Journal of Surgical Research最新文献

{"title":"Safety of an Unconventional Vertical Transumbilical Incision for Pediatric Umbilical Hernia Repair","authors":"Meagan Rosenberg MD ,&nbsp;Aixa Perez Coulter MS, MPH ,&nbsp;Victoria Pepper MD ,&nbsp;Gregory Banever MD, FAAP, FACS ,&nbsp;David Tashjian MD, FAAP, FACS ,&nbsp;Kevin Moriarty MD, FAAP, FACS ,&nbsp;Michael V. Tirabassi MD, FAAP, FACS","doi":"10.1016/j.jss.2025.03.054","DOIUrl":"10.1016/j.jss.2025.03.054","url":null,"abstract":"<div><h3>Introduction</h3><div>Umbilical hernias are a common pediatric surgical problem, typically repaired at 4-5 y of age. Vertical transumbilical incision (VTUI) is a less common surgical approach associated with improved cosmetic outcomes. Our goal was to demonstrate the safety of this approach compared to the periumbilical incision (PUI).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 402 pediatric patients who underwent an index open umbilical hernia repair for any indication at a single institution from 2013 to 2023. Patient demographics, operative outcomes, narcotic use, and complications were compared by incision type. Data were stratified by age and weight. Analysis was performed using student's <em>t</em>-test.</div></div><div><h3>Results</h3><div>We analyzed 402 patients. Three hundred thirty-seven (83.8%) had PUI and 65 (16.2%) had VTUI. Mean (standard deviation) age was 5 (3.18) y, ranging 0-18 y. Females represented 55%. There was no difference in age based on incision type. PUI and VTUI room time (79.2 v 83.3 min, <em>P</em> = 0.10) and anesthetic time (37.8 v 33.2, <em>P</em> = 0.31) were not significantly different. Mean intraoperative morphine milliequivalents per kilogram (MME/kg) were not different between incision types (<em>P</em> = 0.99). Average postanesthesia care unit MME/kg showed no difference between PUI and VTUI (3.7 v. 7.6, <em>P</em> = 0.06). There were 6 (1.5%) complications with no difference based on incision: 4 recurrences (3 PUI, 1 VTUI), 1 hospital readmission (PUI), and 1 patient with uncontrolled pain requiring admission (PUI). Stratified by weight, there were no significant differences in complication rates based on incision type.</div></div><div><h3>Conclusions</h3><div>Our findings support VTUI as a safe alternative in the pediatric population without an increase in postoperative complications, anesthetic time, or MME/kg utilization.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 35-40"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859815","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":"Mortality and Morbidity in Rib Fracture Surgery: Pulmonary Contusion Versus Extrathoracic Trauma","authors":"Melda İşevi MD ,&nbsp;Caner İşevi MD ,&nbsp;Özkul Yılmaz Çolak MD ,&nbsp;Tuğçehan Sezer Akman MD ,&nbsp;Mehmet Gökhan Pirzirenli MD ,&nbsp;Neslihan Ünal Akdemir MD","doi":"10.1016/j.jss.2025.03.055","DOIUrl":"10.1016/j.jss.2025.03.055","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to determine whether the primary cause of morbidity and mortality in patients undergoing rib stabilization surgery due to blunt trauma-induced rib fractures is pulmonary contusion or associated extrathoracic trauma.</div></div><div><h3>Methods</h3><div>Patients aged 18-80 y diagnosed with flail chest following blunt trauma and undergoing rib stabilization surgery between January 1, 2014, and January 1, 2024, were included. Collected data encompassed demographics, trauma type, associated injuries, surgery timing, mechanical ventilation, extubation time, intensive care unit stay, and morbidity/mortality outcomes. Statistical analyses were performed using Statistical Package for the Social Sciences 22.0, with a significance level of <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Among 110 patients, the mean age was 55.6 ± 13.9 y, with 80.9% being male. Early stabilization (&lt;72 h) was performed in 77.3%, and late stabilization (&gt;72 h) in 22.7%. Prolonged intensive care unit stays (&gt;2 d) were observed in 52.7%, with an average hospital stay of 14.63 ± 20.17 d. Pneumonia (31.8%) was the most common morbidity, and the mortality rate was 14.5%. Pulmonary contusion (<em>P</em> = 0.021) and vertebral injury (<em>P</em> = 0.007) were significantly associated with pneumonia. Abdominal trauma increased tracheostomy rates (<em>P</em> = 0.038), and maxillofacial trauma was associated with mortality (<em>P</em> = 0.030).</div></div><div><h3>Conclusions</h3><div>Timely rib stabilization and a multidisciplinary approach are critical for managing thoracic injuries. Trauma severity and associated injuries significantly influence outcomes. Standardized protocols for intervention timing and patient selection may help reduce morbidity and mortality in multitrauma patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 8-16"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Age and Liver Transplant Outcomes in Patients With Acute-On-Chronic Liver Failure","authors":"Jie Zhou MD ,&nbsp;Siyao Zhang MM ,&nbsp;Jingxia Liu BS ,&nbsp;Jiawei Ding MM ,&nbsp;Shenli Ren MSc ,&nbsp;Tao Zhang MM ,&nbsp;Danni Ye MM ,&nbsp;Fangshen Xu MM ,&nbsp;Zheng Chen MM ,&nbsp;Huilin Zheng PhD ,&nbsp;Lei Zhang PhD ,&nbsp;Yu Zhang MD ,&nbsp;Zhenhua Hu MD","doi":"10.1016/j.jss.2025.03.013","DOIUrl":"10.1016/j.jss.2025.03.013","url":null,"abstract":"<div><h3>Introduction</h3><div>To explore the role of age at listing on outcomes for patients with acute-on-chronic liver failure (ACLF) awaiting liver transplantation (LT).</div></div><div><h3>Materials and methods</h3><div>We assessed adult candidates listed for LT in the Scientific Registry of Transplant Recipients database from January 1, 2007 to June 30, 2018. Patients were divided into four groups based on age at listing: I (≤34), II (35-49), III (50-64), and IV (≥65). The ACLF grade was estimated (est-ACLF), and intent-to-treat survival, overall survival (OS), as well as potential predictors for OS was evaluated.</div></div><div><h3>Results</h3><div>Est-ACLF-3 was associated with a higher 30-d cumulative dropout rate and inferior intent-to-treat survival across age groups. No difference was observed in OS among ACLF grades in group I, but significantly inferior OS was observed in higher ACLF grades in groups II-IV. Multivariate analysis showed age (<em>P</em> &lt; 0.001, ref. group I; hazard ratio 0.995 for group II, <em>P</em> = 0.936; 1.196 for group III, <em>P</em> = 0.002; 1.651 for group IV, <em>P</em> &lt; 0.001) and est-ACLF grade (<em>P</em> &lt; 0.001, ref. est-ACLF-0; 1.214 for est-ACLF-1, <em>P</em> &lt; 0.001; 1.246 for est-ACLF-2, <em>P</em> &lt; 0.001; 1.578 for est-ACLF-3, <em>P</em> &lt; 0.001) were independent predictors for OS. Generalized additive model showed different association between age and OS among different ACLF grades.</div></div><div><h3>Conclusions</h3><div>Young patients with high ACLF grades could achieve similar OS compared with those with low grades. Elderly patients with higher ACLF grades were associated with inferior outcomes after LT.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 199-211"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855066","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":"Height Index and Diameter as Predictors of Outcomes in Males With Abdominal Aortic Aneurysms","authors":"Camilo Polania-Sandoval MD,&nbsp;Houssam Farres MD,&nbsp;Camila Esquetini-Vernon MD,&nbsp;Jonathan Vandenberg MD,&nbsp;Hennessy A. Morales Arroyo BS,&nbsp;Biraaj Mahajan MD,&nbsp;Yetzali Claudio Medina BS,&nbsp;Christopher Jacobs MD,&nbsp;Young Erben MD","doi":"10.1016/j.jss.2025.03.053","DOIUrl":"10.1016/j.jss.2025.03.053","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Abdominal aortic aneurysms (AAAs) affect over 1 million adults in the United States, with current guidelines recommending elective repair for males at diameters greater than 5.5 cm. While aneurysm diameter (AD) remains the primary predictor of rupture in men, indexed measurements such as the aortic size index (ASI) and aortic height index (AHI) may improve risk stratification. This study aims to evaluate the association between AD, ASI, and AHI with aortic-related complications in male patients following elective AAA repair.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a single-center retrospective cohort study between 2014 and 2024 in male patients who underwent open or endovascular (endovascular aneurysm repair or fenestrated-endovascular aneurysm repair) AAA repair. Ruptured and saccular aneurysms were excluded. The primary outcome was 30-d and mid-term follow-up aortic-related complications and reintervention. Bivariate analysis was performed between the outcomes and stratified ASI (&gt;2, &gt;2.5, &gt;3, and &gt;3.5), AHI (&gt;2.5, &gt;3, &gt;3.5, and &gt;4), and AD in cm (&gt;5, &gt;5.5, &gt;6, and &gt;6.5 cm). Cox regression analysis was performed between each index as a continuous variable and each outcome. Area under the receiver operating characteristic curve analysis was conducted, and cumulative proportions were calculated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Two hundred male patients were included with a mean age of 74.3 ± 8.5 y. Bivariate analysis demonstrated no significant association between ASI, AHI, or AD categories and 30-d aortic-related complications. During follow-up (mean: 2.6 ± 2.8 y), larger AD at the time of repair was significantly associated with an increased rate of aortic-related complications (AD &gt; 5.5 cm: &lt;em&gt;P&lt;/em&gt; = 0.01; &gt;6 cm: &lt;em&gt;P&lt;/em&gt; = 0.02; &gt;6.5 cm: &lt;em&gt;P&lt;/em&gt; = 0.02) and reinterventions at mid-term (AD &gt; 5.5 cm: &lt;em&gt;P&lt;/em&gt; = 0.02; &gt;6 cm: &lt;em&gt;P&lt;/em&gt; = 0.02; &gt;6.5 cm: &lt;em&gt;P&lt;/em&gt; = 0.01). In Cox regression analysis, AD (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.41-3.2) and AHI (HR: 3.26, 95% CI: 1.47-7.22) were independently associated with mid-term aortic-related complications. Similarly, AD (HR: 1.72, 95% CI: 1.20-2.47) and AHI (HR: 2.21 95% CI: 1.13-4.32) were independently related to reinterventions at mid-term. Cumulative proportions for 30-d complications were 66.7%, 38.5% for mid-term complications, and 39.1% for reinterventions at a 5.5 cm AD, which was equivalent to ASI of 3.2 cm/m&lt;sup&gt;2&lt;/sup&gt; and AHI of 2.9 cm/m for 30-d complications and ASI of 2.35 cm/m&lt;sup&gt;2&lt;/sup&gt; and AHI of 2.9 cm/m for both mid-term complications and reinterventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Larger AD at the time of repair was associated with increased rates of mid-term aortic-related complications and reinterventions for diameters exceeding 5.5 cm. Cox regression analysis identified AD and AHI as independent predictors of mid-term complicati","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 22-29"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859818","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":"Screening for Intimate Partner Violence After Traumatic Injury: A Community-Based Participatory Qualitative Research Study","authors":"Hannah Decker MD, MAS ,&nbsp;Manami Diaz Tsuzuki BA ,&nbsp;Emilia De Marchis MD ,&nbsp;Jill Zawisza BA ,&nbsp;Mary Martinez BA ,&nbsp;Tasce Bongiovanni MD, MHS, MPP","doi":"10.1016/j.jss.2025.03.029","DOIUrl":"10.1016/j.jss.2025.03.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Intimate partner violence (IPV) is common among injured patients and adversely impacts health. We sought to better understand acceptability and appropriateness of screening for IPV following traumatic injury.</div></div><div><h3>Methods</h3><div>We conducted a qualitative, community-based participatory research study in partnership with a community-based organization focused on supporting survivors of IPV. We conducted semistructured interviews exploring attitudes and opinions about IPV screening after injury with English- and Spanish-speaking adults who were IPV survivors or who were admitted to a level 1 trauma center after traumatic injury. We developed a codebook based on the Health Equity Implementation Framework and analyzed data using thematic analysis.</div></div><div><h3>Results</h3><div>We conducted 19 interviews. Participants included twelve IPV survivors, ten women, seven men, and two nonbinary participants. Three interviews were conducted in Spanish. Four themes emerged as follows: 1) participants with a history of IPV described major barriers to disclosure to clinicians; 2) despite these barriers, participants widely supported the practice of asking about IPV; 3) participants highlighted key tactics to improve the experience of inquiry, screening, and disclosure after traumatic injury; and 4) participants largely did not mind the screening questions commonly used to screen patients with traumatic injuries, but identified key gaps.</div></div><div><h3>Conclusions</h3><div>In-hospital screening for IPV among patients with traumatic injury was generally acceptable to study the participants. However, the manner in which the screening is conducted is important to both survivors and participants without a history of IPV.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 233-241"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859178","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":"Bone Marrow-Derived Mesenchymal Stem Cells Alleviate Posthemorrhagic Shock Mesenteric Lymph-Induced Acute Lung Injury","authors":"Wendi Wang MS ,&nbsp;Zhonghua Li MS ,&nbsp;Xiaohui Wu BS ,&nbsp;Tingjiao Suo MS ,&nbsp;Huibo Du MS ,&nbsp;Zi-Gang Zhao PhD ,&nbsp;Chun-Yu Niu PhD ,&nbsp;Zhen-Ao Zhao PhD","doi":"10.1016/j.jss.2025.03.032","DOIUrl":"10.1016/j.jss.2025.03.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Mesenteric lymph is recognized as a conduit in the gut-lung axis. Posthemorrhagic shock mesenteric lymph (PHSML) contains proinflammatory substances and can exacerbate the acute lung injury (ALI) induced by hemorrhagic shock (HS). Mesenchymal stem cells (MSCs) possess anti-inflammatory properties and hold therapeutic potential for ALI. However, the effect and mechanism of MSCs in alleviating PHSML-mediated ALI remains unclear.</div></div><div><h3>Methods</h3><div>Rat hemorrhage shock model and PHSML infusion model were used to induce ALI. MSCs were administrated intravenously to treat ALI. Pulmonary function of rats was assessed by a Buxco pulmonary function analysis system. Hematoxylin and eosin staining was used for histological analysis. Western blot and quantitative real-time polymerase chain reaction were used to detect the expressions of inflammation-related genes.</div></div><div><h3>Results</h3><div>Intravenous infusion of bone marrow-derived MSCs (BMSCs) prolonged the survival of HS rats. Both HS and PHSML could cause pulmonary tissue damage, lung edema, and pulmonary dysfunction, which were all alleviated by BMSC treatment. The pulmonary dysfunction indices (inspiratory resistance, functional residual capacity, and mean mid expiratory flow) were significantly improved by BMSC treatment in the two models. C-X-C motif chemokine ligand and inducible nitric oxide synthase, which are important for neutrophil recruitment and infiltration to the injured site, were down-regulated by BMSCs in the lung tissues of rats with HS or PHSML injury. As a neutrophil marker, myeloperoxidase is also decreased by BMSC treatment. These results indicated that BMSCs may reduce neutrophil recruitment and infiltration through inhibiting C-X-C motif chemokine ligand and inducible nitric oxide synthase expressions.</div></div><div><h3>Conclusions</h3><div>The current findings demonstrate that BMSC therapy can alleviate the ALI induced by PHSML. In mechanism, BMSCs can protect lungs from the inflammatory response mediated by neutrophils. Our study provides novel insight to treat ALI in the gut lymphatics-lung axis.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 212-223"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859175","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":"Anorectal Malformation Fistula Evaluation May Aid in Hirschsprung Diagnosis","authors":"Abigail J. Alexander MD ,&nbsp;Scott S. Short MD ,&nbsp;Angelica Putnam MD ,&nbsp;Jeffrey R. Avansino MD ,&nbsp;Andrea Badillo MD ,&nbsp;Rachel C. Crady MS ,&nbsp;Belinda H. Dickie MD, PhD ,&nbsp;Ron W. Reeder PhD ,&nbsp;Rebecca M. Rentea MD ,&nbsp;K Elizabeth Speck MD ,&nbsp;Richard J. Wood MD ,&nbsp;Michael D. Rollins MD","doi":"10.1016/j.jss.2025.03.050","DOIUrl":"10.1016/j.jss.2025.03.050","url":null,"abstract":"<div><h3>Introduction</h3><div>Concurrence of Hirschsprung disease (HD) and anorectal malformation (ARM) is rare, but early diagnosis is important for proper management. The aim of this study was to define the expected histological findings of rectal fistulae in ARM and to identify findings that may raise suspicion for concurrent HD.</div></div><div><h3>Methods</h3><div>Eighty-six patients with ARM from a single institution were studied. Pathology reports as well as randomly selected fistula specimens were evaluated for the presence of ganglion cells at a single institution. An additional query of the Pediatric Colorectal and Pelvic Learning Consortium database was performed to examine clinical features of patients with HD and ARM.</div></div><div><h3>Results</h3><div>Patients represented the spectrum of ARM, with perineal fistula being the most common. Ganglion cells were present in 78 of 86 (91%) specimens, hypoganglionosis in 5 of 86 specimens (6%), and absent in 3 of 86 (4%) specimens. Of the patients with absence of ganglion cells in their fistula specimens, 2 of 3 (66%) also carried a diagnosis of Trisomy 21. Within the Pediatric Colorectal and Pelvic Learning Consortium database, we identified 12 patients with both ARM and HD out of 1726 ARM subjects (0.7% of ARM patients). Among this group of patients, 33% (<em>n</em> = 4) had chromosomal anomalies.</div></div><div><h3>Conclusions</h3><div>The majority of fistula specimens from patients with ARMs contain ganglion cells. Absence of ganglion cells in patients with ARM should prompt suspicion for HD. This association may be more common in patients with chromosomal anomalies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 30-34"},"PeriodicalIF":1.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859814","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":"Stress and Strain: Ergonomic Practices and Associated Injuries Among Pediatric Surgeons","authors":"Sydney F. Tan MD ,&nbsp;Michael Stellon MD ,&nbsp;Devashish Joshi MD ,&nbsp;Jessica Hellner MS ,&nbsp;Romeo C. Ignacio MD ,&nbsp;Kyle J. Van Arendonk MD, PhD ,&nbsp;Barrie S. Rich MD ,&nbsp;Mehul V. Raval MD ,&nbsp;Erin E. Perrone MD ,&nbsp;Kevin P. Moriarty MD ,&nbsp;Danielle S. Walsh MD ,&nbsp;Jason C. Fisher MD ,&nbsp;Terry L. Buchmiller MD ,&nbsp;Kenneth W. Gow MD ,&nbsp;Hau D. Le MD","doi":"10.1016/j.jss.2025.03.037","DOIUrl":"10.1016/j.jss.2025.03.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Ergonomic injuries pose significant risks to surgeons, affecting health, productivity, care access, and retirement age. Despite unique challenges in pediatric surgery, including varied patient sizes and operations, little is known about pediatric surgeons' ergonomics. This study aimed to assess ergonomic practices and associated injuries among pediatric surgeons.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was distributed to the American Pediatric Surgical Association regular members and fellows. Data collected included demographics, physical health, surgical practices, operating habits, discomfort, injuries, interventions, and outcomes. Associations with injury were analyzed using Fisher's exact test, Pearson's Chi-squared test, and Wilcoxon rank-sum tests.</div></div><div><h3>Results</h3><div>One hundred seventeen (11%) surgeons responded, 53% were male with a median of 15 y in practice (interquartile range: 6-25). Regarding operating habits, 76% did not take regular breaks, 48% double-gloved, and 51% used loupes regularly. Notably, 90% experienced discomfort or pain, and 30% sustained injuries from operating, primarily affecting the neck and cervical spine (53%). White-identifying pediatric surgeons (80%) reported significantly more ergonomic injuries than other races (<em>P</em> &lt; 0.01). Only 18% of respondents received ergonomic training. Ergonomics training and operating with a resident or co-surgeon were associated with less injury (<em>P</em> &lt; 0.05). Among those experiencing discomfort or injury, 13% underwent a procedure, 63% experienced sleep disturbance, 74% reported contribution to burnout, and 88% used pain medications.</div></div><div><h3>Conclusions</h3><div>Ergonomic-related discomfort and injuries occurred in nearly 90% of pediatric surgeons who responded. Few had ergonomic training and most reported an impact on well-being. Modifiable ergonomic factors for pediatric surgeons, along with targeted interventions to reduce injuries, can improve surgeon well-being.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 1-7"},"PeriodicalIF":1.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851668","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":"Using the Geriatric Emergency Perioperative Risk Index Derived from Artificial Intelligence Algorithms to Predict Outcomes of Geriatric Emergency General Surgery","authors":"Dequan Xu PhD,&nbsp;Haoxin Zhou PhD,&nbsp;Jie Rong MPH,&nbsp;Xin Xie MPH,&nbsp;Limin Hou PhD","doi":"10.1016/j.jss.2025.03.008","DOIUrl":"10.1016/j.jss.2025.03.008","url":null,"abstract":"<div><h3>Introduction</h3><div>The objective of this study was to employ artificial intelligence (AI) technology for the development of a model that can accurately forecast the outcome of emergency general surgery (EGS) in elderly patients. Additionally, an innovative visual scoring system called geriatric emergency perioperative risk index (GEPR) was devised based on this model.</div></div><div><h3>Methods</h3><div>A retrospective database of geriatric patients who had undergone EGS was used for the development of the AI model and GEPR. The study employed a specialized algorithm, comprising of four sequential steps namely scale prototype selection, clinical data collection and collation, AI model development, and GEPR development.</div></div><div><h3>Results</h3><div>In total, 1500 patients with the mean age of 69.8 ys were enrolled in the study. RandomForestClassifier algorithm outperformed the other AI models. Based on the feature importance, GEPR was derived, with a total score range of 0–26. The C-statistic of GEPR for in-hospital mortality was 0.872 (95% confidence interval, 0.840–0.905). The observed probability of in-hospital mortality gradually increased from 0% at a score of 0 to 63.3% at a score of 12 and 100% at a score of 15.</div></div><div><h3>Conclusions</h3><div>Using patient-related and technical parameters, a GEPR model derived from AI algorithms for prediction of surgical complications in geriatric EGS was developed. The GEPR model reliably predicts postoperative in-hospital mortality in geriatric EGS patients. Clinical studies are currently being conducted to validate the stability and precision of the GEPR model utilizing the MIMIC-IV database. Further prospective multicenter trials are needed to externally validate the developed model.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 188-198"},"PeriodicalIF":1.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855065","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 Surgeon Mattering and Well-Being in an Expanding Health System","authors":"Lauren A. Szczygiel PhD ,&nbsp;Mary E. Byrnes PhD, MUP ,&nbsp;Justin Dimick MD, MPH ,&nbsp;Meredith Barrett MD","doi":"10.1016/j.jss.2025.03.025","DOIUrl":"10.1016/j.jss.2025.03.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Academic medical centers are undergoing significant growth which may influence surgeons' perceptions of their roles and value within these institutions. This study aimed to explore academic surgeons' perspectives on their roles and sense of value within an expanding academic medical center.</div></div><div><h3>Materials and methods</h3><div>We conducted semi-structured interviews with 39 surgeons at a single academic medical center. Using a qualitative descriptive approach, we analyzed data through iterative coding and theme development.</div></div><div><h3>Results</h3><div>We identified three main themes: (1) Increased administrative responsibilities with inadequate support, (2) Perceived limited influence in organizational decision-making, and (3) Importance of support from health system administration and colleagues. Surgeons interpreted administrative workload and their level of involvement in institutional decisions as key indicators of their value to the organization. Collegial support played a vital role in countering feelings of disengagement and fostering a sense of belonging.</div></div><div><h3>Conclusions</h3><div>The organizational structure of academic medical centers impacts surgeons' perceptions of their value. Addressing administrative burdens, enhancing surgeon participation in governance, and fostering supportive professional networks are potential strategies to improve morale and job satisfaction during organizational growth. Future research should focus on developing interventions to address these areas.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"309 ","pages":"Pages 156-165"},"PeriodicalIF":1.8,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848717","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}