Journal of Surgical Research最新文献

{"title":"Health Equity and Emergency Colorectal Surgery in the United States: A Scoping Review","authors":"Tamara Byrd MD ,&nbsp;Sebastian Boland MD ,&nbsp;Mary Lou Klem PhD, MLIS ,&nbsp;David Silver MD, MPH ,&nbsp;Liling Lu MS ,&nbsp;Matthew D. Neal MD ,&nbsp;Joshua B. Brown MD, MSc","doi":"10.1016/j.jss.2025.01.019","DOIUrl":"10.1016/j.jss.2025.01.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The emergency colorectal surgery population represents one of the most vulnerable subsets of the larger emergency general surgery population, characterized by increased complication rates, mortality rates, health resource utilization, and hospitalization costs. Disparities and inequities are documented for the emergency general surgery population and its emergency colorectal subset. Addressing health inequities can lead to decreased costs and improvement in patient outcomes; however, it is important to have a full scope of drivers of health inequities in different populations. We summarize the scope of literature that evaluates inequities in patients who undergo emergency colorectal surgery using two equity-based frameworks.</div></div><div><h3>Methods</h3><div>We conducted a systematic search using Medline, Embase, and Web of Science Core Collection databases. Articles were evaluated for inclusion based on evaluation of disparities, inequities, and social determinants in patients who underwent emergency abdominal colorectal surgery in the United States between 2014 and 2024. We extracted data based on components of the PROGRESS (place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital) framework and classified studies based on the Phases of Health Disparity Research framework.</div></div><div><h3>Results</h3><div>Twenty-two articles met inclusion criteria. Race/ethnicity was most commonly evaluated in studies (86%) followed by socioeconomic status/insurance status/income. Sex/gender, social support, language, social support, and religion were less commonly evaluated. The majority of the studies focused on malignant disease were in the detecting phase of disparities research.</div></div><div><h3>Conclusions</h3><div>Future studies evaluating inequities in the emergency colorectal surgery population should consider a comprehensive analysis of social factors and measures of structural racism.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 86-92"},"PeriodicalIF":1.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Control Trial Investigating the Effect of Different Treatment Strategies on Mitochondrial Function in Peripheral Arterial Disease-A Study Protocol","authors":"Laura Schoenherr MD ,&nbsp;Juliana Heidler PhD ,&nbsp;Michaela Kluckner MD ,&nbsp;Daniela Lobenwein MD ,&nbsp;Dominik Pesta PhD ,&nbsp;Jan Paul Frese MD ,&nbsp;Sabine Helena Wipper MD ,&nbsp;Alexandra Gratl MD","doi":"10.1016/j.jss.2025.01.014","DOIUrl":"10.1016/j.jss.2025.01.014","url":null,"abstract":"<div><div>Peripheral arterial disease encompasses different clinical symptoms, depending on the severity of the disease. In early stages, a walking-induced pain, known as intermittent claudication, is the leading clinical symptom. Repeating cycles of ischemia and reperfusion induce a typical myopathy, with mitochondria playing the key role within this pathophysiological condition. The aim of this study is to further evaluate the effects of different treatment strategies on mitochondrial function and overall cardiovascular outcomes within a randomized controlled trial. After inclusion, patients will be randomized into different study groups. Study group 1 will receive conservative treatment, while study group 2 will receive revascularization of underlying atherosclerotic lesions. Additionally, a healthy control group will be included. Muscle biopsies will be obtained from ischemic and nonischemic muscle regions, being defined by the anatomic localization of the atherosclerotic lesion, before initiation of treatment as well as after a time interval of 12 wk. Mitochondrial function and content will be evaluated using high-resolution respirometry and citrate synthase activity measurements. Cardiovascular outcomes will be determined by established protocols. This study is registered on <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>–NCT05644158. This study aims to gain further insights into the exact pathophysiological mechanism underlying mitochondrial dysfunction in peripheral arterial disease. The potential effects of mitochondrial regeneration within ischemic muscle regions following a conservative treatment approach will be compared to those reported after revascularization procedures. Additionally, correlation with cardiovascular outcome parameters and <em>in vivo</em> methods will provide a comprehensive approach to this research question.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 78-85"},"PeriodicalIF":1.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Robotic Surgical Approach in Peritoneal Carcinomatosis","authors":"Muhammad Talha Waheed MD ,&nbsp;Matthew C. Hernandez MD ,&nbsp;Ibrahim Malik BS ,&nbsp;Thinzar Lwin MD ,&nbsp;Yanghee Woo MD ,&nbsp;Isaac B. Paz MD ,&nbsp;Laleh Melstrom MD ,&nbsp;Yuman Fong MD ,&nbsp;Stephen J. Lee MD ,&nbsp;Mihae Song MD ,&nbsp;Thanh Dellinger MD ,&nbsp;Mehdi Moslemi-Kebria MD ,&nbsp;Ernest Han MD ,&nbsp;Mustafa Raoof MD","doi":"10.1016/j.jss.2025.01.016","DOIUrl":"10.1016/j.jss.2025.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Advances in robotic instrumentation have facilitated minimally invasive completion of complex cancer operations. The objective of this study is to determine the feasibility of robotic approach for cytoreduction (R-CRS) for peritoneal carcinomatosis in a series of 16 consecutive cases.</div></div><div><h3>Methods</h3><div>Single institution retrospective study of consecutive patients with peritoneal carcinomatosis deemed appropriate for R-CRS after multidisciplinary review between 2017 and 2022. Feasibility was defined as the proportion of patients in whom complete cytoreduction was achieved without conversion to open.</div></div><div><h3>Results</h3><div>A total of 16 patients (median interquartile range [IQR]: age 60 ys [45.8-70.5], body mass index 29 [24.5-33.6], peritoneal carcinomatosis index 5 [2.8-6.3]) underwent R-CRS of which six also received hyperthermic intraperitoneal chemtotherapy. Seven patients had gastrointestinal primary cancers (3 colorectal, 3 appendiceal, 1 small bowel neuroendocrine); and nine had gynecologic cancers (7 ovarian, 2 endometrial). Median operative time was 6.0 h (IQR: 5.0-9.0), and median estimated blood loss was 87.5 mL (IQR: 30.0-262.5). Robotic procedures included: pelvic tumor debulking 12 (75%), omentectomy 8 (50%), peritonectomy 6 (38%), large bowel resection 6 (37%), retroperitoneal mass resection 4 (25%), and hepatectomy 3 (19%). Median length of stay was 3.5 ds (IQR: 1.8-5.3) for the whole cohort and only 2 ds (IQR: 1.0-5.5) for patients who did not undergo hyperthermic intraperitoneal chemotherapy. Feasibility rate was 87.5%, whereas conversion, 30-d complication, and 30-d mortality rates were 12.5%, 18.8%, and 0%, respectively.</div></div><div><h3>Conclusions</h3><div>Our experience with R-CRS demonstrates feasibility of the approach with a potential for benefit in short-term outcomes in a carefully selected cohort of patients when performed at a high-volume robotic surgery center.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 70-77"},"PeriodicalIF":1.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464651","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 Surgery for Patients With Coexisting Heart and Lung Disease: A Retrospective Study","authors":"Yibo Yin MD ,&nbsp;Chaoyang Tong PhD ,&nbsp;Hongwei Zhu MD ,&nbsp;Jingxiang Wu PhD","doi":"10.1016/j.jss.2025.01.012","DOIUrl":"10.1016/j.jss.2025.01.012","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal surgical approach and the associated adverse outcomes in patients with lung cancer and heart disease remain unknown. This study was designed to explore the potential influence of simultaneous or staged surgery on the perioperative and oncological outcomes of these patients.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study analyzed 158 patients who underwent cardiac and thoracic surgery between January 2016 and December 2021. The patients were divided into two groups according to the timing of surgery: simultaneous and staged. Perioperative and oncologic outcomes between the two groups were compared using 1:1 propensity score matching analysis and Kaplan–Meier analysis.</div></div><div><h3>Results</h3><div>In the 50 patients (72% male, mean age 60.9 ± 11.7 y) of the simultaneous surgery group, 10 (20%) developed tumor metastasis or recurrence and 6 (12%) died from tumor metastasis. In the staged surgery group, with 108 patients (75% male, mean age 66.1 ± 8.4 y), 18 (16.7%) developed tumor metastasis or recurrence, and 8 (7.4%) died. There was no significant difference in overall survival or progression-free survival between the groups. Compared with the staged surgery group, the simultaneous surgery group had a higher incidence of pulmonary infection (3.7% <em>versus</em> 18.0%; <em>P</em> = 0.002), longer operative time (173.9 ± 104.4 <em>versus</em> 295.6 ± 77.1 min; <em>P</em> &lt; 0.001), increased intraoperative blood loss (89.2 ± 53.1 <em>versus</em> 386.0 ± 207.0 mL; <em>P</em> &lt; 0.001), and a prolonged hospital stay (7.0 ± 3.1 <em>versus</em> 16.5 ± 6.1 d; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>For patients with concurrent lung cancer and heart disease, staged surgery holds certain advantages when it comes to postoperative complications. Further researches are still needed to verify these findings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 53-61"},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464652","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":"Quantitative and Qualitative Analysis of Clinical Trial Acronyms From Surgical Journals","authors":"Hong-min Ahn MD ,&nbsp;Hyeon Woo Shin ,&nbsp;Heung-Kwon Oh MD, PhD ,&nbsp;Yoon Ju Jung MD ,&nbsp;Anuj Naresh Singhi MD ,&nbsp;Min Hyeong Jo MD ,&nbsp;Mi Jeong Choi MD ,&nbsp;Tae-Gyun Lee MD ,&nbsp;Hye Rim Shin MD ,&nbsp;Duck-Woo Kim MD, PhD ,&nbsp;Sung-Bum Kang MD, PhD","doi":"10.1016/j.jss.2025.01.009","DOIUrl":"10.1016/j.jss.2025.01.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Acronyms, the short form of a word or phrase, are commonly used in medical research to identify studies. However, their usage and quality assessment in surgical journals are unclear. This study aimed to determine the impact of identifying acronyms for clinical studies on the number of citations by comparing studies published in surgical and medical journals.</div></div><div><h3>Methods</h3><div>Articles were screened from five highly cited journals (<em>Annals of Surgery, British Journal of Surgery, JAMA Surgery, Journal of the American College of Surgeons,</em> and <em>New England Journal of Medicine,</em> alphabetically). The correlation between acronym use and number of citations was analyzed. In addition, the characteristics and quality of acronyms, in terms of lettering and wording scores, used to identify studies were evaluated for acronymous trials using a developed and self-validated scoring tool.</div></div><div><h3>Results</h3><div>Of 291 eligible articles, 167 (57.4%) were acronymous studies. Although 70.5% (122/173) of articles in general medical journals used identifying acronyms, only 38.1% (45/118) used them in surgical journals (<em>P</em> &lt; 0.001). The median number of citations was higher for acronymous studies (212 <em>versus</em> 53; <em>P</em> &lt; 0.001). Multivariable analysis revealed that acronymous studies had a 2.5-fold higher possibility of being a highly cited (odds ratio 2.514, <em>P</em> = 0.004). The average quality scores of the acronyms were similar for surgical and general medical journals (5.1 ± 1.7 <em>versus</em> 5.1 ± 1.6, <em>P</em> = 0.949). Surgical journals had lower lettering (2.20 ± 1.14 <em>versus</em> 3.02 ± 1.04, <em>P</em> &lt; 0.001) but higher wording scores (2.89 ± 1.01 <em>versus</em> 2.09 ± 1.14, <em>P</em> &lt; 0.001) than general medical journals.</div></div><div><h3>Conclusions</h3><div>Given the publicity effect of acronyms, a memorable acronym devised using the first or continuous letters for surgical studies may help recognize their clinical impact.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 62-69"},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464032","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":"Expression and Subtype Discordance Between Core Needle Biopsy and Surgical Specimen in Breast Cancer","authors":"Min Xu MS ,&nbsp;Yiwei Yan MA ,&nbsp;Yueqin Chen MS ,&nbsp;Xiaobin Chen MD ,&nbsp;Kai Gong MD ,&nbsp;Fangmeng Fu MD, PhD","doi":"10.1016/j.jss.2025.01.010","DOIUrl":"10.1016/j.jss.2025.01.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptors 2 (HER2s) are crucial for the molecular subtype classification and therapy decision-making in breast cancer. Core needle biopsy (CNB) serves as an essential preoperative diagnostic tool for biomarker evaluation, offering minimal invasiveness and convenience. However, CNB has limitations including insufficient sampling volume, sampling errors, underestimation and false results. This study evaluated the discordance of ER, PR, HER2, and molecular subtype between CNB and surgical specimen (SS) in breast cancer, explored the factors associated with discordance and discussed which specific breast cancer cases were recommended for retesting.</div></div><div><h3>Materials and methods</h3><div>Medical records of invasive breast cancer patients admitted to Fujian Medical University Union Hospital from January 2014 to January 2020 were retrospectively collected. Immunohistochemistry and fluorescence <em>in situ</em> hybridization were used to assess the status of ER, PR, and HER2 in both CNB and SS. The agreement analyses were performed using the Kappa test. Univariable and multivariable logistic regressions were employed to identify factors associated with discordance of biomarkers and molecular subtypes.</div></div><div><h3>Results</h3><div>A total of 2099 patients were included in the study. Discordance rates were 3.9% (<em>n</em> = 82) for the ER, 4.8% (<em>n</em> = 101) for PR and 1.2% (<em>n</em> = 25) for HER2. High agreement was observed between CNB and SS for ER (<em>κ</em>=0.899), PR (<em>κ</em>=0.896) and HER2 (<em>κ</em>=0.972). There were 344 cases of molecular typing discordance, with the majority (<em>n</em> = 226, 65.7%) occurring between Luminal A and Luminal B (HER2-). Factors of ER discordance were large tumor size (OR = 8.715, <em>P</em> &lt; 0.001), ER-low biopsy status (OR = 49.959, <em>P</em> &lt; 0.001) and PR-high biopsy status (OR = 0.046, <em>P</em> &lt; 0.001. Factors of molecular subtype discordance were carcinoma <em>in situ</em> (OR = 1.930, <em>P</em> = 0.007), ER-low biopsy status (OR = 40.527, <em>P</em> &lt; 0.001) and Ki67-high biopsy status (OR = 0.332, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>CNB showed good accuracy in evaluating ER, PR, HER2, and molecular subtypes in breast cancer. However, concerning the factors associated with discordance, we recommend retesting for three CNB cases (1) ER-negative and PR-positive, (2) ER low-expression and PR-negative, and (3) Luminal A subtype with tumors ≤2 cm, which might offer a valuable reference for clinical decision-making.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 42-52"},"PeriodicalIF":1.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tumor Immune Microenvironment Differences Associated With Racial Disparities in Pancreatic Cancer","authors":"Zachary Gao MD ,&nbsp;Joseph Azar MD ,&nbsp;Derek Erstad MD ,&nbsp;Zequn Sun PhD ,&nbsp;Harinarayanan Janakiraman PhD ,&nbsp;Dongjun Chung PhD ,&nbsp;David Lewin MD ,&nbsp;Hyun-Sung Lee MD PhD ,&nbsp;George Van Buren MD ,&nbsp;William Fisher MD ,&nbsp;Mark P. Rubinstein PhD ,&nbsp;E. Ramsay Camp MD","doi":"10.1016/j.jss.2025.01.005","DOIUrl":"10.1016/j.jss.2025.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial differences in antitumoral immunity have been identified in a variety of cancers and may contribute to survival disparities, but limited data exist exploring the molecular differences in pancreatic adenocarcinoma (PDAC). Using racially diverse PDAC datasets, we explored biologic differences that may drive disparities between African American (AA) and European American (EA) PDAC patients.</div></div><div><h3>Methods</h3><div>Genomic PDAC mutational data was analyzed for mutational differences based on race. In a separate cohort, surgical PDAC specimens were processed for both tissue microarray and multiplex gene expression analysis using NanoString.</div></div><div><h3>Results</h3><div>Of the 4679 patient samples in the mutational dataset, AA PDAC patients had significantly more TP53 mutations compared to the EA cohort. The tissue microarray included 12 AA and 41 EA surgically resected treatment-naive PDAC samples. NanoString analysis revealed significant differences between AA and EA groups in immunologic gene annotations (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>In the present study, we demonstrated that across racially diverse datasets, there exist molecular and microenvironmental differences between AA and EA patients that may contribute to cancer survival disparities. Defining molecular differences underlying PDAC racial disparities is an essential step in advancing care and improving outcomes for AA patients that suffer worse survival across cancer types.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 21-32"},"PeriodicalIF":1.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Biopsy Is Not Associated With Adverse Outcomes in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Upfront Resection","authors":"Maximiliano Servin-Rojas MD ,&nbsp;Louisa Bolm MD ,&nbsp;Keith D. Lillemoe MD,&nbsp;Zhi Ven Fong MD, MPH, DrPH,&nbsp;Raja R. Narayan MD, MPH,&nbsp;Carlos Fernández-Del Castillo MD,&nbsp;Motaz Qadan MD, PhD","doi":"10.1016/j.jss.2025.01.007","DOIUrl":"10.1016/j.jss.2025.01.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Obtaining a preoperative histological diagnosis in patients with resectable pancreatic disease has traditionally not been routinely sought, citing concerns in biopsy-associated complications, and risk of tumor seeding. We sought to determine if preoperative biopsy was associated with worse outcomes, including overall survival (OS).</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of the National Cancer Database including adult patients with clinical stage I-III pancreatic ductal adenocarcinoma who underwent upfront surgical resection. Univariate and multivariable analyses were conducted to determine if undergoing a preoperative biopsy was associated with impaired OS, increased 30-d readmissions, or delayed return to intended oncologic therapy (RIOT), defined by receipt of adjuvant therapy.</div></div><div><h3>Results</h3><div>A total of 19,361 patients underwent upfront resection, of whom 11,038 (57%) underwent preoperative biopsy. Patients were more likely to undergo a preoperative biopsy if they were Black (11% <em>versus</em> 9%, <em>P</em> = 0.003), privately insured (34% <em>versus</em> 32%, <em>P</em> &lt; 0.001), treated at academic facilities (58% <em>versus</em> 56%, <em>P</em> &lt; 0.001), had tail tumors (14% <em>versus</em> 13%, <em>P</em> = 0.006), and were clinical stage II (44% <em>versus</em> 40%, <em>P</em> &lt; 0.001). There was no difference in median OS between groups (23.0 mos <em>versus</em> 23.5 mos, <em>P</em> = 0.21). In multivariable analysis, preoperative biopsy did not predict OS, 30-d readmissions, or RIOT.</div></div><div><h3>Conclusions</h3><div>Preoperative biopsy was conducted in 57% of patients undergoing upfront resection and was not associated with impaired OS. Although surgical complications could not be evaluated, there were no differences in 30-d readmissions or RIOT. Preoperative biopsy appears oncologically safe and may help ensure an accurate diagnosis before pancreatectomy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 33-41"},"PeriodicalIF":1.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429789","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":"Simplified Enhanced Recovery After Surgery Intraoperative Fluid Management","authors":"Hilary Gallin MD, MBA ,&nbsp;Marcus V. Ortega MD ,&nbsp;Rachel Sisodia MD ,&nbsp;Jason H. Wasfy MD MPhil ,&nbsp;Jeffrey Ecker MD ,&nbsp;Michael Dezube MEng ,&nbsp;Michael K. Hidrue PhD ,&nbsp;Marcela G. del Carmen MD, MPH ,&nbsp;Dan B. Ellis MD","doi":"10.1016/j.jss.2025.01.006","DOIUrl":"10.1016/j.jss.2025.01.006","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluates the efficacy of a simplified intraoperative fluid administration metric within enhanced recovery after surgery (ERAS) pathways. The objective is to optimize fluid management to improve postoperative outcomes, specifically kidney function.</div></div><div><h3>Methods</h3><div>A retrospective evaluation was conducted at Massachusetts General Hospital on adult patients who underwent open hysterectomy, colectomy, and gastrectomy as part of ERAS pathways. The proposed fluid metric, set at 500 mL/h, was assessed against traditional methods of fluid administration. Data on serum creatinine (Cr) changes as defined as the difference between the baseline value and the maximum value within 1 week of surgery were collected, and compliance with the metric was monitored. Analysis involved Wilcoxon rank-sum test, Kruskal–Wallis test, and quantile regression.</div></div><div><h3>Results</h3><div>The study included 1028 patients. Regression analysis indicated that compared to patients who received the optimal fluid quantity, those receiving below the optimal range showed an absolute increase in median Cr levels of 0.03 mg/dl (95% confidence interval = −0.005, 0.05) while those who received above the optimal range demonstrated an absolute increase in median Cr level of 0.01 (95% confidence interval = −0.03, 0.05).</div></div><div><h3>Conclusions</h3><div>The new fluid metric demonstrated a balanced approach to fluid administration, reducing the risk of overhydration while maintaining sufficient hydration. Additionally, implementing a simplified fluid metric of 500 mL/h in ERAS pathways is effective in improving postoperative kidney function. This approach facilitates adherence to fluid guidelines and can be applied across various healthcare settings. This metric serves as a practical, evidence-based pathway for fluid administration for most patients undergoing most ERAS procedures.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 14-20"},"PeriodicalIF":1.8,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419150","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":"Risk of Severe Sepsis After Blood Product Administration for Traumatic Hemorrhage: A Trauma Quality Improvement Program Study","authors":"Lauren T. Gallagher MD ,&nbsp;Mitchell J. Cohen MD ,&nbsp;Franklin L. Wright MD ,&nbsp;Julie M. Winkle MD ,&nbsp;David J. Douin MD ,&nbsp;Michael D. April MD, DPhil, MSc ,&nbsp;Andrew D. Fisher MD, MPAS ,&nbsp;Julie A. Rizzo MD ,&nbsp;Steven G. Schauer DO, MS","doi":"10.1016/j.jss.2024.12.009","DOIUrl":"10.1016/j.jss.2024.12.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Transfusion of whole blood (WB) for traumatic hemorrhage has generated renewed interest in civilian trauma based on military experience. The association between blood products and severe sepsis remains unknown. We sought to determine which blood products were associated with the development of severe sepsis.</div></div><div><h3>Methods</h3><div>We utilized the TQIP database from 2020 to 2021. We included patients ≥15 ys of age who received at least one blood product and survived at least 24 hs. Severe sepsis is a standardized core quality measure for all reporting centers and defined as sepsis with organ dysfunction. We used descriptive, inferential, and multivariable logistic regression methods to test for associations and adjust for confounders.</div></div><div><h3>Results</h3><div>There were 83,924 patients included, of whom 1471 met criteria for severe sepsis. Patients with severe sepsis tended to be older (47 <em>versus</em> 42, <em>P</em> &lt; 0.001), male (79% <em>versus</em> 74%, <em>P</em> &lt; 0.001), have a higher injury severity score (29 <em>versus</em> 19, <em>P</em> &lt; 0.001), higher proportion of serious injuries to the thorax (65% <em>versus</em> 47%, <em>P</em> &lt; 0.001), abdomen (54% <em>versus</em> 32%, <em>P</em> &lt; 0.001), and extremities (45% <em>versus</em> 32%, <em>P</em> &lt; 0.001). Severe sepsis patients received more packed red cells, WB, platelets, cryoprecipitate, and plasma. When adjusting for age, sex, mechanism of injury, and injury severity score, WB was positively associated with severe sepsis (unit odds ratio 1.04, 95% confidence interval 1.01-1.07).</div></div><div><h3>Conclusions</h3><div>Within this dataset, we found a 4% increased odds of sepsis with each unit of WB received among civilian trauma patients. The effects of blood product administration on immune system function remain unclear. High-quality, prospective explanatory studies are needed to better understand this relationship.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"307 ","pages":"Pages 8-13"},"PeriodicalIF":1.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394653","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}