Journal of Surgical Research最新文献

{"title":"Human Capital and Productivity in Surgery Research Across the Globe: A Big Data Analysis Using Artificial Intelligence","authors":"Georgios Karamitros MD, MS ,&nbsp;Sofoklis Goulas PhD","doi":"10.1016/j.jss.2024.09.047","DOIUrl":"10.1016/j.jss.2024.09.047","url":null,"abstract":"<div><h3>Introduction</h3><div>No investigation of each nation's contribution to knowledge production and human capital in surgery currently exists. Previous studies explored country-level research productivity only in few surgical subspecialties. To identify current and future leaders in surgery research, we conduct a retrospective observational study of each country's human capital and research productivity.</div></div><div><h3>Methods</h3><div>A web-scraping algorithm was deployed on PubMed to retrieve information on the first and senior author of every publication in all PubMed-indexed surgery outlets—a total of 388 journals—between 2010 and 2022, according to the SCImago classification. Each country's human capital is proxied by the number of first and senior authors.</div></div><div><h3>Results</h3><div>A total of 665,668 publications from 110 countries were reviewed. The number of publications rises over time. The United States represents 30.78% and 31.32% of global publications based on first and senior authors, respectively. Other leading contributors include the United Kingdom (5.57% and 5.69% of global first and senior author publications, respectively), China (8.84% and 8.74%), Japan (7.14% and 7.10%), and Italy (4.54% and 4.46%). The number of publications per 100K people ranges between 0.04 and 86.01, suggesting widely varying levels of research productivity relative to the population.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the US dominance in surgery research. Countries with a higher share of first or senior authors may have greater capacity to expand their future research output. As big data research expands, we expect studies deploying artificial intelligence methodologies, such as web scraping, on data repositories to guide healthcare provision and health policy decisions to become mainstream.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 731-743"},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502709","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":"Intensive Care Unit Readmissions in a Level I Trauma Center.","authors":"Benjamin Moore, Kacee J Daniels, Blake Martinez, Kevin W Sexton, Kyle J Kalkwarf, Matthew Roberts, Stephen M Bowman, Hanna K Jensen","doi":"10.1016/j.jss.2024.09.074","DOIUrl":"https://doi.org/10.1016/j.jss.2024.09.074","url":null,"abstract":"<p><strong>Introduction: </strong>Intensive care unit (ICU) readmissions are associated with increased morbidity and mortality rates, longer hospitalization, and increased health-care expenditures. This study sought to present a large cohort of trauma patients readmitted to the ICU, characterizing risk factors and providing quality improvement strategies to limit ICU readmission.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on adult trauma patients admitted to the ICU at a single level I trauma center from 2014 to 2021. Patients were split into readmission and no readmission groups. Patients experiencing readmission were compared to a similar group that was not readmitted using descriptive statistics and logistic regression.</p><p><strong>Results: </strong>In this study, 3632 patients were included and 278 (7.7%) were readmitted to the ICU. Significant differences were found in age, Elixhauser Comorbidity score, number of days on a ventilator, and number of patients requiring ventilator support. Furthermore, logistic regression showed that increasing age and the Elixhauser Comorbidity Score were associated with an increased likelihood of ICU readmission. Over the study period, the ICU readmission rate increased while the ICU length decreased.</p><p><strong>Conclusions: </strong>Age, Elixhauser Comorbidity score, and ventilator use were all significant risk factors for ICU readmission. During our study period, a concerning trend of increasing ICU readmissions and decreased ICU length of stay was found. By identifying this trend, our institution was able to employ mitigation strategies that have successfully reversed the trend in ICU readmissions, decreasing the rate below the national average.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568809","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":"National Health Insurance Claim of Pediatric Appendectomy With Mandatory Diagnosis-Related Group Payment System in Korea","authors":"Yun Jung Lee BS ,&nbsp;Sanghoon Lee MD, PhD","doi":"10.1016/j.jss.2024.09.076","DOIUrl":"10.1016/j.jss.2024.09.076","url":null,"abstract":"<div><h3>Introduction</h3><div>Enforcement of diagnosis-related group system for appendectomy under the National Health Insurance Service has gradually widened and since July 2013 it has been enforced in all medical institutions in Korea. We have analyzed Health Insurance Review &amp; Assessment Service data to observe changes in claim patterns of pediatric appendectomy during this period.</div></div><div><h3>Methods</h3><div>All claims data for appendectomy of patients younger than 18 y from 2011 to 2015 were collected. We analyzed the following factors of all cases: age, gender, length of hospital stay, medical cost, method of insurance claim and region.</div></div><div><h3>Results</h3><div>A total of 112,143 claims were made for appendectomy during the study period. In that, 66,510 (59.3%) were boys and 45,633 (40.7%) were girls. Median length of stay was 5 d and median sum of reimbursement of each claim was 2,198,630 won. Annual number of claims for appendectomy showed a steady decline from 24,888 in 2011 to 19,070 in 2015. Median sum of reimbursement of each claim was 1,862,615, 1,975,500, 2,233,360, 2,376,700, and 2,468,000 won, respectively from 2011 to 2015. Reimbursement for complicated appendectomy increased from 4400 out of 24,888 cases (17.7%) in 2011 to 3865 out of 19,070 cases (20.3%) in 2015. Overall medical cost of all reimbursement for pediatric appendectomy increased from 46,113,202,580 to 47,572,253,300 won.</div></div><div><h3>Conclusions</h3><div>Following the universal enforcement of the diagnosis-related group claim system for appendectomy by the National Health Insurance Service, we observed an increase in the median sum of reimbursement per claim and a rise in the rate of claims for complicated appendectomies. These changes were associated with an overall increase in national medical costs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 709-715"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502712","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":"Prevalence and Extent of Industry Funding to Program Directors Across Pediatric Surgical Specialties","authors":"Jason Silvestre MD ,&nbsp;Abhishek Tippabhatla BS ,&nbsp;Belal Yasinj BS ,&nbsp;Pooya Hosseinzadeh MD","doi":"10.1016/j.jss.2024.09.073","DOIUrl":"10.1016/j.jss.2024.09.073","url":null,"abstract":"<div><h3>Introduction</h3><div>Industry funding in surgical education offers benefits but presents conflicts of interest. This study defines the prevalence and extent of industry funding to fellowship program directors (FPDs) across pediatric surgical specialties.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective cross-sectional analysis of FPDs in pediatric surgical specialties. Data were amalgamated from the Centers for Medicare and Medicaid Services and the Accreditation Council for Graduate Medical Education. Characteristics of FPDs were obtained from academic websites and medical licensing boards. Personal industry payments from 2016 to 2022 were analyzed, and temporal trends were elucidated. Comparisons were made by year, surgical specialty, and control groups with nonparametric tests.</div></div><div><h3>Results</h3><div>A total of 241 FPDs were identified, with 206 (85%) receiving industry payments over the study period. The specialties with the highest prevalence of industry funding to FPDs were pediatric orthopedic surgery (100%), pediatric urology (96%), and pediatric surgery (85%). Total industry payments aggregated to $7.3 million dollars with the majority awarded to pediatric orthopedic surgery (91%). Most industry payments were for royalties or licensing (57%) and consulting fees (31%). Median total industry payments per FPD differed between subspecialties (<em>P</em> &lt; 0.001) and was highest in pediatric orthopedic surgery ($7009, interquartile range [IQR], $1771-$50,239) and lowest in pediatric otolaryngology ($116, IQR, $75-$1626). Male FPDs had higher median total industry payments than female FPDs ($1643, IQR, $172-$8731 <em>versus</em> $193, IQR, $84-$712, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Industry payments to FPDs in pediatric surgical specialties are highly prevalent, but the magnitude varies by specialty. Future work is needed to establish mechanisms that promote equitable partnerships between academia and industry for pediatric surgery training.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 685-690"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502715","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":"Use of Deep Learning to Identify Peripheral Arterial Disease Cases From Narrative Clinical Notes","authors":"Shantanu Dev BS ,&nbsp;Andrew Zolensky BS ,&nbsp;Hanaa Dakour Aridi MD ,&nbsp;Catherine Kelty PhD, MS ,&nbsp;Mackenzie K. Madison MD, MS ,&nbsp;Anush Motaganahalli MPH ,&nbsp;Benjamin S. Brooke MD, PhD, FACS ,&nbsp;Brian Dixon PhD, MPA ,&nbsp;Malaz Boustani MD, MPH ,&nbsp;Zina Ben Miled PhD ,&nbsp;Ping Zhang PhD ,&nbsp;Andrew A. Gonzalez MD, JD, MPH, FACS","doi":"10.1016/j.jss.2024.09.062","DOIUrl":"10.1016/j.jss.2024.09.062","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Peripheral arterial disease (PAD) is the leading cause of amputation in the United States. Despite affecting 8.5 million Americans and more than 200 million people globally, there are significant gaps in awareness by both patients and providers. Ongoing efforts to raise PAD awareness among both the public and health-care professionals have not met widespread success. Thus, there is a need for alternative methods for identifying PAD patients. One potentially promising strategy leverages natural language processing (NLP) to digitally screen patients for PAD. Prior approaches have applied keyword search (KWS) to billing codes or unstructured clinical narratives to identify patients with PAD. However, KWS is limited by its lack of flexibility, the need for manual algorithm development, inconsistent validation, and an inherent failure to capture patients with undiagnosed PAD. Recent advances in deep learning (DL) allow modern NLP models to learn a conceptual representation of the verbiage associated with PAD. This capability may overcome the characteristic constraints of applying strict rule-based algorithms (i.e., searching for a disease-defining set of keywords or billing codes) to real-world clinical data. Herein, we investigate the use of DL to identify patients with PAD from unstructured notes in the electronic health record (EHR).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using EHR data from a statewide health information exchange, we first created a dataset of all patients with diagnostic or procedural codes (International Classification of Diseases version 9 or 10 or Current Procedural Terminology) for PAD. This study population was then subdivided into training (70%) and testing (30%) cohorts. We based ground truth labels (PAD &lt;em&gt;versus&lt;/em&gt; no PAD) on the presence of a primary diagnostic or procedural billing code for PAD at the encounter level. We implemented our KWS-based identification strategy using the currently published state-of-the-art algorithm for identifying PAD cases from unstructured EHR data. We developed a DL model using a BioMed-RoBERTa base that was fine-tuned on the training cohort. We compared the performance of the KWS algorithm to our DL model on a binary classification task (PAD &lt;em&gt;versus&lt;/em&gt; no PAD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our study included 484,363 encounters across 71,355 patients represented in 2,268,062 notes. For the task of correctly identifying PAD related notes in our testing set, the DL outperformed KWS on all model performance measures (Sens 0.70 &lt;em&gt;versus&lt;/em&gt; 0.62; Spec 0.99 &lt;em&gt;versus&lt;/em&gt; 0.94; PPV 0.82 &lt;em&gt;versus&lt;/em&gt; 0.69; NPV 0.97 &lt;em&gt;versus&lt;/em&gt; 0.96; Accuracy 0.96 &lt;em&gt;versus&lt;/em&gt; 0.91; &lt;em&gt;P&lt;/em&gt; value for all comparisons &lt;0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our findings suggest that DL outperforms KWS for identifying PAD cases from clinical narratives. Future planned work derived from this project will develop models to stage patients based","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 699-708"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502721","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":"Can Concurrent Traumatic Hemopneumothorax be Safely Observed?","authors":"Abdul Hafiz Al Tannir, Morgan Tentis, Morgan Maring, Bryce Patin, Elise A Biesboer, Simin Golestani, Courtney J Pokrzywa, Jacob Peschman, Patrick B Murphy, Rachel S Morris, Thomas W Carver, Marc A de Moya","doi":"10.1016/j.jss.2024.09.085","DOIUrl":"https://doi.org/10.1016/j.jss.2024.09.085","url":null,"abstract":"<p><strong>Introduction: </strong>The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX).</p><p><strong>Methods: </strong>We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure.</p><p><strong>Results: </strong>A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates.</p><p><strong>Conclusions: </strong>Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Analysis of Pediatric Traumatic Duodenal Injuries","authors":"Zachary C. Ballinger MD ,&nbsp;Max D. Hazeltine MD, MSCI ,&nbsp;Alyssa Stetson MD ,&nbsp;Erin Caffrey MD ,&nbsp;Michael P. Hirsh MD ,&nbsp;Jeremy T. Aidlen MD ,&nbsp;Muriel A. Cleary MD","doi":"10.1016/j.jss.2024.09.048","DOIUrl":"10.1016/j.jss.2024.09.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic duodenal injuries can be difficult to diagnose and manage due to their severity, rarity, and complexity. This study aimed to analyze demographic and clinical characteristics of children with duodenal injuries using a weighted, national database.</div></div><div><h3>Methods</h3><div>Cases of duodenal injury in patients &lt;18 y of age were identified in a cross-sectional analysis of the 2016 Kids’ Inpatient Database using International Classification of Diseases, 10^th Revision Clinical Modification codes. These were compared to all other trauma hospitalizations age &lt;18 y old through multivariable logistic regression to determine odds of hospitalization for duodenal injuries. Secondary analysis was performed on patients with nonaccidental trauma (NAT).</div></div><div><h3>Results</h3><div>Duodenal injury patients (<em>n</em> = 237) were frequently older, male, or victims of NAT. They had a higher injury severity score, and longer length of stay. The most common mechanism was motor vehicle collision. Patients with duodenal injuries more often had concomitant lung, liver, pancreas, and large bowel injuries. They more frequently underwent laparotomy, large bowel resection, required parenteral nutrition, and received more blood transfusions. NAT subanalysis demonstrated that as compared to non-NAT duodenal injuries, those with duodenal injuries due to NAT were younger, more often in the Northeast, and more often had government insurance. Multivariable logistic regression demonstrated increased odds of hospitalization of duodenal injury for males as compared to females (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI] 1.31-2.67), older age (aOR 1.04, 95% CI 1.01-1.07), and victims of NAT (aOR 4.18, 95% CI 2.19-7.97)</div></div><div><h3>Conclusions</h3><div>Pediatric duodenal injuries most commonly occur in male patients as a result of motor vehicle collisions. Duodenal injury in patients under 3 y of age should raise the index of suspicion for NAT. These injuries overall are severe, are associated with other significant injuries that require intervention, and have a longer length of stay as compared to all other trauma hospitalizations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 716-723"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502688","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":"National Trend of Surgical Stabilization of Rib Fractures: Indications, Approaches, and Disparities","authors":"Bardiya Zangbar MD,&nbsp;Aryan Rafieezadeh MD,&nbsp;Jordan Kirsch DO,&nbsp;Nicole Lin MD,&nbsp;Kartik Prabhakaran MD","doi":"10.1016/j.jss.2024.09.080","DOIUrl":"10.1016/j.jss.2024.09.080","url":null,"abstract":"<div><h3>Introduction</h3><div>Rib fractures are among the most frequent injuries in trauma. This study aims to assess the current nationwide trends in operative rib fixation and identify predictors of surgical stabilization of rib fractures (SSRFs).</div></div><div><h3>Methods</h3><div>A 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program database was performed. Adult trauma patients who had at least one rib fracture were included. We analyzed data regarding type of SSRF including open and thoracoscopic approaches and its trends.</div></div><div><h3>Results</h3><div>A total of 780,275 patients were identified, of which 15,339 patients (1.9%) were managed with SSRF. Trends of both open and endoscopic approaches were increasing during the study period. Patients with ≤2 rib fractures had a decreasing rate of SSRF. Flail chest (odds ratio = 13.42, <em>P</em> &lt; 0.001) was the strongest predictor of SSRF.</div></div><div><h3>Conclusions</h3><div>SSRF is gaining popularity in the management of chest trauma. The presence of a flail segment and multiplicity of rib fractures is among the predictors of SSRF.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 691-698"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502713","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 Comparative Analysis of Zip Code Discordance in Pediatric Gunshot Wounds","authors":"Selby White MS ,&nbsp;Rebecca Moreci MD, MS ,&nbsp;Megan Vasterling BS ,&nbsp;Alison A. Smith MD, PhD ,&nbsp;Jessica A. Zagory MD","doi":"10.1016/j.jss.2024.09.054","DOIUrl":"10.1016/j.jss.2024.09.054","url":null,"abstract":"<div><h3>Introduction</h3><div>With the rate of pediatric gun violence rising, it is imperative to investigate current trauma intervention strategies. For example, previous trauma studies have used zip codes of residence as a proxy for the zip code of injury. This study aims to look at relationships between zip codes of injury and residence specifically in pediatric patients with gunshot wounds.</div></div><div><h3>Methods</h3><div>A retrospective review was performed on two trauma registries: one children's hospital and one primary adult hospital in an urban city. Pediatric patients &lt;15 y old with a gunshot wound from January 2016 to April 2023 were included. Zip code discordance (ZCD) was defined as the patient's zip code of injury differing from their zip code of residence; associations between ZCD and clinical variables were analyzed.</div></div><div><h3>Results</h3><div>Of the 238 patients included in this study, ZCD was observed in 40.3% of patients. Overall, there was a predominance of non-Hispanic, Black males; however, there were significantly more Black patients with ZCD (92.7% <em>versus</em> 79.6%, <em>P</em> = 0.02). Adjusted analysis revealed that ZCD was associated with a longer hospital length of stay (odds ratio 1.41, 95% confidence interval 1.19-1.67, <em>P</em> &lt; 0.01) and a higher likelihood of mortality (odds ratio 6.79, 95% confidence interval 2.39-23.1, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>These findings reveal differences between pediatric patients with and without ZCD, emphasizing the importance of accurate zip code reporting. Future studies should investigate why the associations between ZCD and clinical outcomes occurred.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 724-730"},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502687","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":"In-Hospital Drug Use Affects a Broad Patient Population and the Health Care System","authors":"Kendra M. Black MD, MA ,&nbsp;Lisa M. Kurth MD ,&nbsp;Allyson M. Hynes MD, FAAEM, FACEP ,&nbsp;Jay J. Doucet MD ,&nbsp;Jessica L. Weaver MD, PhD","doi":"10.1016/j.jss.2024.09.077","DOIUrl":"10.1016/j.jss.2024.09.077","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who suffer from addiction sometimes take illicit substances while in the hospital (in-hospital drug use [IHDU]), which can lead to unnecessary work-up and preventable treatments when symptoms develop. The purpose of this study was to define the frequency and scope of this problem, who it affects, and its impact on the medical system.</div></div><div><h3>Methods</h3><div>We reviewed all incident reports from our large, urban level 1 trauma center that involved a patient being found with illicit substances in the hospital between January 2020 and January 2023. Reports were included if patients were witnessed taking the illicit substance or if they admitted to taking one in the hospital. Individual medical charts were then reviewed to determine the details of the incident and the response of the medical team.</div></div><div><h3>Results</h3><div>Thirty-one incidents meeting the inclusion criteria were found. Of the patients involved, 74.2% were male and ranged in age from 21 to 82 years old. The admitting services included internal or family medicine (48.4%), trauma (32.3%), surgical intensive care unit (ICU) (6.5%), medical ICU (6.5%), obstetrics and gynecology (3.2%), and plastic surgery (3.2%). Interventions ranged from no intervention to transfer to the ICU and intubation. 29.0% had visitors immediately prior to the incident, which may be how the substances were obtained. 16.1% left against medical advice after having their drugs confiscated.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that a broad range of patients are at risk for IHDU, and that IHDU can lead to medical complications, additional medical expense, or patients at risk of incomplete care due to leaving against medical advice. Future work is necessary to understand patient outcomes and financial implications of IHDU, as well as to develop tools to identify those patients most at risk.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 679-684"},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502710","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}