Journal of Surgical Research最新文献

{"title":"Ischemia-Modified Albumin and Oxidative Stress Marker in Acute Appendicitis: A Prospective Study","authors":"Ozan Caliskan MD ,&nbsp;Beyza Nur Ozkan MD ,&nbsp;Mehmet Taner Unlu MD ,&nbsp;Nurcihan Aygun MD ,&nbsp;Eray Metin Guler MD ,&nbsp;Mehmet Uludag MD","doi":"10.1016/j.jss.2025.03.070","DOIUrl":"10.1016/j.jss.2025.03.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute appendicitis is a common surgical emergency in childhood and adulthood. However, perforated appendicitis is a condition that requires early diagnosis and treatment due to the increased risk of complications. In our study, we aimed to evaluate the clinical values of various biochemical, hematological, and inflammatory parameters in order to distinguish acute appendicitis from perforated appendicitis.</div></div><div><h3>Materials and methods</h3><div>A total of 87 participants aged 18-65 y were enrolled in this prospective study. 29 patients with acute appendicitis, 29 patients with perforated appendicitis, and 29 healthy controls were included. Serum urea, creatinine, lactate dehydrogenase, and C-reactive protein concentrations were measured using an automated analyser, and whole blood parameters were measured using a haematological analyser. Total antioxidant status, total oxidant status, total thiol (TT), and native thiol (NT) levels were measured photometrically. Oxidative stress index and disulfide (DIS) level were calculated mathematically. Interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and ischemia-modified albumin (IMA) levels were measured photometrically using commercially purchased kits.</div></div><div><h3>Results</h3><div>The elevated levels of urea, lactate dehydrogenase, C-reactive protein, white blood cell, and platelet count in the acute and perforated appendicitis groups compared to controls, significantly (<em>P</em> &lt; 0.001). Oxidative stress markers (total oxidant status, oxidative stress index, DIS, DIS/TT, DIS/NT, and IMA) were higher, while antioxidant markers (total antioxidant status, TT, NT, and NT/TT) were lower in the appendicitis groups (<em>P</em> &lt; 0.001). Additionally, inflammatory markers IL-1β, IL-6, and tumor necrosis factor-α were elevated, particularly in the perforated appendicitis group (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>IMA is a promising biomarker for distinguishing perforated appendicitis from acute appendicitis. Its role, in conjunction with other oxidative stress and inflammatory markers, may enhance diagnostic precision and aid clinicians in timely intervention, potentially reducing complications associated with delayed or missed diagnoses. Further studies are warranted to validate these findings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 23-30"},"PeriodicalIF":1.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069673","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":"Leveraging American Society of Anesthesiologists Physical Status Classification and Surgeon Risk Estimates to Stratify Surgical Risk: A Prospective Observational Study","authors":"Margaret T. Berrigan MD, MS ,&nbsp;Brendin R. Beaulieu-Jones MD, MBA, MBI ,&nbsp;Jayson S. Marwaha MD, MBI ,&nbsp;Stephen R. Odom MD, FACS ,&nbsp;Alok Gupta MD, FACS ,&nbsp;Charles S. Parsons MD, FACS ,&nbsp;Anupamaa J. Seshadri MD, FACS ,&nbsp;Charles H. Cook MD, FACS ,&nbsp;Gabriel A. Brat MD, MPH, FACS","doi":"10.1016/j.jss.2025.03.067","DOIUrl":"10.1016/j.jss.2025.03.067","url":null,"abstract":"<div><h3>Introduction</h3><div>The American Society of Anesthesiologists Physical Status Classification (ASA PS class) is generated by the anesthesiologist before surgery. It is correlated with postoperative complications but does not integrate surgery-specific considerations or intraoperative events. We sought to combine ASA PS class with surgeon-generated risk estimates to create an easily deployed and accurate postsurgical risk stratification tool.</div></div><div><h3>Methods</h3><div>Surgeons at one academic center were surveyed before surgery to evaluate perceived risk of postsurgery complications. ASA PS class, presurgery clinical features, and clinical postsurgery outcomes were abstracted from an institutional database and the electronic health record. Binomial regression models predicting overall 30-d morbidity were trained using presurgery clinical features, ASA PS class, and surgeon risk estimates, alone and in combination.</div></div><div><h3>Results</h3><div>Surgeon risk estimates were collected from 11 surgeons for 286 patients undergoing 68 procedure types. One hundred seventy-five (61.89%) patients had ASA PS class 3 or higher. One hundred twenty (41.96%) patients were estimated to be at higher than average risk before surgery. The overall complication rate was 27.27%. ASA PS class and surgeon risk estimates predicted surgery complication with area under the receiver operating characteristic curve (AUC) 0.79 (95% confidence interval [CI] 0.71-0.86) and AUC 0.71 (95% CI 0.63-0.78), respectively. Combining ASA PS class and the surgeon risk estimate resulted in model discrimination (AUC 0.84, 95% CI 0.78-0.89) similar to that of a clinical data–based model (AUC 0.84, 95% CI 0.78-0.88). Subgroup analysis showed that attending surgeons are better able to predict postsurgery complications than senior trainees; risk estimates from both groups were improved by combination with the ASA PS class.</div></div><div><h3>Conclusions</h3><div>ASA PS class and surgeon risk estimates are independently predictive of overall 30-d morbidity. Taken together, these assessments resulted in improved anticipation of postsurgery complications with model discrimination on par with a traditional clinical data–based model. Judgment-derived assessments alone can be used to accurately predict a patient's postsurgery risk. Future research should identify scenarios where clinician judgment is especially valuable for postsurgery risk stratification and how to best integrate clinician judgment with risk stratification systems to encourage routine use of these tools and promote optimal postsurgery management.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 323-330"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949086","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":"Derivation of FAST CLOTS: A Multivariable Risk Assessment Model for Postoperative Venous Thromboembolism","authors":"Eli Mlaver MD, MSc ,&nbsp;Jyotirmay Sharma MD ,&nbsp;Elizabeth M. Hechenbleikner MD ,&nbsp;Jordan A. Kempker MD, MSc","doi":"10.1016/j.jss.2025.03.069","DOIUrl":"10.1016/j.jss.2025.03.069","url":null,"abstract":"<div><h3>Introduction</h3><div>Venous thromboembolism (VTE) remains a leading preventable cause of postoperative morbidity and mortality in part due to failure of consistent, standardized risk assessment. Available risk assessment models (RAMs) are burdensome and lack procedural specificity or actionable thresholds for intervention. A parsimonious, clinically oriented VTE RAM has the potential to increase adherence to risk assessment.</div></div><div><h3>Methods</h3><div>We applied multivariable logistic regression modeling with a clinically guided forward selection process to the 2019 National Surgical Quality Improvement Project public user file. Considered predictors included patient demographics, comorbidities, and elements of the preoperative assessment. Procedural specificity was introduced by grouping Current Procedural Terminology codes and capturing minimally invasive techniques. Model performance was internally compared to three currently available RAMs: the Caprini score, cancer, old age, BMI, race, ASA model, and American College of Surgeons risk calculator.</div></div><div><h3>Results</h3><div>VTE occurred in 8161 (0.76%) of 1,079,441 patients. The following eleven variables were chosen for model inclusion: age, body mass index, functional status, American Society of Anesthesiologists Physical Status classification; history of steroid use, ascites, or cancer; preoperative sepsis or blood transfusion; and Current Procedural Terminology group and minimally invasive surgery. The new FAST CLOTS model has a c-statistic of 0.753 and an 89% sensitivity for VTE outcomes at the chosen cut-off of 6 out of a maximum possible total of 24 points.</div></div><div><h3>Conclusions</h3><div>As it was derived with an emphasis on biological plausibility and face validity to clinicians, the FAST CLOTS model addresses many of the limitations of currently available RAMs. If further validated and refined, adoption may improve care quality and patient outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 362-372"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948686","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":"Evaluating Outcomes in Adolescents With Pilonidal Disease Treated With Pilonidal Sinus Trephination","authors":"Katherine C. Bergus MD, MPH ,&nbsp;Carley Lutz BS ,&nbsp;Josh Bricker PhD ,&nbsp;Lindsey Asti PhD, MPH ,&nbsp;Kyle J. Van Arendonk MD, PhD ,&nbsp;Cory N. Criss MD ,&nbsp;Katherine J. Deans MD, MHSc ,&nbsp;Peter C. Minneci MD, MHSc","doi":"10.1016/j.jss.2025.04.010","DOIUrl":"10.1016/j.jss.2025.04.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Pilonidal disease is a common chronic infectious process caused by entrapment of hair follicles in the gluteal cleft that can be managed with conservative therapies or operative intervention, including pilonidal sinus trephination. While trephination has been found to be safe and effective in adults, outcomes in adolescents are limited. This study investigated wound healing and 1-y disease recurrence in adolescents after trephination.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022. Patient demographics, treatment history, operative management, and clinical outcomes up to 12 mo postoperatively were collected. We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo.</div></div><div><h3>Results</h3><div>Among 63 patients, the median age at the time of index operation was 16.5 y. Most patients were male (52.4%), and most were White (73.0%). At the time of initial clinic intake, all patients had a current or prior chronic gluteal cleft fistula and/or pilonidal sinus, and 93.7% had experienced ≥1 flare of pilonidal disease. Patients more commonly underwent trephination for a chronic wound than active disease (81.0% <em>versus</em> 19.0%). Nearly half of patients had at least one fistula present (49.2%) and a median of three pits. Wound healing was delayed in 20.5% and was associated with non-White race (odds ratio 7.31, 95% confidence interval 1.68, 31.85) but not Fitzpatrick skin type (<em>P</em> = 0.29) in univariable analysis. Recurrence at 1 y was 25.0% and was also associated with non-White race (odds ratio 8.85, 95% confidence interval 2.02, 38.71) but not Fitzpatrick skin type (<em>P</em> = 0.10) in univariable analysis.</div></div><div><h3>Conclusions</h3><div>Pilonidal sinus trephination may be an appropriate surgical option for select adolescents with chronic, fistulous pilonidal disease. Further research is needed to determine if race and ethnicity are associated with healing complications and recurrence of pilonidal disease.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 331-339"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949085","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":"Association of Body Mass Index With Severe Sepsis Outcomes in Critically-Ill Severely Injured Adult Trauma Patients: A National Analysis","authors":"Sanjan Kumar BS ,&nbsp;Hazem Nasef BS ,&nbsp;Zackary Yates BS ,&nbsp;Nickolas Hernandez BS ,&nbsp;Brian Chin BS ,&nbsp;Logan Rogers BS ,&nbsp;Sarthak Kumar BS ,&nbsp;Tracy Zito MD, FACS ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2025.04.006","DOIUrl":"10.1016/j.jss.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study is to evaluate clinical outcomes of critically-ill adult trauma patients with severe sepsis and severe injuries by body mass index (BMI) classification.</div></div><div><h3>Methods</h3><div>This retrospective study utilized the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2021 to evaluate the relationship between BMI and severe sepsis outcomes. Patients included in this study included critically-ill adult (age ≥18 ys) trauma patients with severe injuries (injury severity score [ISS] ≥15) and a diagnosis of severe sepsis. The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit length-of-stay, ventilation-free-days, and complications, including acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, ventilator-associated pneumonia, and acute kidney injury.</div></div><div><h3>Results</h3><div>There were a total of 3268 patients included in this analysis. There was no significant association between obesity and odds of in-hospital mortality (odds ratio [OR]: 0.811, 95% confidence interval [CI]: 0.410-1.601, <em>P</em> = 0.545), intensive care unit length-of-stay (B = 5.114, 95% CI: −4.041-14.328, <em>P</em> = 0.268), ventilation-free-days (B = −0.280, 95% CI: −8.558-7.999, <em>P</em> = 0.946), deep vein thrombosis (OR: 1.625, 95% CI: 0.368-7.174, <em>P</em> = 0.522), pulmonary embolism (OR: 5.4 × 10ˆ14, 95% CI: 0.000-N/A, <em>P</em> = 0.992), acute respiratory distress syndrome (OR: 1.858, 95% CI: 0.668-5.179, <em>P</em> = 0.235), ventilator-associated pneumonia (OR: 0.809, 95% CI: 0.312-2.099, <em>P</em> = 0.664), or acute kidney injury (OR: 0.984, 95% CI: 0.449-2.154, <em>P</em> = 0.967) when compared to being normal weight. There was also no significant association between the remaining BMI classifications and all study outcomes.</div></div><div><h3>Conclusions</h3><div>Obesity had no association with outcomes of severely injured critically ill adult trauma patients with severe sepsis as demonstrated through comparable clinical outcomes between study populations regardless of BMI classification.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 353-361"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948685","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":"Low-Cost, High-Fidelity Skin and Intestine Surrogates for Surgical Training","authors":"Oliver Giraldo-Londoño PhD ,&nbsp;Chadwick Bettale BS ,&nbsp;Kyle Martinez BS ,&nbsp;Milot Thaqi MD ,&nbsp;Andrew Wheeler MD","doi":"10.1016/j.jss.2025.03.068","DOIUrl":"10.1016/j.jss.2025.03.068","url":null,"abstract":"<div><h3>Introduction</h3><div>Organ surrogates play a pivotal role in training surgical residents, offering a safe and cost-effective alternative to live human patients or animals. However, existing surrogates often fall short, either due to their high cost or inability to accurately replicate the mechanical behavior and anatomical complexity of human tissue. This study aims to address these limitations by developing affordable, realistic, and biomechanically accurate organ surrogates tailored for surgical training.</div></div><div><h3>Materials and Methods</h3><div>Our methods involve 3D printing customized molds for pour casting, injection molding, and rotational molding, employing off-the-shelf platinum-cure silicone rubbers and specially formulated silicone-based blends as base materials. This approach ensures cost-effectiveness and allows utilizing commercially available materials and accessible laboratory equipment, enabling low-cost in-house fabrication of multi-layered skin and intestine surrogates for surgical training.</div></div><div><h3>Results</h3><div>Feedback received from surgical residents and surgeons at the University of Missouri School of Medicine indicates that our surrogates consistently outperform industry-standard models in terms of biomechanical accuracy. Moreover, our cost analysis revealed that our fabrication methods yield surrogates that are over 90% less expensive than commercial alternatives.</div></div><div><h3>Conclusions</h3><div>The skin and intestine surrogates developed in this study demonstrate the feasibility of creating affordable, high-fidelity surgical training models using accessible materials and established fabrication techniques. By addressing the limitations of existing surrogates, this work lays the foundation for developing a broader range of anatomical models. These advances have the potential to improve the effectiveness and accessibility of surgical training.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 8-22"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946654","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":"Association of Trainee Gender With Critically-Ill Trauma Patient Outcomes","authors":"Nicole B. Lyons MD,&nbsp;Luciana Tito Bustillos MD,&nbsp;Brianna L. Collie MD,&nbsp;Akki Gunda BA,&nbsp;Victoria DeTrolio BS,&nbsp;Christopher F. O'Neil MD,&nbsp;Walter A. Ramsey MD,&nbsp;Enrique Ginzburg MD,&nbsp;Nicholas Namias MD, MBA,&nbsp;Carl I. Schulman MD, PhD, MSPH,&nbsp;Joyce I. Kaufman MD","doi":"10.1016/j.jss.2025.04.004","DOIUrl":"10.1016/j.jss.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent research has shown that female attending surgeons have slightly better outcomes than male attending surgeons. We aimed to evaluate if this gender difference extends to trainees caring for critically-ill trauma patients.</div></div><div><h3>Methods</h3><div>The trauma registry at a level 1 academic trauma center was reviewed from October 2015 to December 2021. All patients admitted with an injury severity score ≥25 were included. The trauma team members for each patient were determined by the past resident and fellow call schedules. Teams with two female (female/female) or two male (male/male) trainees were included in the analysis. Primary outcome was mortality. Secondary outcomes included hospital and intensive care unit length of stay, return to intensive care unit, readmission, infectious complications, and venous thromboembolism.</div></div><div><h3>Results</h3><div>1909 patients met inclusion criteria; of which, 625 were on an FF or MM team. Median age was 37 y and 80% were male. The mortality on female/female teams was 22.7%, compared to 25.5% on male/male teams, <em>P</em> = 0.496. There were also no differences between teams for any of the secondary outcomes.</div></div><div><h3>Conclusions</h3><div>There was no statistically significant difference in mortality rates for severely injured trauma patients based on whether the trainees on their team were men or women. As gender discrimination still exists in the field of surgery, studies like this that demonstrate similar or better outcomes for female surgeons can help to dissipate bias.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"311 ","pages":"Pages 1-7"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946655","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":"Prognostic Implications of Node Status in Colon Adenocarcinoma With Synchronous Liver Metastasis","authors":"Marc M. Mankarious MD ,&nbsp;Austin C. Portolese MD ,&nbsp;Maude Trepanier MD ,&nbsp;Chan Shen PhD ,&nbsp;Michael J. Deutsch MD ,&nbsp;Jeffrey S. Scow MD ,&nbsp;Audrey S. Kulaylat MD ,&nbsp;Nimalan A. Jeganathan MD","doi":"10.1016/j.jss.2025.04.007","DOIUrl":"10.1016/j.jss.2025.04.007","url":null,"abstract":"<div><h3>Introduction</h3><div>In patients with metastatic colon cancer undergoing curative resection, lymph node status does not change management or staging as per current guidelines. The aim of this project is to assess the prognostic value of lymph node status and yield in clinical stage IV-A colon adenocarcinoma undergoing curative resection.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study from the National Cancer Database from 2010 to 2018 that examines adults with colon adenocarcinoma with synchronous liver metastasis who underwent primary colectomy, hepatic metastasectomy, and systemic therapy. Survival analysis of subgroups with node-positive and node-negative was performed by Kaplan–Meier analysis and the Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Of 2071 patients with clinical stage IV-A colon adenocarcinoma, 25.6% had negative lymph nodes (N-LNs). Patients with N-LNs had higher median survival compared to patients with positive lymph nodes (62.03 <em>versus</em> 48.69 mo, <em>P</em> &lt; 0.001) and lower mortality risk (hazard ratio 0.75, <em>P</em> &lt; 0.001). Resection of ≥12 lymph nodes was associated with longer median survival compared to patients with &lt;12 lymph nodes in patients with positive lymph nodes (49.64 <em>versus</em> 28.09 mo, <em>P</em> &lt; 0.001) but not in patients with N-LNs (63.01 <em>versus</em> 55.46 mo, <em>P</em> = 0.09). This relationship remained regardless of chemotherapy sequence.</div></div><div><h3>Conclusions</h3><div>In the setting of hepatic metastases in clinical stage IV colon adenocarcinoma, lymph node status is prognostic as N-LNs are associated with increased overall survival. Further research is necessary to delineate underlying differences in tumor biology and to help predict nodal status preoperatively.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 340-352"},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948684","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":"Causation Not Correlation: Simple Mediation Analysis of Amputation Costs","authors":"Johnathan V. Torikashvili BS ,&nbsp;Meagan D. Read MD ,&nbsp;Rajavi Parikh DO ,&nbsp;Tyler Zander MD ,&nbsp;Melissa Kendall MD ,&nbsp;Emily A. Grimsley MD ,&nbsp;Paul C. Kuo MD, MS, MBA, FACS","doi":"10.1016/j.jss.2025.04.008","DOIUrl":"10.1016/j.jss.2025.04.008","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic significantly impacted health-care delivery and hospital financials. This study aims to identify the pandemic's effects on costs associated with nonelective major lower extremity amputation (LEA) and mediating factors influencing this cost.</div></div><div><h3>Methods</h3><div>The 2019-2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent nonelective LEA. Patient inflation-adjusted costs were collected. Florida COVID-19 mortality rates established 9-month COVID-heavy (CH) and COVID-light (CL) timeframes, compared to a 9-month pre-COVID (PC; 2019) timeframe. Simple mediation analysis with 2000 bootstrapping interactions evaluated patient comorbidity, surgical complications, and hospital treatment factors as potential mediators on cost.</div></div><div><h3>Results</h3><div>A total of 5963 patients were included (1957 PC, 1994 CH, 2012 CL). Compared to PC, COVID timeframes had significantly increased total (+7.8%), hospital (+14.5%), intensive care unit (+14.3%), and operating room (+14.9%) costs. Simple mediation analysis identified potential influencers of increased cost: (1) acute kidney injury during CL (<em>P</em> = 0.03), (2) sepsis during CL (<em>P</em> = 0.02), and (3) electrolyte/acid-base disorders during CH and CL (<em>P</em> &lt; 0.01). Sensitivity analysis (E-values) could not exclude unmeasured confounding from the model findings.</div></div><div><h3>Conclusions</h3><div>The COVID-19 pandemic led to substantial cost increases associated with nonelective major LEAs, but simple mediation analysis did not identify sensitive mediators to cost. This suggests systemic factors, such as supply chain disruptions and staffing shortages, may warrant investigation. The pandemic highlighted the need for resilient health-care systems that can address both acute and chronic care needs while mitigating inequities exacerbated by crises.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"310 ","pages":"Pages 315-322"},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949087","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":"Corrigendum to 'Incidental Thyroid Cancer in Patients With Graves' Disease: Not as Rare as We Previously Believed' [Journal of Surgical Research volume 308 (2025) 122-128].","authors":"Shaidy Moronta, Lauren Slattery, Rongzhi Wang, Fiemu Nwariaku, Jessica Liu McMullin","doi":"10.1016/j.jss.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.jss.2025.04.013","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078699","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}