Journal of Surgical Research最新文献

{"title":"Cost of Veteran Coronary Artery Bypass Grafting: Veterans Health Administration Versus Community Care","authors":"Jake L. Cotton MD ,&nbsp;Adnan Syed BS ,&nbsp;Danielle Abbitt MD ,&nbsp;Andrew Mecum BA ,&nbsp;Chiagoziem Anigbogu BA ,&nbsp;Teresa S. Jones MD ,&nbsp;Muhammad Aftab MD ,&nbsp;Jessica Y. Rove MD ,&nbsp;Edward L. Jones MD","doi":"10.1016/j.jss.2025.09.001","DOIUrl":"10.1016/j.jss.2025.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The community care program within the Veterans Health Administration (VHA) funds veteran care in the community. Cost of this program has increased with limited comparisons between VHA and community care hospitals. We seek to compare differences in cost of coronary artery bypass grafting (CABG) between VHA and community care hospitals.</div></div><div><h3>Methods</h3><div>We perform a retrospective cohort review of veterans undergoing CABG between October 1, 2018, and September 30, 2020, within VHA and community care hospitals within Veteran Integrated Service Network 19. Cost of index hospitalization was measured using VHA databases.</div></div><div><h3>Results</h3><div>Three hundred sixty-one veterans met final inclusion criteria at a total of 37 hospitals. One hundred ninety-five (54%) underwent surgery within the VHA and 166 (46%) underwent surgery in the community. CABG performed within the VHA were similar in cost to community (VHA median [interquartile range]: $122,213 [$80,829-$162,586] <em>versus</em> community: $112,923 [$74,797-$154,729]; <em>P</em> = 0.23), despite a longer postoperative length of stay. When controlling for other factors including hospital length of stay with a log gamma model, VHA performed CABG were less expensive than community (<em>P</em> = 0.007). There was no difference in index hospitalization metrics and 30-d outcomes.</div></div><div><h3>Conclusions</h3><div>CABG within the VHA is lower cost than community care after controlling for other factors. Continuous evaluation of community care cost is necessary to ensure efficient use of funding and program sustainability.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 145-150"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213087","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":"Silence of the Brittle: The Role of Frailty in Pain Perception and Management in Geriatric Trauma Patients.","authors":"Mohammad Al Ma'ani, Francisco Castillo Diaz, Muhammad Haris Khurshid, Omar Hejazi, Tanya Anand, Audrey L Spencer, Collin Stewart, Anastasia Kunac, Louis J Magnotti, Bellal Joseph","doi":"10.1016/j.jss.2025.06.079","DOIUrl":"10.1016/j.jss.2025.06.079","url":null,"abstract":"<p><strong>Introduction: </strong>Pain management in geriatric trauma patients is linked to improved quality of life and better outcomes. However, the role of patient-related factors in pain perception and management is unknown. The aim of our study is to assess whether frailty is associated with differences in daily pain scores and analgesic use among geriatric trauma patients.</p><p><strong>Methods: </strong>We performed a 2-y (2021-2022) analysis of geriatric database at our level I trauma center. We included all geriatric (≥65 y) patients admitted to our trauma service with normal neurological exam and length of stay >48 h. Patients were stratified using the trauma-specific frailty index into frail (F) and nonfrail (NF) groups. Daily pain scores (10-point numeric scale), the highest reported pain score during the admission, regional and systemic analgesia received in the first 7 d, and overall analgesic requirements were recorded and compared. Analgesics were converted to morphine milligram equivalents. Descriptive statistics and multivariable linear regression analyses, adjusting for potential confounding factors were performed.</p><p><strong>Results: </strong>We identified a total of 275 geriatric trauma patients (NF 167, F 108). The mean age was 78 (8) y and 52% were male. The median injury severity score was 9 [4-10], with 93% sustaining blunt injuries. There were no significant differences in terms of patients' demographic and injury characteristics between F and NF groups. On univariate analysis, the F group were less likely to report pain and had significantly lower opioid morphine milligram equivalent requirements in the first week of admission and overall. On linear regression analysis, frailty was independently associated with lower average pain scores in the first week (β = -1.81, 95% confidence interval [CI] [-3.51 to -0.11], P = 0.038), lower overall highest pain scores (β = -0.97, 95% CI [-1.64 to -0.302], P = 0.05), and received less opioids per day in the first week (β = -10.63, 95% CI [-16.55 to -4.71], P < 0.001) and overall (β = -15.02, 95% CI [-22.81 to -7.24], P < 0.001). Subanalysis of patients substratified by injury severity score showed similar trends.</p><p><strong>Conclusions: </strong>Frailty was associated with lower reported pain scores and reduced opioid use, regardless of injury severity. Whether these discrepancies are owing to differences in pain perception by patients or under-reporting it to health-care providers is yet to be understood. These findings lay the foundation for further research to explore the role of frailty on the pathophysiology of pain in geriatric trauma patients.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"291-297"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817029","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(25)00601-8","DOIUrl":"10.1016/S0022-4804(25)00601-8","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Page xi"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219611","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":"Should We Utilize Regional Anesthesia for Traumatic Rib Fracture Patients? A TQIP-Based Study.","authors":"Marina Levochkina, Carter Colwell, Taneen Maghsoudi, Katie Bower, Tonja Locklear, Maxine Lee, Michael Saccocci, Hunter Sharp, Joshua Stodghill","doi":"10.1016/j.jss.2025.06.091","DOIUrl":"10.1016/j.jss.2025.06.091","url":null,"abstract":"<p><strong>Introduction: </strong>Rib fractures are a common injury in trauma patients and can lead to pneumonia, respiratory failure, and mortality. Multimodal analgesia, alone or with regional anesthetic (epidural or local block), is a mainstay in management. Single-institution studies have evaluated the effectiveness of regional anesthesia with varied results. This study utilized national trauma registry (Trauma Quality Improvement Program [TQIP]) data to evaluate the association between regional anesthesia and mortality, as well as secondary outcomes of hospital complications and ventilator/intensive care unit (ICU)/hospital length of stay (HLOS).</p><p><strong>Materials and methods: </strong>Utilizing TQIP data from 2021, all patients with isolated chest trauma were identified. Data collected included demographic, medical comorbidities, injury severity, type of injury, hospital complications, ventilator/ICU/HLOS, and in-hospital mortality. Patients were categorized as those receiving regional anesthesia (epidural or peripheral nerve block) or no regional anesthesia. Propensity matching was performed, and outcomes were compared.</p><p><strong>Results: </strong>After propensity matching, 1295 patients were included in each group. There was no significant difference in in-hospital mortality between the two groups. Increased HLOS, ICU admissions, unplanned intubations, and unplanned upgrade to the ICU were associated with regional anesthesia. There were no other significant differences in outcomes between the two groups.</p><p><strong>Conclusions: </strong>A review of TQIP data did not detect a difference in mortality with regional anesthesia for rib fracture management. Rather, regional anesthesia was associated with increased HLOS, ICU admissions, unplanned intubations, and unplanned upgrade to the ICU. Further study is warranted to assess if subsets of patients might benefit from these procedures.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"273-283"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804308","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: Prior Emergency Department Utilization and Nonaccidental Trauma in Children","authors":"R. Scott Eldredge MD,&nbsp;Lois W. Sayrs PhD,&nbsp;David M. Notrica MD","doi":"10.1016/j.jss.2025.06.045","DOIUrl":"10.1016/j.jss.2025.06.045","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 716-717"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707897","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: Comparison of Risk Assessment Tools’ Prediction of Outcomes for Penetrating Trauma","authors":"Pouria Farahani,&nbsp;Reza Kamyab MD,&nbsp;Amirhossein Keshavarz MD","doi":"10.1016/j.jss.2025.05.031","DOIUrl":"10.1016/j.jss.2025.05.031","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 718-719"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804304","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":"Opioid Administration in Complex Ventilated Patients in a Surgical Intensive Care Unit","authors":"Macllain R. Edington BS ,&nbsp;Allison Wells MS ,&nbsp;Hanna Jensen MD, PhD ,&nbsp;Brett Bailey PharmD ,&nbsp;Kyle J. Kalkwarf MD","doi":"10.1016/j.jss.2025.09.014","DOIUrl":"10.1016/j.jss.2025.09.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective pain management in the surgical intensive care unit (SICU) is challenging, particularly for ventilated patients requiring neuromuscular blockade (NMB) infusions or extracorporeal membrane oxygenation (ECMO) support. While opioids are effective, they pose risks like sedation, respiratory depression, and withdrawal. Data on how NMB and ECMO influence opioid utilization patterns in ventilated SICU patients remain limited. We hypothesized that NMB and ECMO are associated with increased opioid utilization.</div></div><div><h3>Materials and methods</h3><div>This retrospective observational study was conducted at a single academic medical center. Data were extracted from the electronic health record and visualized using a business intelligence tool. Patients were grouped by ECMO status and then further stratified into four groups based on the combinations of ECMO and NMB. Statistical analyses included chi-square tests, <em>t</em>-tests, Wilcoxon rank-sum tests, and multivariable linear regression models.</div></div><div><h3>Results</h3><div>A total of 1550 patients were included in the study, including 23 ECMO-supported patients and 1527 non-ECMO patients. Within ECMO patients, NMB was associated with 265.1% higher opioid use (774.89 <em>versus</em> 212.24 MME/patient/d, <em>P</em> = 0.007), while non-ECMO patients with NMB had 226.5% higher opioid use (558.23 <em>versus</em> 170.97 MME/patient/d, <em>P</em> &lt; 0.001). Among NMB patients, opioid use was similar between ECMO and non-ECMO patients (<em>P</em> = 0.112). Among non-NMB patients, opioid use was also similar between ECMO and non-ECMO patients (<em>P</em> = 0.725).</div></div><div><h3>Conclusions</h3><div>NMB infusions were associated with increased opioid utilization in these patients, whereas ECMO alone was not significantly associated with opioid use. These findings underscore the need for strategies to reduce excessive opioid use in this complex population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 139-144"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Isoperistaltic Anastomosis Increases Neo-Terminal Ileum Intubation Rates in Crohn's Disease Patients.\" J Surg Res. 2025 Jul 21;313:421-430.","authors":"Tamar Thurm, Galia Berman, Ayal Hirsch, Liat Deutsch, Nathaniel Aviv Cohen, Haim Leibovitzh, Yulia Ron, Nadav Dvir, Eran Itzkovitz, Hagit Tulchinsky, Jonathan B Yuval, Yehuda Kariv, Guy Lahat, Nitsan Maharshak, Meir Zemel","doi":"10.1016/j.jss.2025.08.001","DOIUrl":"10.1016/j.jss.2025.08.001","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"742"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958559","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":"Normothermic Machine Perfusion and Liver Transplant Waitlist Times: A Single-Center Matched Cohort Study","authors":"Belen Rivera MD ,&nbsp;Gabriel Cojuc-Konigsberg MD ,&nbsp;Stalin Canizares MD ,&nbsp;Ritah R. Chumdermpadetsuk MD ,&nbsp;Martin Dib MD ,&nbsp;David Lee MD ,&nbsp;Devin E. Eckhoff MD","doi":"10.1016/j.jss.2025.03.064","DOIUrl":"10.1016/j.jss.2025.03.064","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Normothermic machine perfusion (NMP) is a promising technology for expanding the donor liver pool. This study aims to evaluate the association between the implementation of NMP on </span>liver transplant waitlist times at a single center.</div></div><div><h3>Methods</h3><div><span>We conducted a retrospective cohort study of patients who underwent liver transplant at Beth Israel Deaconess Medical Center from 2014 to 2024. Waitlist times were compared between pre-NMP and post-NMP implementation periods. Matched cohorts based on sex, age, and the model for end-stage liver disease score were used to compare patients who received machine-perfused livers (NMP group) and those who did not (non-NMP group). Waitlist duration, donor type, hospital stay, overall survival, and </span>graft failure were measured. A subgroup of patients diagnosed with hepatocellular carcinoma (HCC) was analyzed.</div></div><div><h3>Results</h3><div>Of 429 patients, median waitlist times were significantly reduced from 309 d pre-NMP to 48 d post-NMP (<em>P</em> &lt; 0.001). In the matched analysis, the NMP group had a median waitlist time of 71 d, compared to 345 d for non-NMP group (<em>P</em> &lt; 0.001). The NMP group had a 2-d shorter hospital stay than the non-NMP group (<em>P</em> &lt; 0.001). For HCC patients, waitlist times decreased from 472 d pre-NMP to 83 d post-NMP (<em>P</em> &lt; 0.001), and in the matched HCC cohorts, waitlist times decreased from 492 d to 121 d in the non-NMP and NMP groups, respectively (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>NMP implementation was associated with significantly shorter liver transplant waitlist times and reduced hospital stays, without compromising short-term survival outcomes. NMP may address the liver transplant shortage and improve access for patients, particularly those with HCC.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 707-715"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225801","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":"AAS Fall Courses JSR Ad 2025","authors":"","doi":"10.1016/S0022-4804(25)00609-2","DOIUrl":"10.1016/S0022-4804(25)00609-2","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Page xii"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219612","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}