Journal of Surgical Research最新文献

{"title":"Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends","authors":"Nina D. Kosciuszek DO, MS , Michael Froehlich MD , Robert P. Moore MD , Maroun Yammine MD , Stephanie C. Cardamone MD , David A. Chesler MD , James M. Barsi MD , Jaime P. Doody MD , Alvin Wong MD , Michael L. Ernst MD , Richard J. Scriven MD , Kristen A. Calabro MD , Kenneth W. Gow MD, MHA","doi":"10.1016/j.jss.2025.06.094","DOIUrl":"10.1016/j.jss.2025.06.094","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical specialization is critical in medical training, with fellowships as key pathways for career advancement and shaping the pediatric surgical workforce. Given the surgical condition and procedural overlap between subspecialties, skills often complement each other to enhance comprehensive pediatric care. This study examines the balance of supply and demand across pediatric surgical fellowship positions, evaluating trends in individual fields and their collective impact on pediatric surgical care.</div></div><div><h3>Methods</h3><div>We analyzed available fellowship match data from 2004 to 2024 across nine pediatric subspecialties: anesthesiology, cardiac surgery, general surgery, gynecology, neurosurgery, orthopedics, otolaryngology, plastic surgery, and urology. Data were obtained from the National Resident Matching Program, San Francisco Match, and the Pediatric Orthopedic Society of North America. Applicant-to-position ratios were calculated, with 1 indicating balance, >1 reflecting higher demand, and <1 indicating lower demand. Statistical analysis was performed using least squares regression and ANOVA in SPSS (IBM SPSS Statistics, Version 29.0.2.0 (IBM Corp, Armonk, NY)). Data are expressed as mean ± standard deviation, where applicable.</div></div><div><h3>Results</h3><div>Nine subspecialties were assessed. Higher demand was found for available positions in pediatric general surgery (1.80 ± 0.23), gynecology (1.35 ± 0.21), and cardiac surgery (1.21 ± 0.46). Specialties with lower demand included urology (0.81 ± 0.08), plastic surgery (0.88 ± 0.13), anesthesiology (0.92 ± 0.20), otolaryngology (0.95 ± 0.14), and neurosurgery (0.96 ± 0.20). An analysis of trends revealed that all specialties experienced a decline in the ratio of applicants to available positions, except for orthopedics, which saw significant decreases in the ratios for anesthesiology, general surgery, and plastic surgery. The average number of unfilled fellowship positions was most notable for anesthesiology (35.2 ± 19.5), orthopedics (16.4 ± 5.5), and otolaryngology (11.2 ± 4.7). The percentage of unfilled positions was notably high for urology (31.9% ± 8.8%), plastic surgery (27.6% ± 11.6%), and otolaryngology (24.0% ± 9.4%).</div></div><div><h3>Conclusions</h3><div>The findings suggest that pediatric general surgery, gynecology, and cardiac surgery continue to attract strong interest, while anesthesiology, orthopedics, otolaryngology, plastic surgery, and urology are seeing fewer applicants than available positions. What is most concerning, however, is that almost all fields have witnessed a decline in interest over time. If it continues, this trend portends poorly for the future of pediatric surgical care, as an imbalance between the decreasing supply of specialists and the growing demand for specialized care could lead to gaps in patient services. Addressing these imbalances is crucial to sustaining a well-rounded, highly qualifi","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 200-212"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958490","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":"Preoperative Glucagon-like Peptide-1 Therapy in Bariatric Surgery Patients with Morbid Obesity (PreMO): Rationale and Study Design for a Randomized Controlled Trial","authors":"Varun Jain MD ,&nbsp;Colleen A. McMullen MA, MBA ,&nbsp;Joy I. Kimbrough BSN, MBA ,&nbsp;Anna K. Rockich PharmD, MS ,&nbsp;Daniel L. Davenport PhD ,&nbsp;Gregory S. Hawk PhD ,&nbsp;Barbara S. Nikolajczyk PhD ,&nbsp;Philip A. Kern MD ,&nbsp;Simon J. Fisher MD, PhD ,&nbsp;Joshua P. Steiner MD ,&nbsp;William B. Inabnet III MD, MHA ,&nbsp;Marlene E. Starr PhD","doi":"10.1016/j.jss.2026.01.004","DOIUrl":"10.1016/j.jss.2026.01.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Bariatric surgery is the most effective treatment modality for individuals with morbid obesity, providing significant and durable weight loss and comorbidity resolution. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide receptor agonists have shown promise as weight loss drugs, in addition to their use in the treatment of metabolic disorders. While multimodal weight management is the standard of care for individuals with morbid obesity, the benefit of antecedent GLP-1 therapy prior to bariatric surgery has not been well-studied. The objective of this study is to conduct a clinical trial testing the hypothesis that preoperative treatment with a dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonist enhances preoperative weight loss and decreases tissue inflammation, resulting in improved postoperative outcomes.</div></div><div><h3>Materials and methods</h3><div>We designed a randomized controlled trial (RCT) comparing preoperative treatment with tirzepatide <em>versus</em> standard medical care prior to minimally invasive bariatric surgery with a target enrollment of 50 patients randomized 1:1. For 3 mo preoperatively, the control arm will receive standard care in the form of dietary and lifestyle modification recommendations, whereas the treatment arm will receive weekly tirzepatide, in addition to standard care. Blood will be collected at enrollment through 12-mo postoperatively and analyzed for inflammatory and metabolic markers. Tissues (adipose, stomach, and liver) will be collected intraoperatively for transcriptome profiling and histological assessment.</div></div><div><h3>Results</h3><div>This is an ongoing trial with no reportable results.</div></div><div><h3>Conclusion</h3><div>Completion of this pilot RCT will provide data to support initiation of a multicenter RCT to determine therapeutic efficacy, and mechanisms of action, by which patients could benefit from preoperative treatment with tirzepatide.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 58-65"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125415","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":"Surgeon Perspectives on Decisional Antecedents in Preoperative Decision-Making","authors":"Elizabeth Palmer Kelly PhD ,&nbsp;Julia McGee BS ,&nbsp;Celia E. Wills PhD, RN ,&nbsp;Robert Strouse MFA ,&nbsp;Tanya R. Gure MD ,&nbsp;Maryanna Klatt PhD ,&nbsp;Timothy M. Pawlik MD, MPH, MTS, PhD, MBA","doi":"10.1016/j.jss.2026.01.009","DOIUrl":"10.1016/j.jss.2026.01.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Shared decision-making (SDM) is widely endorsed in surgical care, yet it is inconsistently applied. A lack of attention to decisional antecedents, including patients’ beliefs, goals, experiences, emotions, and social context, may contribute to this gap, particularly in time-constrained preoperative settings. The current study sought to characterize surgeon perspectives on decisional antecedents and identify opportunities to strengthen SDM within routine surgical workflows.</div></div><div><h3>Methods</h3><div>In-depth, semistructured interviews were conducted with surgeons at a single academic medical center. Surgeons were identified through departmental faculty lists and invited by email. Interviews were conducted via Zoom, transcribed verbatim, and analyzed thematically in NVivo using an inductive approach. Two team members independently coded transcripts and developed themes through iterative discussion.</div></div><div><h3>Results</h3><div>Eighteen surgeons from six subspecialties participated. Five themes characterized how surgeons approached SDM in preoperative consultations: (1) variability in patient engagement, (2) role of decisional antecedents, (3) time and cognitive constraints, (4) value of pre-encounter context, and (5) third parties reveal patient values. Surgeons reported that patients differ widely in their readiness, informational needs, prior experiences, and desired involvement, yet this information was often not available to them because routine workflows provided few opportunities to uncover it. Surgeons viewed decisional antecedents and third-party perspectives (e.g., family, caregivers) as central to SDM but reported structural barriers to incorporate these factors during time-limited consultations.</div></div><div><h3>Conclusions</h3><div>Pre-visit strategies are needed to surface key contextual factors to support SDM within existing surgical workflows.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 134-140"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165820","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":"Survival of Patients With Noncolorectal Non-Neuroendocrine Liver Metastases: A Nationwide Cohort Study From the Danish Liver Cancer Group","authors":"Lauge Hjorth Mikkelsen MD, PhD ,&nbsp;Peter Nørgaard Larsen MD ,&nbsp;Lucas Alexander Knøfler MD ,&nbsp;Torsten Pless MD ,&nbsp;Anders Riegels Knudsen MD, PhD ,&nbsp;Susanne Dam Nielsen MD, DMSc ,&nbsp;Mette Lise Lousdal PhD ,&nbsp;Morten Ladekarl MD, DMSc ,&nbsp;Mogens Stender MD, PhD ,&nbsp;Hans-Christian Pommergaard MD, PhD, DMSc","doi":"10.1016/j.jss.2026.01.006","DOIUrl":"10.1016/j.jss.2026.01.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical treatment of noncolorectal, non-neuroendocrine liver metastases (NCNNLM) remains unclear. This nationwide study evaluated the outcome of patients with NCNNLM, evaluated at multidisciplinary team conferences and included in the Danish Liver Cancer Group Database, according to surgery or no surgery.</div></div><div><h3>Methods</h3><div>We identified all patients with NCNNLM evaluated at multidisciplinary team conferences at the four specialized centers in Denmark between October 2013 and November 2023. Patient characteristics and survival were analyzed using descriptive statistics and illustrated by Kaplan–Meier curves, respectively. Prognostic factors were assessed with logistic regression, Cox regression, and accelerated failure time models.</div></div><div><h3>Results</h3><div>605 patients were included in the analyses. The median follow-up was 20 mo, none were lost to follow-up. The median age of patients was 64 y, with a female predominance (58%). Most patients (93%) had World Health Organization (WHO) performance status 0-1. The overall 5-y survival rate was 29%, with a median survival of 27 mo. Surgery was performed in 307 patients (51%). Surgical intervention was associated with better survival compared with nonsurgical treatment (median survival 39 <em>versus</em> 13 mo, <em>P</em> &lt; 0.05). Poor prognostic factors included age exceeding 64 y (hazard ratio = 1.022, <em>P</em> &lt; 0.0001) and WHO performance status 2-4 (odds ratio 6.89, <em>P</em> = 0.007).</div></div><div><h3>Conclusions</h3><div>NCNNLM carries a poor prognosis. Surgery of liver metastasis is associated with improved survival with age, WHO performance status, and primary cancer type serving as important prognostic factors. However, from our study we could not establish a causal effect of surgery and confounding by indication is likely.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 125-133"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165833","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":"On The Cover","authors":"","doi":"10.1016/S0022-4804(26)00072-7","DOIUrl":"10.1016/S0022-4804(26)00072-7","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Page vi"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147400649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Small Bowel Obstruction in Patients With No Prior Surgery: A Systematic Review","authors":"Kyle D. Klingbeil MD, PhD, MS ,&nbsp;Ami Hayashi MD ,&nbsp;Erik Balians BS ,&nbsp;Robert E. Johnson MLIS ,&nbsp;Edward Livingston MD, FACS","doi":"10.1016/j.jss.2026.01.018","DOIUrl":"10.1016/j.jss.2026.01.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Small bowel obstruction in patients without prior abdominal surgery (NPA-SBO) presents a diagnostic and therapeutic challenge. Although traditionally thought to require operative exploration, recent studies suggest that most patients may be managed nonoperatively.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis of studies reporting outcomes for adult patients with NPA-SBO published between 1996 and 2023. Databases were queried on September 30, 2024. The primary outcome was the proportion of patients successfully treated by nonoperative management. Secondary outcomes include complications, recurrence, rates of malignancy and adhesions. Pooled estimates were calculated using random-effects models.</div></div><div><h3>Results</h3><div>Fifteen studies encompassing 855 patients were included. Overall, 74% (95% CI, 66%-82%) of the patients were successfully managed nonoperatively. Complications occurred in 23% of the patients who underwent surgery (95% CI: 17%-28%) and in 10% of the patients who did not have surgery (95% CI: 0%-31%). Recurrence occurred in 7% for those treated without surgery (95% CI: 2%-11%). Malignancy was identified in 12% (95% CI, 6%-18%) of the cases, while adhesions accounted for 36% (95% CI, 22%-49%) of NPA-SBOs. Negative laparotomy occurred in 14% (95% CI, 8%-23%) of the patients, underscoring the diagnostic uncertainty in this population.</div></div><div><h3>Conclusions</h3><div>Approximately three of four patients with NPA-SBO can be successfully treated with nonoperative management, with low complication and recurrence rates. While surgery remains essential for selected patients, an initial trial of nonoperative therapy in appropriately selected patients is warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 185-192"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191630","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":"Quality of Life After Parathyroidectomy in Patients With End-Stage Renal Disease: A Systematic Review","authors":"Sarah Macy Lawler MD ,&nbsp;Kristen M. HoSang MD ,&nbsp;Travis Nace MSLIS ,&nbsp;Jocelynne Dorotan BA ,&nbsp;Lindsay E. Kuo MD, MBA","doi":"10.1016/j.jss.2026.01.013","DOIUrl":"10.1016/j.jss.2026.01.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), with parathyroid hormone (PTH) overproduction leading to symptoms such as bone pain, pruritus, and fatigue. These symptoms diminish the already compromised quality of life (QoL) in ESRD patients. Parathyroidectomy (PTX) is offered to those who fail medical management, but its association with QoL is not addressed in treatment guidelines. This systematic review examines QoL in SHPT patients after PTX.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from 2014 to 2024 using terms including ESRD, chronic kidney disease, QoL, PTX, and SHPT. Two reviewers screened titles, abstracts, and full texts. The primary outcome was change in QoL as assessed by validated questionnaires.</div></div><div><h3>Results</h3><div>Of 6234 articles reviewed, 10 (0.16%) studies met the inclusion criteria. There were 6 case series, 2 prospective cohort studies, 1 case control study, and 1 retrospective cohort study. Across these, 575 patients underwent PTX for symptomatic SHPT. QoL was assessed using Short-Form Health Survey (5 studies), Kidney disease quality of Life Instrument (4), parathyroidectomy assessment of symptoms(2), visual analog scale(2), and median symptom index score(1). All studies reported higher physical QoL scores after PTX compared to baseline. Improvement in mental health symptoms was variable.</div></div><div><h3>Conclusions</h3><div>PTX in patients with SHPT is associated with improved physical functioning and fewer mental health–related symptoms, with higher overall QoL. QoL and symptom burden may represent important factors in the decision to pursue surgical management for SHPT when medical management is not adequate.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 160-169"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191641","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":"Hospital Unit Variation in Pediatric Postoperative Opioid Administration Is Associated With Increased Neonatal Opioid Exposure","authors":"Kali Bravo HBS,&nbsp;Julie C. McKee RN, MS, CPNP-AC/PC,&nbsp;Russell Wells BS, MCR,&nbsp;Shawn Izadi MD, MPH,&nbsp;Benjamin Carr MD,&nbsp;Sanjay Krishnaswami MD","doi":"10.1016/j.jss.2026.01.001","DOIUrl":"10.1016/j.jss.2026.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Opioid stewardship is an important tenet of modern pediatric surgical care. However, the burden of opioid use for common surgical procedures in infants remains undefined. We aimed to compare patterns of opioid administration for a common operation between children recovering on different hospital units.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of pediatric and neonatal patients at a single children's hospital undergoing isolated laparoscopic gastrostomy tube placement from 2021 to 2023. Opioid exposure was tracked in morphine milligram equivalents per kilogram (MME/kg), intraoperatively and 48 h postoperatively.</div></div><div><h3>Results</h3><div>A total of 158 ward (aged 0-17 y, median 14 mo) and 51 neonatal intensive care unit (NICU) patients (aged 3 wk to 7 mo, median 3 mo) were included. Intraoperative MME/kg did not differ significantly between the NICU and ward (median 0.46 <em>versus</em> 0.47 MME/kg, <em>P</em> = 0.63), but the postoperative use was significantly higher in the NICU (median 0.28 <em>versus</em> 0.00 MME/kg, <em>P</em> &lt; 0.0001), as was the number of postoperative administrations (median 2 <em>versus</em> 0, <em>P</em> &lt; 0.0001) and opioid exposure time (median 10 <em>versus</em> 2 h, <em>P</em> &lt; 0.0001). Similar trends were observed on subset analysis of NICU versus ward patients ≤12 mo; the median postoperative use (0.28 <em>versus</em> 0.00 MME/kg, <em>P</em> &lt; 0.0001), median number of postoperative administrations (2 <em>versus</em> 0, <em>P</em> &lt; 0.0001), and median time to last dose (10 <em>versus</em> 2 h, <em>P</em> = 0.0002) were all significantly higher in the NICU.</div></div><div><h3>Conclusions</h3><div>NICU patients had a significantly higher postoperative opioid use than pediatric ward patients after identical surgeries. Further work is needed to identify root causes, validate findings across other procedures and institutions, optimize opioid stewardship, and limit variation across hospital units.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 24-29"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100244","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":"Rupture Predictors and Clinical Outcomes in Jejunal Artery Aneurysms: A Literature Case Series Review","authors":"Ana Maria Minaya-Bravo PhD ,&nbsp;Cristina Vera-Mansilla MD ,&nbsp;Fernando Ruiz-Grande PhD","doi":"10.1016/j.jss.2026.01.002","DOIUrl":"10.1016/j.jss.2026.01.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Jejunal artery aneurysms (JAAs) account for 1% of all visceral artery aneurysms (VAAs). Fewer than 100 cases have been reported in the English literature, rupture rates approach 60%, compared with 10%-20% for other VAAs. Their rupture risk and management remain poorly defined.</div></div><div><h3>Methods</h3><div>We reviewed the English literature from 1944 to June 2025 and identified 44 cases of JAAs with analyzable data. Primary objective was to explore predictors of rupture; secondary objective was management. Given the rarity and heterogeneity of reports, statistical analyses were exploratory. To the best of our knowledge, this is the largest series of JAAs with analyzable data reported to date.</div></div><div><h3>Results</h3><div>Overall rupture rate was 59%, most (64.7%) measured ≤10 mm and occurred in younger individuals (mean age 41.9 <em>versus</em> 57.3 ys, <em>P</em> = 0.0199). Mortality rate was 9.1% (<em>n</em> = 4), including two with connective tissue disease; 26.9% of ruptured cases had no medical history. Rupture was associated with gastrointestinal hemorrhage (<em>P</em> = 0.0019) but not with pain (<em>P</em> = 0.310). Surgical management most common was: aneurysm excision (47.7%) or bowel resection (27.3%). Embolization was performed in 7 cases, with no mortality.</div></div><div><h3>Conclusions</h3><div>Most of ruptures occurred in small aneurysms (&lt;10 mm) challenging the conventional 2 cm intervention threshold applied to other VAAs. These findings suggest that arterial wall pathology and unstable flow may contribute to rupture, independently of size. Management should be individualized incorporating patient-specific risk factors and underlying vascular vulnerability. This is consistent with the recent international Society for Vascular Surgery Clinical Practical Guidelines recommendations. Further studies are required to define risk stratification.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 77-89"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165713","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":"Gaps in the Electronic Medical Record May Contribute to Low Participation in Lung Cancer Screening","authors":"Kayla A. Fay MPH ,&nbsp;Karen E. Schifferdecker PhD, MPH ,&nbsp;Linda M. Kinney MPA ,&nbsp;Ellie J. Kyung PhD ,&nbsp;Sean R. Halloran BA ,&nbsp;Samuel Youkilis BA ,&nbsp;Shoshana H. Bardach PhD ,&nbsp;Amanda N. Perry BA ,&nbsp;Maureen B. Boardman MSN, FNP-C, FAANP ,&nbsp;Rian M. Hasson MD, MPH","doi":"10.1016/j.jss.2025.11.074","DOIUrl":"10.1016/j.jss.2025.11.074","url":null,"abstract":"<div><h3>Introduction</h3><div>Best Practice Advisories (BPAs) are electronic medical record (EMR) tools that help increase uptake of recommended health care behaviors, such as cancer screenings, by identifying eligible patients and alerting providers. However, incomplete/inaccurate documentation within the EMR can be a potential barrier to BPA utility. The purpose of this work was to investigate the effectiveness of a BPA tool to identify eligible patients for lung cancer screening (LCS) using available EMR smoking histories.</div></div><div><h3>Materials and methods</h3><div>Retrospective observational review was conducted of a BPA programmed to identify LCS-eligible patients at a single quaternary, LCS-accredited, academic medical center. Programming targeted patients aged 50-77 y classified as “current” or “former smokers,” excluding patients with recent lung computed tomography scans and/or lung cancer diagnoses. Data analyzed included frequency of BPA activation and the associated smoking history. Descriptive statistics were used to analyze outcomes.</div></div><div><h3>Results</h3><div>Between January 2017 and December 2021, there were 25,172 BPA activations, of which 11,701 were removed because they occurred outside a clinical/telehealth visit. This left 14,101 BPAs linked to 3150 patients. EMR information was not sufficient to calculate pack-year history for 48.9% (1541/3150), and the LCS order rate was 2.5% (78/3150). Although pulmonary disease specialists accounted for 13.7% (236/1721) of total LCS orders, the BPA did not activate for them.</div></div><div><h3>Conclusions</h3><div>Incomplete EMR data entry may contribute to the complexities of identifying LCS-eligible patients. This highlights the value of improving the completeness of EMR smoking history data and conducting targeted BPA audits to understand optimal activation parameters to improve clinician orders for LCS.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 40-46"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125385","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}