Journal of Surgical Research最新文献

{"title":"Beyond the Basics of Cost-effectiveness Methods: Advanced Methods for Surgical Decision-making","authors":"Yang Zhang MScPH,&nbsp;Grace E. Ratcliff MPH,&nbsp;Jinyi Zhu PhD","doi":"10.1016/j.jss.2025.11.073","DOIUrl":"10.1016/j.jss.2025.11.073","url":null,"abstract":"<div><h3>Introduction</h3><div>As the scope and goals of health care evaluation expand, traditional cost-effectiveness analysis (CEA) methods, which typically evaluate interventions based on their cost per quality-adjusted life year gained, often fall short in capturing the real-world complexities of surgical decision-making. Building on our companion article on foundational CEA, there is an increasing need for advanced analytic tools that incorporate uncertainty, system constraints, and equity considerations.</div></div><div><h3>Methods</h3><div>In this article, we explain a curated set of advanced methods building on our companion introductory article. These include value of information analysis, discrete event simulation, and equity-informative economic evaluations (including distributional and extended CEA). For each method, we describe the underlying analytic framework, explain its relevance to real-world surgical decision-making, and illustrate its application using published examples from surgical or health policy contexts.</div></div><div><h3>Results</h3><div>These methods enhance the relevance and interpretability of economic evaluations by enabling analysts to quantify the value of future research, simulate care delivery in resource-constrained systems, and incorporate equity concerns into economic decision-making. A summary table compares the full suite of methods across both explainers for ease of reference.</div></div><div><h3>Conclusions</h3><div>Advanced CEA methods provide important tools for addressing challenges in modern surgical and policy decision-making. This explainer aims to equip surgeons and surgical health services researchers with practical insight into when and how to apply these approaches to improve the rigor, realism, and ethical relevance of economic evaluations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 255-263"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018133","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":"Surgical Resection for Pulmonary Metastasis From Cholangiocarcinoma: A Retrospective Case Series","authors":"Yuhi Yoshizaki MD, PhD ,&nbsp;Nobuyuki Takemura MD, PhD ,&nbsp;Takashi Kokudo MD, PhD ,&nbsp;Fuyuki Inagaki MD, PhD ,&nbsp;Fuminori Mihara MD ,&nbsp;Tatsuo Maeyashiki MD, PhD ,&nbsp;Satoshi Nagasaka MD, PhD ,&nbsp;Norihiro Kokudo MD, PhD","doi":"10.1016/j.jss.2025.12.006","DOIUrl":"10.1016/j.jss.2025.12.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Cholangiocarcinoma (CCA) is associated with a high incidence of recurrence and patients occasionally develop pulmonary metastases. Systemic chemotherapy is the first-line treatment for unresectable or recurrent CCA. However, we have occasionally encountered cases of favorable prognosis following pulmonary resection for CCA metastases.</div></div><div><h3>Materials and methods</h3><div>Data from patients undergoing surgery for CCA between 2012 and 2021 were obtained from a prospectively maintained database. We retrospectively reviewed patients with pulmonary metastases from CCA, including those who underwent pulmonary resection and those who did not. Additionally, we described a representative case of repeated pulmonary resection with long-term survival.</div></div><div><h3>Results</h3><div>Among 122 patients who underwent surgery for CCA with curative intent, 64 patients (52.5%) experienced recurrence, including 14 patients (11.5%) who developed pulmonary metastases. Of these, five underwent pulmonary resection, including 1 who received two resections. None of the patients experienced postoperative complications. With a median follow-up of 2.6 y, three patients remained alive without recurrence. A representative case achieved long-term survival after repeated pulmonary resections. The 5-y overall survival rates were significantly better in patients who underwent pulmonary resection than in those who did not (75.0% <em>versus</em> 0%, <em>P =</em> 0.011).</div></div><div><h3>Conclusions</h3><div>Pulmonary resection may represent a feasible treatment option for carefully selected patients with pulmonary metastases from CCA.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 171-179"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978670","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":"Associations of Hernia Sac Size, Serum Indicators, and Postoperative Complications After Laparoscopic Inguinal Hernia Repair","authors":"Fan Liu MD,&nbsp;Tao Kuang MD,&nbsp;Chao Chen MD,&nbsp;Guangyu Liu MD","doi":"10.1016/j.jss.2025.12.019","DOIUrl":"10.1016/j.jss.2025.12.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Inguinal hernia is a common surgical condition with a low rate of self-healing. This study aimed to analyze the associations of hernia sac size, serum indicators, and postoperative complications following laparoscopic inguinal hernia surgery.</div></div><div><h3>Methods</h3><div>Eighty-one patients with inguinal hernia who underwent laparoscopic surgery from January 2021 to July 2024 were enrolled and followed up at 2 weeks, 1 month, 3 months, and 6 months after surgery. Based on the presence or absence of postoperative complications, the patients were divided into a complication group (<em>n</em> = 30) and a noncomplication group (<em>n</em> = 51). The complication group was subdivided according to the type of complication into a seroma group/a nonseroma group, an incision infection group/a nonincision infection group, and a chronic pain group/a nonchronic pain group.</div></div><div><h3>Results</h3><div>The postoperative follow-up showed that 30 of the 81 patients had complications, with an incidence rate of 37.04%. Multivariate ridge regression analysis identified hernia sac size, body mass index, and age as significant positive predictors of postoperative complications, whereas serum Na⁺ level was inversely associated (<em>P</em> &lt; 0.05). The combined ridge regression model had an area under the curve of 0.93 (95% confidence interval: 0.86-0.98), with a sensitivity of 91% and specificity of 88%, indicating good discriminatory ability. Subgroup analyses further demonstrated consistent predictive capacity for seroma, incision infection, and chronic pain.</div></div><div><h3>Conclusions</h3><div>Hernia sac size, body mass index, age, and serum Na⁺ are independently associated with postoperative complications following laparoscopic inguinal hernia repair. A combined predictive model incorporating these factors allows early risk stratification, which may guide targeted perioperative management.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 180-187"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978674","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":"Assessing Racial Bias Within American Society of Anesthesiologists Classification","authors":"Michael A. Jacobs MS ,&nbsp;Brenna N. McKaig BS ,&nbsp;Susanne Schmidt PhD ,&nbsp;Paula K. Shireman MD, MBA, MS ,&nbsp;James W. Ibinson MD, PhD ,&nbsp;Jessica H. Maxwell MD, MPH ,&nbsp;Daniel E. Hall MD, MDiv, MHSc","doi":"10.1016/j.jss.2025.12.040","DOIUrl":"10.1016/j.jss.2025.12.040","url":null,"abstract":"<div><h3>Introduction</h3><div>The American Society of Anesthesiologists (ASA) classification system is widely used to evaluate surgical risk, make patient care decisions, and determine reimbursement. However, race/ethnicity bias in ASA class is largely unexplored, with potential ramifications for healthcare disparities.</div></div><div><h3>Methods</h3><div>In a retrospective cohort study of 350,187 Veterans Health Administration surgical cases and 4,051,185 non–Veterans Health Administration cases, race/ethnicity groups were matched on the components of the Risk Analysis Index, a surgical frailty measure, and preoperative acute serious conditions, conditions associated with urgent/emergent surgeries, to evaluate differences in ASA class.</div></div><div><h3>Results</h3><div>After matching, Black cases had higher ASA class <em>versus</em> White cases (adjusted odds ratios = 1.37 and 1.07, 95% confidence intervals = 1.37-1.38 and 1.04-1.09, <em>P</em> &lt; 0.001). Hispanic cases had lower ASA class <em>versus</em> White cases (adjusted odds ratios = 0.96 and 0.96, 95% confidence intervals = 0.96-0.97 and 0.93-0.99, <em>P</em> &lt; 0.001 and 0.008), though the effect changed sign in a sensitivity analysis.</div></div><div><h3>Conclusions</h3><div>ASA class varies by race/ethnicity, representing bias that could drive health disparities. Given the matching strategy used, such bias may have practical implications for patient outcomes and quality improvement. For Black patients, a higher ASA class may drive increased preoperative testing, surgical delays, and increased costs. For Hispanic patients, a lower ASA class may drive reduced preoperative screening and riskier outpatient procedures. For some purposes, the ASA class may need to be replaced with other measures of patient morbidity. For others, ASA class may need to be revised and assigned by automated systems with safeguards against race/ethnicity bias.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 264-271"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018938","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":"Effectiveness and Validity of Informed Consent in Patients Undergoing Surgery in Cameroon: A Prospective Survey","authors":"Robert Tchounzou MD ,&nbsp;Obi Cyril Egbe MD ,&nbsp;Mark T. Yost MD, MPH ,&nbsp;Brandon Carl Monica Pouekoua MD ,&nbsp;Pascal Nwandum MD ,&nbsp;Mefire Alain Chichom MD","doi":"10.1016/j.jss.2025.12.010","DOIUrl":"10.1016/j.jss.2025.12.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The process of informed consent before surgery has not been evaluated in Cameroon. We hypothesized that the process of informed consent for patients operated on in the Southwest Region of Cameroon is not appropriate.</div></div><div><h3>Materials and methods</h3><div>We conducted a prospective, cross-sectional study in three health institutions in the Southwest region of Cameroon. A pretested questionnaire was administered to patients in the postoperative period to assess the basic components of the informed consent process. Patient's satisfaction and the overall validity of the process were measured.</div></div><div><h3>Results</h3><div>We included 468 consenting patients in this study. Their mean age was 31.41 ± 8.6 y. The majority of patients (58.5%) underwent an elective procedure. The informed consent process was administered on the day of surgery, sometimes on the operative table for 53.4% of patients. Over half of the patients did not receive specific information on the surgical procedure. Though most of them (64.5%) received information about anesthesia, none were ever given the opportunity to choose the type of anesthesia. A total of 268 (57.3%) patients were informed about the potential risks of the surgical and anesthetic procedures. The majority (86.54%) were never informed that the surgery could possibly not yield the expected results. Over 70% of patients never read the consent form, and the overall process was considered fully valid in 1.1% of patients.</div></div><div><h3>Conclusions</h3><div>Though the process of informed consent is now widespread, it is still inadequate as some basic components are not fulfilled and patients’ participation in the final decision is poor.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 25-31"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927884","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 Structured Guide to Univariate Test Selection Based on Normality, Variance Homogeneity, and Graphical Data Exploration","authors":"Javier Arredondo Montero MD, PhD","doi":"10.1016/j.jss.2025.10.053","DOIUrl":"10.1016/j.jss.2025.10.053","url":null,"abstract":"<div><h3>Introduction</h3><div>The credibility of surgical research depends on appropriate statistical methodology. However, univariate statistical tests are frequently applied inconsistently, and key assumptions—particularly normality and variance homogeneity—are often misunderstood or inadequately assessed. These methodological shortcomings can distort inference, undermine internal validity, and compromise the clinical interpretability of research findings.</div></div><div><h3>Methods</h3><div>This article presents a structured, assumption-based framework to guide univariate statistical test selection in surgical research. The approach integrates visual data exploration (histograms, Q–Q plots, violin plots) with formal assumption testing, including the Shapiro-Wilk test for normality and Levene’s test for variance homogeneity, explicitly addressing the sample-size dependence of normality tests, which may lack power in small samples and overdetect trivial deviations in large datasets. The framework addresses common pitfalls related to distributional shape (including bimodality), outliers, data transformation, and the treatment of ordinal variables. When standard assumptions are violated, the framework discusses robust alternatives—such as Welch’s tests, nonparametric approaches, and modern robust estimators—to preserve valid and interpretable statistical inference.</div></div><div><h3>Results</h3><div>The proposed framework yields a practical decision algorithm, supported by summary tables and illustrative figures, that links data characteristics to appropriate univariate tests and summary measures. By emphasizing combined visual and statistical assessment, the framework clarifies when parametric, robust parametric, or nonparametric methods are most suitable and highlights frequent sources of misinterpretation in the surgical literature.</div></div><div><h3>Conclusions</h3><div>An assumption-driven approach to univariate test selection enhances statistical rigor, transparency, and reproducibility in surgical research. By aligning test choice and data summarization with underlying distributional properties, this framework supports more reliable statistical inference and clinically meaningful interpretation of univariate analyses.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 230-240"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010210","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":"Establishing a Mass Casualty Threshold in a Resource-Limited Hospital Setting: A Retrospective Analysis of a Trauma Registry From Malawi","authors":"Tori Hester MPH ,&nbsp;Selena J. An MD, MSPH, MA ,&nbsp;Jotham Gondwe ,&nbsp;Anthony Charles MD, MPH ,&nbsp;Jared Gallaher MD, MPH","doi":"10.1016/j.jss.2025.12.013","DOIUrl":"10.1016/j.jss.2025.12.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Mass casualty incidents (MCIs) easily overwhelm hospitals in resource-limited settings. Unfortunately, limited data exists on this problem, and few hospitals are prepared to deal with these events. We hypothesized that excessive patient volume would be associated with worse outcomes at a tertiary hospital in Lilongwe, Malawi, and that these data would provide a foundation for targeted interventions and improvement.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed the Kamuzu Central Hospital Trauma Registry from 2010 to 2021. Using arrival data, we characterized patient co-arrival volume trends. We <em>a priori</em> set the mass casualty threshold at 2 standard deviations above the mean number of patient co-arrivals in 1 h. We performed bivariate and multivariable logistic regression analyses to investigate the relationship between mortality and the number of co-arrivals above the threshold.</div></div><div><h3>Results</h3><div>A total of 161,383 patients were analyzed. The median age was 24 y, and 73.8% were male. Crude mortality was 2.4%. A total of 3007 patients (1.9%) presented above the mass casualty threshold of 11 patients. Mortality for this group was 4.2% compared to 2.4% for those below the threshold. Those who have an arrival status above the MCI threshold of 11 patient arrivals in 1 h have 1.70 (95% confidence interval: 1.36, 2.12, <em>P</em> value &lt; 0.001) times the odds of mortality than patients below the MCI threshold when adjusting for sex, age, primary injury type, and arrival time.</div></div><div><h3>Conclusions</h3><div>Overwhelming and sudden patient volume is associated with higher odds of mortality in a resource-limited setting. Our results will inform a mass casualty protocol to maximize efficient resource use in similar settings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 89-97"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927797","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":"Xq28 Variants as Novel Male-Specific Susceptibility Factors for Hirschsprung Disease","authors":"Xiaoli Xie MS ,&nbsp;Xiaoyu Zuo PhD ,&nbsp;Qiuming He MD ,&nbsp;Wei Zhong MS ,&nbsp;Liucheng Yang MD","doi":"10.1016/j.jss.2025.12.017","DOIUrl":"10.1016/j.jss.2025.12.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Hirschsprung's disease (HSCR) is a complex congenital digestive tract disease affected by multiple genes. Despite the identification of &gt;20 risk loci, no susceptibility variants map to sex chromosomes—a striking gap given the 4- to 6-fold male predominance in short-segment HSCR. This study investigates the contribution of X-chromosomal variation to HSCR pathogenesis.</div></div><div><h3>Methods</h3><div>We conducted a large case-control study involving a South Chinese population. Four single nucleotide polymorphisms (SNPs) in a disease hotspot region spanning on Xq28 were genotyped through MassARRAY genotyping platform. Association analysis of the selected SNPs with HSCR were performed using PLINK1.9. RNA quantitative analysis, immunohistochemistry staining, and Western blot analysis were performed to observe the expression of the newly identified gene <em>IRAK1</em> of colon tissues of HSCR patients.</div></div><div><h3>Results</h3><div>This study included 1470 HSCR patients and 1473 ethnically matched controls. Four SNPs (rs2071128, rs17422, rs1059702, and rs2734647) were identified as associated with HSCR in a male-specific manner, with odds ratios ranging from 1.20 to 1.52. These variants conferred an even higher risk for long-segment HSCR in males, with odds ratios between 1.75 and 2.53. We demonstrated higher expression of the newly identified gene <em>IRAK1</em> in aganglionic colon samples compared with ganglionic colon tissues, especially in the males (<em>P</em> = 0.00046).</div></div><div><h3>Conclusions</h3><div>We identified a novel male-specific region Xq28 as associated with HSCR. The differential expression of the newly identified gene <em>IRAK1</em> in HSCR patients suggests an important role for the HSCR-associated common variants in shaping the male-specific disease.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 162-170"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978669","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":"Performance of Postoperative Imaging for Leak Detection Following Repair of Upper Gastrointestinal Perforation","authors":"Mary Junak MD ,&nbsp;Devashish Joshi MD ,&nbsp;Victoria R. Rendell MD ,&nbsp;Giuseppe V. Toia MD ,&nbsp;Charles Patrick Shahan MD, MS","doi":"10.1016/j.jss.2025.12.026","DOIUrl":"10.1016/j.jss.2025.12.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric and duodenal perforations are surgical emergencies with high morbidity and mortality. Postoperative leak is a serious complication, yet there are no guidelines for imaging modality or patient selection. This study compared fluoroscopic upper gastrointestinal series (fUGI) and computed tomography (CT) for postoperative leak detection following surgical repair.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of patients who underwent repair of a gastric or duodenal perforation between 2011 and 2023. Surgical interventions, postoperative imaging (UGI vs CT), and clinical outcomes were assessed. Post repair leak was defined by radiographic evidence of contrast extravasation, change in drain character, and/or intraoperative findings. Performance of UGI and CT to identify post repair leak was assessed.</div></div><div><h3>Results</h3><div>A total of 168 patients were included; 142 underwent open repair and 26 laparoscopic. An omental patch was used in 87.5%, and drains were placed in 81.5%. Postoperative imaging was obtained in 85.7%, most often on postoperative day 5, with 95 fUGI and 49 CT studies. Postoperative leak occurred in 20.2% (34/168). All patients with leaks underwent imaging. For patients with confirmed leaks, fUGI demonstrated a sensitivity of 56.3% and negative predictive value (NPV) of 91.9%, while CT demonstrated a sensitivity of 44.4% and NPV of 75.6%. Discordant imaging results were frequent, and CT contrast protocols were not standardized.</div></div><div><h3>Conclusions</h3><div>Postoperative imaging after gastric or duodenal perforation repair is common but variable, often performed for surveillance. fUGI demonstrated modestly higher sensitivity and NPV compared with CT, suggesting greater reliability for ruling out early leaks. Both modalities showed limitations, underscoring the need for standardized imaging protocols.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 188-192"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978708","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":"Diagnostic Overshadowing: Delayed Management in Substance Use Disorder Patients With Splenic Injury","authors":"Yasmin Arda MD,&nbsp;Ikemsinachi C. Nzenwa MBChB, MSc,&nbsp;Vahe S. Panossian MD,&nbsp;Tiemen E.T. Holtrop MD,&nbsp;Haytham M.A. Kaafarani MD, MPH,&nbsp;John O. Hwabejire MD, MPH,&nbsp;George C. Velmahos MD, PhD,&nbsp;Michael P. DeWane MD","doi":"10.1016/j.jss.2025.12.041","DOIUrl":"10.1016/j.jss.2025.12.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnostic overshadowing, a type of cognitive bias, happens when a pre-existing medical condition overshadows the evaluation of other potential diagnoses. This study aimed to explore diagnostic overshadowing in trauma due to the impact of substance and alcohol use disorder (SUD) on time to diagnosis and management in patients with blunt splenic injury.</div></div><div><h3>Methods</h3><div>The 2017-2020 American College of Surgeons Trauma Quality Improvement Project database was used to identify patients ≥18 y with blunt splenic injury who underwent splenectomy. Patients were stratified into those with and without SUD. Delayed diagnosis (time to abdominal computed tomography scan &gt;1 h) and delayed splenectomy (&gt;2 h) were defined using median-based thresholds to measure distributional shifts in care timeliness between groups. Multivariable logistic regression examined the impact of SUD on delayed diagnosis, delayed splenectomy, and outcomes (e.g., mortality, postoperative complications). A sensitivity analysis was conducted by excluding patients with a positive alcohol screen on admission.</div></div><div><h3>Results</h3><div>Nine thousand two hundred thirty-seven patients were included: 1739 (19%) SUD and 7498 (81%) non-SUD. The median time to splenectomy was 2.4 h (interquartile range = 1.2-7.1) in SUD patients compared with 2 h (interquartile range = 1.1-4.9) in non-SUD patients (<em>P</em> &lt; 0.001). On multivariable analyses, SUD patients were more likely to experience delayed diagnosis (adjusted odds ratio [aOR] = 1.13, 95% confidence interval [CI] = 1.04-1.23), delayed splenectomy (aOR = 1.25, 95% CI = 1.09-1.42), and composite complications (aOR = 1.14, 95% CI = 1.01-1.31) compared with non-SUD patients. After excluding intoxicated patients, those with SUD were still more likely to have delayed diagnosis and management, with a greater risk of delayed splenectomy compared with the overall cohort.</div></div><div><h3>Conclusions</h3><div>Diagnostic overshadowing, exemplified in blunt splenic injury patients with SUD, can be measured and can negatively impact patient care. Further studies are needed to explore the prevalence and impact of diagnostic overshadowing in trauma patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 323-330"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035046","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}