Journal of Surgical Research最新文献

{"title":"TAVI in Patients With Severe Aortic Stenosis and Coexisting Mitral Valve Regurgitation","authors":"Mohammed Salem MD ,&nbsp;Tomasz Stankowski MD ,&nbsp;Sleiman Sebastian Aboul-Hassan MD ,&nbsp;Anja Muehle MD ,&nbsp;Axel Harnath MD ,&nbsp;Kristin Rochor MD ,&nbsp;Claude Tshibangu Lukusa MD ,&nbsp;Volker Herwig MD ,&nbsp;Temirlan Erkenov MD ,&nbsp;Barłomiej Perek MD ,&nbsp;Dirk Fritzsche MD","doi":"10.1016/j.jss.2024.10.012","DOIUrl":"10.1016/j.jss.2024.10.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Severe aortic stenosis with coexisting mitral regurgitation (MR) of various severity is a common finding. The goal of our study was to evaluate the relation between transcatheter transfemoral aortic valve implantation (TAVI) on coexisting MR and compare the outcome in MR improvement and nonimprovement groups.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 252 patients who underwent TAVI with associated at least moderate MR between January 2018 and December 2020. Effect of changes in MR grade at discharge and 6-12 mo follow-up were compared.</div></div><div><h3>Results</h3><div>Echocardiography was performed at discharge in 245 patients and at follow-up in 154 patients. MR improvement was seen in 60.8% patients and nonimprovement in 39.2%. Overall survival was significantly higher in the MR improvement group (<em>P</em> = 0.020). There was a statistically significant effect on MR grade with a significant increase in the proportion of patients with mild MR at follow-up compared to discharge (58.4% versus 38.3%, <em>P</em> &lt; 0.001). A similar positive effect was seen on left ventricular ejection fraction (LVEF) at follow-up compared to discharge (<em>P</em> &lt; 0.001). LVEF in the MR improvement group was significantly higher at follow-up versus discharge (<em>P</em> &lt; 0.001), but there was no statistically significant change in LVEF in the nonimprovement group at follow-up versus discharge (<em>P</em> &lt; 0.722).</div></div><div><h3>Conclusions</h3><div>TAVI in severe aortic stenosis with coexisting significant mitral valve regurgitation decreases MR severity in more than 60% of patients and improved LVEF as well as mortality.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 101-111"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622934","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":"Novel Asymmetrical Linear Stapler: Safety Test and Pathological Assessment in a Porcine Model","authors":"Yong Chae Jung MD ,&nbsp;Wen Xue Piao MD ,&nbsp;Ji-yeon Kim MD, PhD ,&nbsp;Sang-il Lee MD, PhD ,&nbsp;Ying Jie Cui MD ,&nbsp;Yooyoung Chong MD ,&nbsp;Hyun Jin Cho MD, PhD ,&nbsp;Min-Woong Kang MD, PhD","doi":"10.1016/j.jss.2024.10.003","DOIUrl":"10.1016/j.jss.2024.10.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Prognosis in patients undergoing resection for lung and gastrointestinal cancers may differ, depending on the microscopic involvement of surgical margins. Linear staplers, widely used for pulmonary or bowel resection, consist of three rows of fasteners on both sides of a resection line. Although multiple rows of fasteners ensure stump and specimen closure, specimen could compromise accurate pathological evaluation of the true surgical margin. We aimed to compare the novel asymmetrical linear stapler (NALS) with the symmetrical linear stapler (SLS) in a porcine model for stump security and accurate pathological evaluation.</div></div><div><h3>Materials and Methods</h3><div>We used the NALS with three and two rows of staples on the stump and specimen sides, respectively. We performed small bowel resection in a porcine model using the NALS and examined hemostasis of resection margin, tightness of stumps under a specific burst pressure, distances between the true resection margin and staple line, and pathology of the resection margin. An SLS was used as the control.</div></div><div><h3>Results</h3><div>No bleeding was observed at the tissue site after initial blotting of the stapler line with either stapler type. The staplers endured a burst pressure of 3.6 kPa for 15 s without leakage. The distance between the cutting edge and staple line for two rows was significantly greater than the distance between the cutting edge and the nearest staple line for three rows.</div></div><div><h3>Conclusions</h3><div>The NALS is safe and may be more accurate than is SLS for the pathological evaluation of true surgical margins.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 58-66"},"PeriodicalIF":1.8,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622898","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":"Psoas Muscle Volume as an Indicator of Sarcopenia and Disposition in Traumatic Hip Fracture Patients","authors":"Sahak E. Hovsepian MS ,&nbsp;Catherine H. Zwemer BS ,&nbsp;Alex I. Halpern MD ,&nbsp;Sophia H. Wu BS ,&nbsp;Christian M. Farag BA ,&nbsp;Aalap Herur-Raman MS ,&nbsp;Ahmed Ismail BS ,&nbsp;Aneil P. Srivastava BS ,&nbsp;Oleksiy Melnyk BS ,&nbsp;Mary Baginsky MS, RD ,&nbsp;Susan Kartiko MD, PhD","doi":"10.1016/j.jss.2024.10.005","DOIUrl":"10.1016/j.jss.2024.10.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition.</div></div><div><h3>Methods</h3><div>A retrospective review of surgically managed hip fracture patients at a single institution level one American College of Surgeons verified trauma center between 2017 and 2022 was performed. The primary endpoint was patient disposition after hospitalization. TPV was collected via three dimension reconstruction of computed tomography images. Student's <em>t</em>-test was used to assess for association between TPV and demographic variables. Binary logistic regressions were performed to examine variables that could predict patient disposition among the patients.</div></div><div><h3>Results</h3><div>We identified 64 surgically managed hip fracture patients, 57.8% of whom were males, with a median age of 74 (IQR: 62, 88). Black race (244.4 vs. 190.3, <em>P</em> = 0.032) and younger age (252.2 vs. 181.8, <em>P</em> = 0.004) were associated with higher TPV. Male patients with higher TPV had a higher likelihood of being discharged home as opposed to a skilled nursing or rehabilitation facility (251.3 vs. 191.1, <em>P</em> = 0.02). In multivariable analysis adjusting for sex, race, body mass index, and age, males with a higher TPV were more likely to be discharged home (odds ratio: 1.012; 95% confidence interval: 1.004 1.020; <em>P</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>Psoas muscle volume can be used to predict which male patients are likely to be discharged home postoperatively after surgically managed traumatic hip fracture.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 67-73"},"PeriodicalIF":1.8,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622911","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":"Prophylactic Sartorius Flap Reconstruction is Associated With Reduced Vascular Graft Infection","authors":"Young Kim MD, MS,&nbsp;Roberto S. Loanzon MD,&nbsp;Christina L. Cui MD, MAS,&nbsp;Kevin W. Southerland MD,&nbsp;Zachary F. Williams MD","doi":"10.1016/j.jss.2024.10.004","DOIUrl":"10.1016/j.jss.2024.10.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound complications. In this study, we examined our experience with prophylactic sartorius muscle flap coverage and its association with prosthetic vascular graft infection.</div></div><div><h3>Methods</h3><div>In this single-center analysis, electronic medical records were retrospectively reviewed for all sartorius muscle flap procedures performed from 2012 to 2021. Prophylactic indication was defined as flap reconstruction during index revascularization in the absence of active inguinal infection.</div></div><div><h3>Results</h3><div>Over the 9-y period, a total of 54 prophylactic sartorius flaps were performed in 47 patients. The median patient age was 66 y (interquartile range [IQR] 61-77 y). Wound complications requiring reintervention occurred in 16 (29.6%) patients, including 6 (11.1%) surgical site infections, 5 (9.3%) wound dehiscence, and 5 (9.3%) infected seromata. Among patients suffering wound complications, 30-d readmission (75.0% <em>versus</em> 26.3%, <em>P</em> = 0.004) and reoperative flap creation rates (25.0% <em>versus</em> 2.6%, <em>P</em> = 0.010) were higher, whereas 30-d mortality rates (0.0% <em>versus</em> 5.3%, <em>P</em> = 0.51) were similar. Only one patient (1.9%) developed vascular graft infection over a median follow-up period of 2.4 y (IQR 0.9-4.0 y). On multivariate analysis, body mass index (adjusted odds ratio 1.23, 95% confidence interval, 1.12-1.35, <em>P</em> = 0.023) was associated with reoperative wound complications.</div></div><div><h3>Conclusions</h3><div>Wound complications were common after prophylactic sartorius flap creation in this high-risk population; however, infection of the underlying vascular graft was rare. These data suggest that sartorius flap may be effective in a prophylactic role.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 52-57"},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622908","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":"Neurologic Complications Associated With Burn Injury and Resuscitation","authors":"Connor L. Kenney MD ,&nbsp;Brian D. Stephens MD ,&nbsp;Kelsey A. Cacic MD ,&nbsp;Alicia M. Williams MD ,&nbsp;Steven G. Schauer DO ,&nbsp;Jan-Michael Van Gent DO ,&nbsp;Geoffrey W. Peitz MD ,&nbsp;Michael D. April MD ,&nbsp;Julie A. Rizzo MD","doi":"10.1016/j.jss.2024.09.086","DOIUrl":"10.1016/j.jss.2024.09.086","url":null,"abstract":"<div><h3>Background</h3><div>Treatment for large burn injuries relies on adequate fluid resuscitation secondary to the severe systemic inflammatory response. With improved critical care and better understanding of the complications of over and under resuscitation, morbidity and mortality rates are decreasing. Neurologic complications are not often considered as an over-resuscitation complication after burn injury but may be considered an additional form of compartment syndrome–intracranial compartment syndrome; however, it has not been evaluated for a possible threshold similar to the Ivy Index for abdominal compartment syndrome.</div></div><div><h3>Methodology</h3><div>This study was conducted as a single center, retrospective review of patients admitted to the Burn Intensive Care Unit within 24 h of injury and who received neuroimaging within 96 h. Patients were grouped based on the resuscitation volumes at ≤200 and &gt;200 mL/kg for evaluation of the development of worsening neurologic findings.</div></div><div><h3>Results</h3><div>Forty-one patients were available for review with 30 patients ≤200 mL/kg and 11 patients &gt;200 mL/kg. Twenty-one patients (70.0%) and 7 patients (63.6%), &lt; 200 and &gt; 200 mL/kg respectively, has repeat imaging. Follow-up imaging was found to be worse in patients receiving greater than 200 mL/kg (85.7% <em>versus</em> 47.6%, <em>P</em> value 0.064).</div></div><div><h3>Conclusions</h3><div>Providers should be aware of the potential for neurologic sequelae of resuscitation that is often only found on imaging in patients receiving high-volume resuscitation for their burn injury.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 36-40"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604655","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 Multifactorial Analysis of Trauma Outcomes: Comorbidities, Race, and Socioeconomic Status","authors":"Andrew Tian-Yang Yu BA, MHS,&nbsp;Anika Gnaedinger BS,&nbsp;Braylee Grisel BS,&nbsp;Manuel Castillo-Angeles MD, MPH,&nbsp;Joseph Fernandez-Moure MD, MS,&nbsp;Suresh Agarwal MD,&nbsp;Krista L. Haines DO, MA","doi":"10.1016/j.jss.2024.09.075","DOIUrl":"10.1016/j.jss.2024.09.075","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma patients with comorbid conditions are known to have poorer outcomes. We hypothesize that these outcomes are further influenced by race or ethnicity and socioeconomic status.</div></div><div><h3>Methods</h3><div>We queried patient records in the Trauma Quality Improvement Program database from 2017 to 2019 and assessed those with selected comorbidities: chronic kidney disease (CKD), diabetes, cardiac comorbidities (angina pectoris, congestive heart failure, myocardial infarct, and hypertension), and chronic obstructive pulmonary disease (COPD). We used multivariate logistic and linear regression models to investigate the interaction of race or ethnicity and insurance status in trauma patients with the above comorbidities, adjusting for injury severity, demographic factors, and other comorbidities.</div></div><div><h3>Results</h3><div>We identified 44,388 patients with CKD, 357,008 with diabetes, 947,980 with cardiac comorbidities, and 205,525 with COPD from a total of 2,493,327 records. Patients were mostly White and non-Hispanic, with Medicare as a payor; patients with diabetes and CKD were male, while patients with cardiac comorbidities and COPD were female. Minority patients had increased hospital mortality and longer hospital stays; length of stay was associated with differences in payor and with increases or decreases observed across different payor-comorbidity interactions. Discharge dispositions were also associated with differences in race or ethnicity and payor.</div></div><div><h3>Conclusions</h3><div>In an analysis of trauma patients with specific comorbidities, racial or ethnic background and socioeconomic status were associated with differences in outcomes, even after adjusting for injury severity and other factors. These results indicate that comorbidity indices alone are insufficient for optimal patient care, necessitating the inclusion of social determinants in treatment and discharge planning.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 41-51"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604690","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 Gastroschisis and Omphalocele Treated at Children’s Surgery Verified Centers in Texas","authors":"Sarah Peiffer MD, MPH ,&nbsp;Alexander Mina MD ,&nbsp;Paulina Powell BS ,&nbsp;Mike Gyimah MD ,&nbsp;Alice King MD","doi":"10.1016/j.jss.2024.10.001","DOIUrl":"10.1016/j.jss.2024.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior abdominal wall defects (AWDs), such as gastroschisis or omphalocele, are often diagnosed prenatally and counseled to deliver at facilities with resources capable of managing their AWD and complex-associated anomalies. The American College of Surgeons instituted their Children’s Surgery Verification (CSV) program to identify facilities with the optimal resources for pediatric surgical care. We aimed to evaluate the impact of CSV status on the outcomes of AWD and potential health disparities in the care of AWD in the first year of life in Texas.</div></div><div><h3>Materials and Methods</h3><div>We performed a multicenter epidemiological cohort study of infants &lt;1 y of age at discharge with AWD from 2013 to 2021. Data were extracted from the Texas Health Care Information Council Public Use Data File. Patients who were transferred were excluded to avoid systematic double counting.</div></div><div><h3>Results</h3><div>We identified 2282 AWD patients with 26% treated at CSV centers and 68% undergoing surgical abdominal wall repair. The majority (70%) had gastroschisis. CSV center care recipients were more likely to be non-Hispanic (64% <em>versus</em> 58%, <em>P</em> = 0.018), reside in urban counties (92% <em>versus</em> 82%, <em>P</em> &lt; 0.001), or counties not along the Mexican border (98% <em>versus</em> 81%, <em>P</em> &lt; 0.001) when compared with non-CSV patients. While non-CSV admissions had lower costs per day ($9316 <em>versus</em> $10,109, <em>P</em> = 0.003), CSV centers had slightly lower mortality although this was not statistically significant (8% <em>versus</em> 10%, <em>P</em> = 0.153) despite higher illness severity scores (extreme illness severity: 51% <em>versus</em> 44%, <em>P</em> = 0.019). However, it is notable that non-CSV centers had higher rates of prematurity (62% <em>versus</em> 55%, <em>P</em> = 0.003). Multivariable logistic regression analysis for mortality revealed that treatment at CSV centers (adjusted odds ratio 0.562, <em>P</em> = 0.005) was protective. Predictive modeling revealed that CSV centers have lower predicted mortality across all illness severity levels as compared with non-CSV centers.</div></div><div><h3>Conclusions</h3><div>AWD treated at CSV centers have superior outcomes with improved mortality despite increased patient complexity and illness severity. Disparities in care at CSV centers exist based on race and geographic residency. Ongoing quality efforts are needed to improve quality universally and recognize facilities providing high-quality care while also ensuring equitable access to high-quality pediatric surgical care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 28-35"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564251","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":"Letter Regarding: Digital Ink and Surgical Dreams: Perceptions of Artificial Intelligence-Generated Essays in Residency Applications.","authors":"Shigeki Matsubara, Daisuke Matsubara","doi":"10.1016/j.jss.2024.08.025","DOIUrl":"10.1016/j.jss.2024.08.025","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"797-798"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391409","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":"Response Regarding: Physicians Are Unable to Consistently Predict Patient Health Literacy in a Breast Clinic.","authors":"Lena M Turkheimer, Shayna L Showalter","doi":"10.1016/j.jss.2024.08.024","DOIUrl":"10.1016/j.jss.2024.08.024","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"796"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391410","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(24)00698-X","DOIUrl":"10.1016/S0022-4804(24)00698-X","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Page xi"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700008","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}