Journal of Surgical Research最新文献

{"title":"Steroidogenesis in Pediatric Adrenal Rests in the Spermatic Cord","authors":"Tsubasa Shironomae PhD, MD ,&nbsp;Yuto Yamazaki PhD, MD ,&nbsp;Shinako Takeda PhD, MD ,&nbsp;Keiko Ainoya PhD, MD ,&nbsp;Junji Takeyama PhD, MD ,&nbsp;Kiyohide Sakai PhD, MD ,&nbsp;Hironobu Sasano PhD, MD ,&nbsp;Takashi Suzuki PhD, MD","doi":"10.1016/j.jss.2026.01.020","DOIUrl":"10.1016/j.jss.2026.01.020","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate steroidogenesis in pediatric adrenal rests in the spermatic cord.</div></div><div><h3>Methods</h3><div>We reviewed pediatric patients who underwent surgical exploration of the inguinal and scrotal areas retrospectively. When we detected spermatic cord masses during the surgery, we resected it for pathological evaluation.</div></div><div><h3>Results</h3><div>We first reviewed clinical records of 249 surgeries in 194 male patients in the retrospective fashion and subsequently detected ten adrenal rests in nine cases. Steroid synthases, androgen receptor, Ki-67 were immunolocalized in nine cases to further explore steroidogenesis and potential effects of androgens. All adrenal rests harbored multiple zonae as in eutopic adrenal cortex with fetal adrenal cortex detected in four-fifth adrenal rests in infancy but none after infancy. Age was significantly negatively correlated with adrenocortical areas evaluated by image analysis (<em>P</em> &lt; 0.0001). Immunoreactivity of aldosterone synthase (CYP11B2), 11-beta-hydroxylase, cytochrome P450 17A1, and sulfotransferase 2A1 was diffusely detected mainly in the areas corresponding to the zona glomerulosa (ZG), the zona fasciculata (ZF), the ZF and zona reticularis, and the zona reticularis and fetal adrenal cortex-like structures, respectively. CYP11B2-positive area ratio tended to decrease from birth to early childhood but increase in prepuberty. Diffuse cytoplasmic androgen receptor immunoreactivity was detected in ZG-like cells in prepubertal specimens. Ki-67 positive cells were mainly detected in the ZG- and ZF-like cells, mostly in infancy.</div></div><div><h3>Conclusions</h3><div>Androgen-dependent aldosterone biosynthesis may differ between adrenal rests and eutopic adrenal glands, but steroidogenesis in adrenal rests in the spermatic cord is considered normal.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 117-124"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165682","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":"Decisions in Crisis: Amputation Timing and Short-Term Outcomes in Severe Blunt Lower Limb Trauma","authors":"Aryan Rafieezadeh MD,&nbsp;Kartik Prabhakaran MD,&nbsp;Rishwanth Vetri MD,&nbsp;Riddhi Mehta MBBS,&nbsp;Jordan Kirsch DO,&nbsp;Ilya Shnaydman MD,&nbsp;Joshua Klein DO,&nbsp;Gabriel Froula DO,&nbsp;Matthew Bronstein MD,&nbsp;Amanda Carlson MD,&nbsp;Aaron Zuckerman MD,&nbsp;Bardiya Zangbar MD","doi":"10.1016/j.jss.2026.01.016","DOIUrl":"10.1016/j.jss.2026.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Limb amputation is a challenging decision, and delayed procedures may be associated with higher complication rates. This study compares outcomes between early and late amputation in patients with isolated blunt severe lower limb injuries.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively reviewed the Trauma Quality Improvement Program (2017-2021), including all ages with isolated severe blunt lower limb injury (Abbreviated Injury Scale ≥ 3) who underwent amputation. Patients were stratified into early (≤48 h) and late (&gt;48 h) amputation groups. The primary outcome was mortality, while secondary outcomes included in-hospital complications, hospital and intensive care unit (ICU) length of stay, and discharge disposition. Propensity score matching was performed to compare outcomes between groups.</div></div><div><h3>Results</h3><div>Of 4439 patients included, 1959 cases (44.1%) had early amputation (mean procedure time of 1.25 ± 0.43 d), and 2480 cases (55.9%) had late amputations (mean procedure time of 10.34 ± 9.05 d). After matching (1733 per group), mortality did not differ between groups (<em>P</em> = 0.06). Patients in the early amputation group, compared to the late amputation group, had lower rates of acute kidney injury (2.3% <em>versus</em> 4.6%), osteomyelitis (0.7% <em>versus</em> 1.4%), unplanned intubation (1.2% <em>versus</em> 2.4%), unplanned ICU admission (2.8% <em>versus</em> 5.3%), unplanned return to the operation room (2.5% <em>versus</em> 7.9%), and higher rates of home discharge (30.9% <em>versus</em> 27.5%) (<em>P</em> &lt; 0.05). The hospital and ICU length of stay were significantly lower in the early amputation group compared to the late amputation group (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Early amputation in serious blunt lower limb injuries was associated with fewer observed complications, shorter hospital and ICU stays, and a higher rate of home discharge compared to late amputation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 170-177"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191640","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":"Cutting Costs, Saving Lives: A Surgeon's Guide to the Foundations of Cost-effectiveness Analysis","authors":"Yang Zhang MScPH,&nbsp;Grace E. Ratcliff MPH,&nbsp;Jinyi Zhu PhD","doi":"10.1016/j.jss.2025.12.044","DOIUrl":"10.1016/j.jss.2025.12.044","url":null,"abstract":"<div><h3>Introduction</h3><div>As surgical care faces increasing financial scrutiny, there is a growing need for clinicians to understand the economic value of interventions. Cost-effectiveness analysis (CEA) provides a structured approach to comparing clinical strategies in terms of both outcomes and costs; however, these methods remain underutilized and underappreciated in many surgical disciplines.</div></div><div><h3>Materials and Methods</h3><div>This article introduces foundational concepts in CEA, including comparative evaluation, quality-adjusted and disability-adjusted life years, cost estimation, incremental cost-effectiveness ratios, and modeling techniques such as decision trees, Markov models, and microsimulation. We also explain the role of sensitivity analyses in addressing uncertainty. Concepts are illustrated with examples relevant to surgical and policy decision-making.</div></div><div><h3>Results</h3><div>The explainer provides a structured framework for interpreting and critiquing CEAs, highlighting how model structure, perspective, and assumptions affect conclusions about value. It provides guidance for critically appraising published CEAs and understanding their implications for clinical practice, resource allocation, and guideline development.</div></div><div><h3>Conclusions</h3><div>This article serves as a practical entry point for clinicians, researchers, and decision-makers seeking to understand and apply cost-effectiveness methods. It is intended to build foundational fluency in economic evaluation and support more informed engagement with value-based care, policy design, and evidence appraisal.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 366-378"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078507","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":"Impact of Online Ergonomic Education on Musculoskeletal Disorders Among Minimally Invasive Surgeons","authors":"Lauren Hilt BS,&nbsp;Brianne Sherman BS,&nbsp;Madelyn Erdman BS,&nbsp;Rana M. Higgins MD","doi":"10.1016/j.jss.2025.12.007","DOIUrl":"10.1016/j.jss.2025.12.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Musculoskeletal disorders (MSDs) are common among minimally invasive surgeons, with increased rates of pain primarily in the upper body. This study aims to evaluate the impact of online ergonomic education modules on the rate of MSDs among minimally invasive surgeons.</div></div><div><h3>Materials and Methods</h3><div>Minimally invasive surgeons from nine surgical subspecialties at a single institution were recruited to participate in February 2024. The initial survey identified demographics and MSD prevalence. One month later, in March 2024, participants received online ergonomic modules, followed by a secondary survey in April 2024.</div></div><div><h3>Results</h3><div>A total of 23 out of 75 minimally invasive focused surgeons (30.7%) from seven surgical subspecialties participated in the initial survey: 12 males (52.2%), mean age 45 y, 11.4 mean years in practice, and practice breakdowns of 45.6% robotic, 37% laparoscopic, 31.1% open, and 29.5% natural orifice surgery. 65.2% of surgeons reported MSDs most commonly in the shoulder (65.1%) and upper back (59.1%). Among participants, 47.8% of surgeons had not received prior ergonomic education or implemented ergonomic change in the operating room. Six surgeons (26.1%) participated in the secondary survey, representing five subspecialties. There was no significant change in MSD rates for these surgeons (66.7% premodules <em>versus</em> 66.7% postmodules). In total, 66.7% surgeons made immediate ergonomic changes after the modules, and 100% reported they would endorse the modules to colleagues.</div></div><div><h3>Conclusions</h3><div>Minimally invasive surgeons experience high prevalence of MSDs. Although the online modules did not significantly reduce MSD rates immediately, surgeons did implement ergonomic modifications and unanimously recommended the modules. This emphasizes the need for broad and recurrent ergonomic initiatives for long-term benefit.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 110-119"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927868","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":"Case-Crossover Design for Assessing Associations With Short-Term, Intermediate-Term, and Long-Term Exposures","authors":"Yaguang Wei PhD ,&nbsp;Joel D. Schwartz PhD ,&nbsp;Min Zhang PhD ,&nbsp;Robert O. Wright MD, MPH","doi":"10.1016/j.jss.2025.11.072","DOIUrl":"10.1016/j.jss.2025.11.072","url":null,"abstract":"<div><h3>Introduction</h3><div>The case-crossover design is a widely applicable design for observational studies. Its major advantages include robustness against unmeasured time-invariant and slowly varying confounders, as well as high statistical efficiency, both attributable to its self-controlled nature.</div></div><div><h3>Methods</h3><div>In this tutorial, we illustrate applications of the case-crossover design not only for assessing associations with short-term exposures, for which it was originally developed, but also for intermediate- and long-term exposures, using examples from our published studies. We further discuss key methodological considerations for its practical implementation.</div></div><div><h3>Results</h3><div>We presented two subtypes of the case-crossover design, time-stratified and symmetric bidirectional, illustrated through examples of published studies evaluating the associations between air pollution exposures and the risk of hypertension hospitalization. As the exposure time frame extends from short to long term, the ability of the case-crossover design to inherently adjust for slowly varying confounders through self-matching diminishes. Consequently, additional confounders should be included in the regression model. Several considerations are important when using the case-crossover design: first, analyses are restricted to discordant individuals whose exposures differ between the case and control periods; second, there should be no underlying time trend in exposure within the time scheme of case and control periods.</div></div><div><h3>Conclusions</h3><div>Despite these limitations, the case-crossover design remains an attractive method for observational studies as it inherently adjusts for unmeasured time invariant and slowly varying confounders, such as genetics. While the examples focus on air pollution, the broad applicability of the case-crossover design makes it a valuable approach in various fields, including clinical research.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 219-224"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978673","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":"Technique and History of Abdominal Surgery are Associated With Need for Gastrocutaneous Fistula Closure Following Gastrostomy Removal: A Case-Control Study","authors":"Kerry A. Swanson MD ,&nbsp;Madeleine E. Yancy ,&nbsp;Daniel M. Alligood MD ,&nbsp;Alex J. Park MD ,&nbsp;Hannah M. Phelps MD ,&nbsp;Jesse D. Vrecenak MD","doi":"10.1016/j.jss.2025.12.027","DOIUrl":"10.1016/j.jss.2025.12.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Following gastrostomy tube (GT) removal, persistent gastrocutaneous fistula (GCF) requiring operative closure is a common occurrence. We sought to examine factors associated with the need for operative closure of a GCF in pediatric patients.</div></div><div><h3>Materials and methods</h3><div>A retrospective case-control study of patients who underwent GT placement and removal from 2018 to 2023 was performed. Direct comparisons and multivariate regression models were used to determine factors associated with the need for operative closure of a GCF.</div></div><div><h3>Results</h3><div>During the study period, 618 patients underwent GT placement. Of those, only 178 patients subsequently underwent removal and were included. The prevalence of GCF requiring operative closure was 27.5%. Multivariate analysis demonstrated prior and concurrent abdominal surgery were associated with increased odds of GCF (odds ratio [OR] 5.30, 95% confidence interval [CI] 1.27-23.6, <em>P</em> = 0.023; OR 4.50, 95% CI 1.23-17.1, <em>P</em> = 0.024 respectively). Purse-string securement significantly increased the odds of persistent GCF when compared to transabdominal Stamm securement without purse string (OR 8.52, 95% CI 2.73-28.6, <em>P</em> &lt; 0.001) without any difference in GT dislodgement (<em>P</em> = 0.639). Younger age was associated with GCF on comparative cohort analysis (<em>P</em> &lt; 0.001). When stratifying patients as greater or less than 6 mo of age, newborn patients had higher rates of GCF closure (<em>P</em> = 0.025) and shorter durations between placement and removal (<em>P</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>GCF is associated with younger age, other abdominal surgeries, and securement techniques. Transabdominal securement may be associated with a reduced risk of persistent GCF without associated increase in dislodgment. Given the increased rate of persistent GCF and shorter duration of GT needs in younger patients, discharge with a nasoenteric tube rather than a GT should be considered for children under 6 mo.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 331-338"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035153","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":"Frailty Index Predicts Withdrawal of Life-Sustaining Therapy in Geriatric Patients With Rib Fractures","authors":"Reid Bartholomew MD ,&nbsp;Jeffery Nelson MD ,&nbsp;Saskya Byerly MD ,&nbsp;Dina M. Filiberto MD","doi":"10.1016/j.jss.2025.12.028","DOIUrl":"10.1016/j.jss.2025.12.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Geriatric patients with rib fractures have a high morbidity and mortality. The 5-item–modified frailty index (mFI-5) is associated with increased complications and mortality in trauma patients. We aim to determine predictors of withdrawal of life-sustaining therapy (WDLST) in geriatric patients with rib fractures.</div></div><div><h3>Materials and methods</h3><div>Patients were stratified by WDLST and compared. We conducted a multivariable logistic regression (MLR) to determine predictors of WDLST.</div></div><div><h3>Results</h3><div>A total of 4707 patients were included, 92 (2%) patients underwent WDLST. MLR found history of advanced directive and injury severity score are associated with WDLST. On MLR, mFI-5 score of &gt;0.4 (adjusted odds ratio = 2.55, 95% confidence interval 1.31-4.96, <em>P</em> = 0.006), which is equivalent to having &gt;2 risk factors, was associated with WDLST. The WDLST cohort had higher mortality (88% <em>versus</em> 1%, <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>The severity of injury and older age are associated with WDLST. The mFI-5 is a tool that may be useful to obtain earlier palliative care intervention.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 225-229"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010137","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)00041-7","DOIUrl":"10.1016/S0022-4804(26)00041-7","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Page viii"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188648","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":"Plasma Proteomic Signatures for Diverticulitis Risk Stratification","authors":"Thomas E. Ueland MD ,&nbsp;John P. Shelley PhD ,&nbsp;Jonathan D. Mosley MD, PhD ,&nbsp;Jamie R. Robinson MD, PhD ,&nbsp;Eric R. Gamazon PhD ,&nbsp;Lillias H. Maguire MD ,&nbsp;Richard Peek MD ,&nbsp;Alexander T. Hawkins MD, MPH","doi":"10.1016/j.jss.2025.06.093","DOIUrl":"10.1016/j.jss.2025.06.093","url":null,"abstract":"<div><h3>Introduction</h3><div>Approaches for risk stratification in diverticulitis have emphasized lifestyle factors, with a possible emerging role for molecular signatures. We aimed to evaluate whether plasma proteomic profiles complement dietary and genetic factors in diverticulitis risk stratification.</div></div><div><h3>Materials and methods</h3><div>This UK Biobank study derived a plasma proteomic risk score for severe diverticulitis (operative or recurrent inpatient disease). The cohort was split into a training set for derivation and an independent testing set for evaluation. Differential expression and gene set enrichment analysis identified pathway-level differences, while least absolute shrinkage and selector operator models calculated the score. To evaluate utility in stratification, the proteomic risk score was included in Cox regression models with demographics, lifestyle factors, and genetic risk. A phenome-wide association study explored for conditions associated with diverticulitis proteomic signatures.</div></div><div><h3>Results</h3><div>Among 43,539 patients and 1459 plasma proteins measured at enrollment, there were 551 cases of severe diverticulitis throughout follow-up. Differential expression analysis implicated extracellular matrix and neuronal pathways, while least absolute shrinkage and selector operator regression retained 151 proteins. This proteomic risk score was associated with greater risk of severe diverticulitis (hazard ratio [95% confidence interval], 1.48 [1.18-1.87]), and a full model with proteomic and genetic factors improved upon a base model with demographic and lifestyle factors (maximum at 5-y area under the receiver operating characteristics curve [95% confidence interval], training set: 0.83 [0.79-0.86] <em>versus</em> 0.69 [0.64-0.73]; testing set 0.75 <em>versus</em> 0.70; <em>P</em> &lt; 0.01) In the phenome-wide association study, elevated proteomic risk for diverticulitis was associated with renal dysfunction and cardiometabolic traits.</div></div><div><h3>Conclusions</h3><div>Plasma proteomic profiles complemented genetic and lifestyle factors in diverticulitis risk stratification.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 387-395"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958552","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":"Adaptation and Recovery Challenges After Ostomy Surgery: Qualitative Study of Clinician Perspectives","authors":"Stefanie J. Soelling MD, MPH ,&nbsp;Atziri Rubio-Chavez MD ,&nbsp;Laura Baird BA ,&nbsp;Mary E. Brindle MD ,&nbsp;Zara Cooper MD, MSc ,&nbsp;Ana-Maria Vranceanu PhD ,&nbsp;Christine S. Ritchie MD, MSPH ,&nbsp;Christy E. Cauley MD, MPH","doi":"10.1016/j.jss.2025.12.009","DOIUrl":"10.1016/j.jss.2025.12.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients undergoing colorectal surgery with fecal ostomy experience biopsychosocial challenges during recovery. We aimed (1) to describe clinician's perceived challenges with biopsychosocial recovery after ostomy surgery and (2) to examine current solutions to address patient psychosocial challenges while recovering.</div></div><div><h3>Methods</h3><div>We conducted qualitative focus groups evaluating clinician perspectives using a semistructured interview guide. Colorectal surgeons, gastrointestinal psychologists, colorectal surgery nurse practitioners, and ostomy nurses were included.</div></div><div><h3>Results</h3><div>Five interview sessions were performed including focus groups and individual interviews. Clinicians were 73% female, all White, and with varied experience (2-40 y in practice). All participants reported ostomy-related emotional distress occurs after surgery and impacts patient recovery and adaptation. Participants reported distress was mitigated when the ostomy relieved functional symptoms and in patients with time to cope with needing an ostomy due to chronic diseases. Patients with permanent ostomies were felt to adapt faster. Emotional distress increased dependence on caregivers, prolonged hospital stays, and delayed adaptation to daily life. Ostomy nurses reported they spent significant time addressing patient distress in clinical encounters. Participants reported a lack of training, time, and resources to help manage patients’ emotional distress.</div></div><div><h3>Conclusions</h3><div>Clinicians treating colorectal surgery patients with ostomy frequently note clinically significant emotional distress. This distress hinders patients’ ability to adapt to life with an ostomy. An ostomy specific distress management intervention is needed to improve biopsychosocial outcomes during surgical recovery and adaptation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 154-161"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966346","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}