliable small animal model provides a valuable platform for testing surgical adjuncts. UBM hydrogel shows promise in reducing rectal anastomotic leak rates through both mechanical support and biochemical modulation of healing. This model enables further investigation into anastomotic healing mechanisms and potential therapeutic strategies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 241-250"},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244674","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":"Key Indicators Associated With Survival in Pediatric Trauma Massive Transfusion Protocol","authors":"Theodore Wang BS,&nbsp;Sorasicha Nithikasem BS,&nbsp;Thomas Hong BS,&nbsp;Sathyaprasad Burjonrappa MD","doi":"10.1016/j.jss.2025.09.026","DOIUrl":"10.1016/j.jss.2025.09.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Prior studies and scoring systems have been developed to optimize massive transfusion protocol (MTP) in adults, but an established protocol for children does not yet exist. This study aimed to evaluate the factors associated with survival in MTP activation among pediatric trauma patients.</div></div><div><h3>Methods</h3><div>Patients aged 18 y and under who received MTP were queried from the National Trauma Data Bank from 2017 to 2019, with MTP defined as receiving &gt;40 mL/kg of blood products (e.g., red blood cells, plasma, and platelets) within 4 h of admission. Patients with fatal injuries and/or no signs of life on admission were excluded. Baseline characteristics and clinical outcomes were compared between patients who were discharged alive (DC-alive) and those who died (DC-deceased). Multivariable regression was performed to identify indicators predictive of survival and expressed in odds ratios (ORs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Of 9115 patients who underwent transfusion, 947 (10.4%) required MTP and remained in the cohort. A total of 642 patients (68%) survived. Patients who survived were more likely to undergo hemorrhage control surgery (71% <em>versus</em> 40%, <em>P</em> &lt; 0.001). No predominance of any combination of blood products transfused (e.g., red blood cells, plasma, and platelets) was observed between groups (<em>P</em> = 1.00). Factors associated with survival included tachycardia (OR 2.44, 95% CI 1.60-3.76) and presentation to level I pediatric trauma centers (OR 1.47, 95% CI 0.96-2.27). Poor prognostic factors for survival included hypothermia (OR 0.52, 95% CI 0.32-0.85), severe Glasgow coma score (GCS; OR 0.07, 95% CI 0.04-0.12), very severe injury severity score (ISS; OR 0.38, 95% CI 0.22-0.64), self-payment (OR 0.35, 95% CI 0.19-0.65), and &gt;80 mL per kilogram (mL/kg) of transfused blood products (OR 0.56, 95% CI 0.37-0.85).</div></div><div><h3>Conclusions</h3><div>Tachycardia and pediatric-verified trauma centers appear to be protective in pediatric trauma MTP; decreased survival was associated with hypothermia, severe Glasgow coma score, very severe injury severity score, self-payment, and &gt;80 mL/kg of transfused blood products. Prediction tools should identify patients who are most likely to benefit from MTP and alternative interventions for those unlikely to improve with MTP.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 251-259"},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244763","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":"Beauty Is in the Eye of the Beholder: Cosmetic Outcomes After Precision Breast Intraoperative Radiation Therapy","authors":"Maria Reyes-Matos MD, MS-CR,&nbsp;Lena M. Turkheimer MD, MPH,&nbsp;Chris A. Campbell MD, FACS,&nbsp;Shayna L. Showalter MD, FACS","doi":"10.1016/j.jss.2025.09.029","DOIUrl":"10.1016/j.jss.2025.09.029","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Precision Breast</em> Intraoperative Radiation Therapy (<em>PB</em>-IORT) is a novel form of IORT that combines computed tomography–guided treatment planning with high-dose-rate brachytherapy to deliver individualized radiation that spares the skin and chest wall. We analyzed cosmetic outcomes following <em>PB</em>-IORT as scored by breast clinicians, a plastic surgeon, and patients, and assessed the interrater reliability between the scores.</div></div><div><h3>Methods</h3><div>As part of a phase II clinical trial, the study cohort included 357 patients treated with PB-IORT who had up to 24 mo of follow-up data. At each follow-up visit, the patient, plastic surgeon, and breast clinicians completed the Harvard Cosmesis Scale and a survey that evaluates changes in breast pigmentation, shape, and size. Interrater agreement was assessed using Kappa statistics.</div></div><div><h3>Results</h3><div>At 24 mo, 88.7% (95% confidence interval [CI]: 84.77, 92.61) of patients rated their cosmesis as “excellent” or “good’ with the Harvard Cosmesis Scale; 93.7% (95% CI: 90.80, 96.14) and 80.3% (95% CI: 75.08, 85.50) of patients were rated similarly by the breast clinicians and the plastic surgeon, respectively. There was minimal agreement between patients, breast clinicians, and the plastic surgeon for all variables (Kappa &lt;0.40). Breast clinicians rated cosmesis the most favorably.</div></div><div><h3>Conclusions</h3><div><em>PB</em>-IORT delivers a single, high dose of radiation without compromising cosmetic outcomes. Cosmetic outcome scores from patients, breast clinicians, and the plastic surgeon had low interrater reliability. The patient's perspective is paramount when assessing cosmetic outcomes after breast surgery. We advocate that future studies include patient-reported outcomes as the primary means of evaluating cosmetic outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 210-217"},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244713","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":"22-Modifier Designation Accurately Predicts Perioperative Resource Utilization and Outcomes in Liver Transplantation","authors":"Molly Weavers BS ,&nbsp;Zach Leslie BS ,&nbsp;Matthew Wright MD ,&nbsp;Michael Dryden MD ,&nbsp;Michael G. Megaly MD ,&nbsp;Joseph Sushil Rao MD ,&nbsp;Abraham J. Matar MD","doi":"10.1016/j.jss.2025.09.004","DOIUrl":"10.1016/j.jss.2025.09.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Significant ambiguity exists regarding the diagnostic accuracy of a 22-modifier designation, especially in technically complex operations such as liver transplantation (LT). We sought to evaluate the diagnostic accuracy of 22-modifier in LT by correlating 22-modifier designation with LT outcomes.</div></div><div><h3>Methods</h3><div>All adult liver transplants between January 1, 2015, and December 31, 2022, at a single academic medical center were reviewed. Hospital billing records were queried, and patients were stratified into two groups – with and without a procedural 22-modifier reimbursed.</div></div><div><h3>Results</h3><div>Among 588 LT included, 55 (9.4%) received a 22-modifier designation while 533 (90.6%) did not. The most common indications for 22-modifier were adhesiolysis &gt;60 min (77.8%) and portal vein thrombosis (16.7%). In both univariate and multivariate analysis, prior abdominal surgery and retransplantation were pretransplant risk factors associated with 22-modifier use. 22-modifier LT were associated with increased perioperative resource utilization including case length (<em>P</em> = 0.002), intraoperative transfusion requirements (red blood cell [<em>P</em> &lt; 0.0001], fresh frozen plasma [&lt;0.0001], cryoprecipitate [0.003]), length of intensive care unit stay (<em>P</em> = 0.01), and length of hospital stay (<em>P</em> = 0.01). Similarly, 22-modifier LT were associated with increased postoperative complications including abdominal re-exploration (<em>P</em> &lt; 0.0001) and biliary complications (<em>P</em> = 0.04). Finally, 22-modifier LT were associated with inferior long term outcomes including graft (<em>P</em> = 0.0003) and patient survival (<em>P</em> = 0.0002).</div></div><div><h3>Conclusions</h3><div>22-modifier designation in LT accurately identifies higher complexity cases associated with increased perioperative resource utilization, postoperative complications, and inferior long-term graft and patient survival.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 260-267"},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244746","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}