Journal of Surgical Research最新文献

{"title":"Instrument Tray Standardization for Pediatric Laparoscopic Appendectomy: A Sustainability Initiative","authors":"William G. Lee MD,&nbsp;Shannon T. Wong-Michalak MD,&nbsp;Vikram Krishna MD,&nbsp;Eveline H. Shue MD,&nbsp;Juan Carlos Pelayo MD,&nbsp;Eugene S. Kim MD","doi":"10.1016/j.jss.2025.07.040","DOIUrl":"10.1016/j.jss.2025.07.040","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare-related carbon dioxide emissions (CO₂e) account for 8.5% of national greenhouse gas emissions, with high-volume disposable instrument use and high-energy sterilization of reusable instruments as large contributors. Instrument standardization for common surgical procedures has been shown to reduce cost, but few studies have evaluated the environmental impact of this practice. We sought to evaluate the association between instrument-based carbon emissions and instrument tray standardization for pediatric laparoscopic appendectomy.</div></div><div><h3>Materials and Methods</h3><div>A collaborative multidepartmental needs assessment was performed at a tertiary academic medical center to create a standardized instrument tray for laparoscopic appendectomy cases. Following tray implementation, a retrospective cohort study of children (≤ 18 y) who underwent laparoscopic appendectomy between January 8, 2022 and January 4, 2024, was conducted. Outcomes included instrument-based carbon footprint per case (kilograms of CO₂e), number of instruments used per case (disposable, reusable), instrument-based cost per case, and procedure time. Outcomes were compared before and after standardized tray implementation using Mann–Whitney U and chi-square tests.</div></div><div><h3>Results</h3><div>Fifty-three patients underwent laparoscopic appendectomy with no difference in demographic/clinical characteristics or 30-d clinical outcomes before versus after standardized tray implementation. Postimplementation, the median carbon footprint per case decreased from 113.2 kg CO₂e to 75.5 kg CO₂e (<em>P</em> = 0.04). The median number of disposable instruments (<em>P</em> &lt; 0.001), reusable instruments (<em>P</em> = 0.02), and instrument trays (<em>P</em> &lt; 0.001) used per case also decreased after implementation. However, total procedure time (<em>P</em> = 0.695) and instrument-based cost per case (<em>P</em> = 0.087) did not decrease significantly.</div></div><div><h3>Conclusions</h3><div>Instrument tray standardization for pediatric laparoscopic appendectomy may reduce our carbon footprint by decreasing the volume of instruments used per case. These findings highlight the environmental benefits of optimizing instrument variability in pediatric surgery.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 334-339"},"PeriodicalIF":1.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841719","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":"Review of Open Payments Received by Department of Surgery Faculty at a Large Academic Institution","authors":"Azeem Izhar MBBS ,&nbsp;Bipul Mainali BS ,&nbsp;Ramsha Akhund MD ,&nbsp;Raj Roy MBBS ,&nbsp;Andrea Gillis MD ,&nbsp;Brenessa Lindeman MD, MEHP ,&nbsp;Jessica M. Fazendin MD ,&nbsp;Herbert Chen MD","doi":"10.1016/j.jss.2025.07.031","DOIUrl":"10.1016/j.jss.2025.07.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Increased scrutiny of physician–industry relationships has underscored the need to better understand payment patterns across medical specialties. Our study leverages the Open Payments Database to analyze payments made to the faculty members, aiming to identify payment patterns and provide insights into the evolving financial dynamics between the industry and health care professionals.</div></div><div><h3>Methods</h3><div>We examined data for 136 faculty members in the Department of Surgery at our institution from the Open Payments Database (<span><span>https://openpaymentsdata.cms.gov/</span><svg><path></path></svg></span>) for 2023. All faculty members with at least one nonresearch payment were included. The total, mean, and median payment values were compared across the nine divisions within the Department of Surgery, by sex and faculty rank (assistant, associate, and full professor).</div></div><div><h3>Results</h3><div>Substantial differences were noted between divisions; 83% cardiothoracic surgical faculty received payments, whereas no payments were recorded for pediatric surgical faculty. A major portion of the payments were made to the gastrointestinal surgical faculty amounting $305,733 (77% of the total). Nearly all faculty (95%) had payments under $10,000, and of those, 70.5% received under $1000. The largest sum of payments (41%) was made in the education category. Associate professors had the highest median payment at $502, followed by assistant professors at $298, and full professors received the lowest median amount of payment at $264.</div></div><div><h3>Conclusions</h3><div>The gap in payments is attributed to a few faculty members receiving substantial sums at the associate and full professor levels. The majority of faculty studied received small total sums, indicating that variations in compensation among surgery divisions are primarily driven by a few large payments.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 347-352"},"PeriodicalIF":1.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841636","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":"Scaling Smarter Preoperative Testing: A Multisite Evaluation of Adaptations to De-implementation Strategy Using Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies","authors":"Erin Kim MPH ,&nbsp;Nicole M. Mott MD, MSCR ,&nbsp;Dana Greene Jr. MPH ,&nbsp;Valerie Mefford MPH ,&nbsp;Anthony Cuttitta MPH ,&nbsp;Shawna N. Smith PhD ,&nbsp;Eve A. Kerr MD, MPH ,&nbsp;Anthony L. Edelman MD, MBA, FASA ,&nbsp;Michael R. Mathis MD ,&nbsp;Michael J. Englesbe MD ,&nbsp;Hari Nathan MD, PhD ,&nbsp;Lesly A. Dossett MD, MPH","doi":"10.1016/j.jss.2025.07.033","DOIUrl":"10.1016/j.jss.2025.07.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Unnecessary preoperative testing before low-risk surgery contributes to excess healthcare costs, care cascades, and surgical delays. The Right-Sizing Testing Before Elective Surgery intervention is a multilevel, multicomponent intervention piloted at three hospital sites to reduce low-value testing. To understand how the de-implementation strategies could be tailored across diverse healthcare settings, we applied the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) to track site-specific modifications.</div></div><div><h3>Methods</h3><div>The Right-Sizing Testing Before Elective Surgery intervention components included a site visit, a decision aid, implementation coaching, facilitation, and audit and feedback. From March to August 2024, the intervention was piloted at three Michigan hospitals with varied sizes, workflows, and baseline testing patterns. Semi-structured interviews were conducted with stakeholders after implementation. Using FRAME-IS, we analyzed interview transcripts and field notes from site visits and coaching sessions to identify and compare intervention modifications.</div></div><div><h3>Results</h3><div>Using FRAME-IS, we identified nine unique modifications, varying by type, level of implementation, and rationale. Content modifications involved alternative risk-classification methods within the decision aid. Evaluation changes addressed the need for more timely or detailed data for audit and feedback. Training adaptations included case-based exercises for low adopters, and context adaptations involved repackaging printed materials. All modifications were fidelity-consistent and aligned with local infrastructure and workflows.</div></div><div><h3>Conclusions</h3><div>A multicomponent intervention can be adapted to diverse clinical settings while maintaining fidelity to its core components. These findings can inform broader de-implementation efforts by illustrating how tailoring interventions enhances alignment with local workflows, infrastructure, and organizational context.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 353-361"},"PeriodicalIF":1.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841657","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":"Endovascular Revascularization: A Limb Salvage Strategy After Lower Extremity Burns","authors":"Desiree N. Pinto MD, MPH ,&nbsp;Isabel Snee BS ,&nbsp;Saher Sabri MD ,&nbsp;Bonnie C. Carney PhD ,&nbsp;Melissa M. McLawhorn RN, BSN ,&nbsp;Lauren T. Moffatt PhD ,&nbsp;Taryn E. Travis MD ,&nbsp;Jeffrey W. Shupp MD ,&nbsp;Shawn Tejiram MD","doi":"10.1016/j.jss.2025.07.027","DOIUrl":"10.1016/j.jss.2025.07.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Wound complications and amputations are common after lower extremity burn injury in patients with diabetes mellitus (DM). Endovascular revascularization has the potential to promote wound healing and limb salvage in this patient population but has yet to be evaluated. This study describes a burn center's experience incorporating endovascular revascularization into the acute management of lower extremity burns.</div></div><div><h3>Methods</h3><div>Patients admitted to a regional burn center from August 2021 to August 2023 with a lower extremity burn, DM, and an abnormal pulse or noninvasive vascular exam who then underwent diagnostic angiography with or without endovascular revascularization were included in this review. Intraoperative findings and outcomes related to wound healing and amputations were recorded. Significant graft loss was defined as more than 50% surface area loss, prolonged wound care, or need for reoperation following autografting. Digit or transmetatarsal amputations were considered minor amputations. Below or above the knee amputations were considered major amputations.</div></div><div><h3>Results</h3><div>Of the 23 patients included, there were 29 burn wounds and 32 lower extremities evaluated by angiography. Flow-limiting disease was identified in 16.9% of vessels. Vessel run off to the foot significantly improved postintervention to 2 vessels (2.0-3.0) from one vessel (1.0-2.3, <em>P</em> = 0.0025). After revascularization, 40% of wounds healed without operative intervention and 30% required autografting, of which none had significant graft loss. Major amputations occurred in 30% of cases secondary to infection.</div></div><div><h3>Conclusions</h3><div>Lower extremity angiography identified flow-limiting, peripheral artery disease often in this cohort of burn-injured patients with DM. In patients who underwent endovascular revascularization, there was no significant graft loss and a 70% limb salvage rate. Endovascular revascularization has the potential to improve outcomes in burn-injured patients with DM and associated peripheral artery disease, but prospective studies are needed.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 318-325"},"PeriodicalIF":1.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144814003","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":"Association of Whole Blood on Mortality and Inhospital Complications: A Statewide Analysis","authors":"McKell Quattrone MD ,&nbsp;Michael J. Stack MD ,&nbsp;Chan Shen PhD ,&nbsp;Sandeep Pradhan MBBS, MPH ,&nbsp;Kishan Mehta BA ,&nbsp;Ashley R. Ludwig DO ,&nbsp;Scott B. Armen MD, FACS ,&nbsp;John S. Oh MD, FACS","doi":"10.1016/j.jss.2025.07.041","DOIUrl":"10.1016/j.jss.2025.07.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Whole blood (WB) transfusion is increasingly used in the civilian trauma population compared to standard component therapy (CT). Prior prospective observational and retrospective studies have shown a mortality benefit. We aim to assess statewide clinical outcomes associated with WB use in an adult trauma population.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of the Pennsylvania Trauma Outcomes Study registry from 2019 to 2022. Adult trauma patients (≥18 y) who received at least one transfusion within the first 4 h following injury were included. Patients were grouped into WB ± CT and CT only and propensity matched in a 1:1 manner. Associations of WB on mortality and inhospital complications were analyzed using univariable and multivariable analyses.</div></div><div><h3>Results</h3><div>Five thousand, four hundred sixty-four patients met the inclusion criteria (mean age 50, 74% male, median ISS 21) with 2186 included in analysis following propensity matching. Mean WB transfused was 2.4 units with a WB to total transfusion volume ratio of 0.6. CT resuscitation was balanced with a packed red blood cell to fresh frozen plasma and platelets ratio &lt;1.5 for all groups. WB was not associated with a decreased odds of mortality (odds ratio [OR] 1.29 (0.96-1.72), <em>P</em> = 0.09), acute kidney injury (OR 1.26 (0.74-2.14), <em>P</em> = 0.39), infection (OR 1.34 (0.81-2.11), <em>P</em> = 0.28) or venous thromboembolism (OR 1.49 (0.99-2.23), <em>P</em> = 0.06). Similar outcomes in mortality were observed for patients requiring massive transfusions (OR 1.20 (0.86-1.69), <em>P</em> = 0.28), and patients with a high shock index (OR 1.31 (0.89-1.92), <em>P</em> = 0.17).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that WB is not associated with improved mortality compared to CT alone. Ongoing research is needed to further classify which populations benefit from receiving WB.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 326-333"},"PeriodicalIF":1.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841741","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":"Medical Student Preparation for the Operating Room: A Survey of Students’ Use of Digital and Non-peer-reviewed Educational Resources","authors":"Pooja S. Salvi MD ,&nbsp;James M. Healy MD MHS ,&nbsp;Demetri Merianos MD ,&nbsp;Robert A. Cowles MD","doi":"10.1016/j.jss.2025.07.022","DOIUrl":"10.1016/j.jss.2025.07.022","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate how medical students prepare for the operating room (OR) during their surgical clerkship, focusing on utilization of peer-reviewed and nonpeer-reviewed educational resources.</div></div><div><h3>Methods</h3><div>A prospective cross-sectional survey was conducted using an anonymous online questionnaire to assess OR preparation habits and study resource utilization at three US medical schools. Logistic regression identified factors influencing the use of non-peer-reviewed resources.</div></div><div><h3>Results</h3><div>One hundred forty-five third- and fourth-year medical students (37.9% response rate) who had completed their surgical clerkships between September 2021 and August 2022 were included. Most students (86.2%) used nonpeer-reviewed resources for OR preparation, with 27.5% relying on these as their primary tools. Popular resources included YouTube, high-yield review books, and online textbooks, with study of anatomy and patient charts comprising the most prevalent preparation activities. Preparation time was generally limited, with most students dedicating less than an hour per day. Students who spent more than 1 h preparing for the OR daily were less likely to use nonpeer-reviewed resources (odds ratio: 0.3, confidence interval: 0.1-0.9).</div></div><div><h3>Conclusions</h3><div>This study reveals a significant reliance on nonpeer-reviewed resources for OR preparation among medical students, highlighting a shift in how information is accessed. Despite students’ understanding of peer review, the preference for easily accessible digital resources suggests a need for improved guidance on evaluating information quality. Surgical educators have a responsibility to facilitate the identification of high-quality resources.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 340-346"},"PeriodicalIF":1.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144814002","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":"Braun Enteroenterostomy in Pancreaticoduodenectomy – Association With Delayed Gastric Emptying in the Era of Enhanced Recovery","authors":"Ofra Carmel MD,&nbsp;Michal Perets MD,&nbsp;Michael Neumann MD,&nbsp;James Tankel MD,&nbsp;Gal Fridlender MD,&nbsp;Petachia Reissman MD,&nbsp;Menahem Ben Haim MD,&nbsp;Amir Dagan MD","doi":"10.1016/j.jss.2025.07.032","DOIUrl":"10.1016/j.jss.2025.07.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Pancreaticoduodenectomy (PD) is a complex and high-risk surgical procedure commonly performed to treat pancreatic and periampullary cancers. Despite its curative potential, it carries a high rate of complications, particularly delayed gastric emptying (DGE), which prolongs hospital stays, delays adjuvant therapy, increases costs, and impairs quality of life. Although enhanced recovery after surgery protocols improve outcomes, the impact of Braun enteroenterostomy (BEE) on reducing DGE within these protocols remains unclear. This study evaluated the relationship between BEE and DGE within an enhanced recovery protocol.</div></div><div><h3>Methods</h3><div>A single center retrospective analysis was conducted on 214 patients who underwent elective PD with curative intent between December 2014 and February 2021. Patients were divided into the following two groups: those with BEE (76) and those without (138). Outcomes were assessed using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Although overall DGE rates were similar, severe DGE was significantly lower in the Braun group (2.6% <em>versus</em> 15.9%, <em>P</em> = 0.003). Patients with BEE had shorter hospital stays (14.7 ± 8 <em>versus</em> 21.4 ± 24.5 days, <em>P</em> = 0.004) and fewer major complications (17.1% <em>versus</em> 37%, <em>P</em> = 0.002). Multivariate analysis confirmed BEE was independently associated with lower odds of major complications (odds ratio 0.44, <em>P</em> = 0.033).</div></div><div><h3>Conclusions</h3><div>Incorporating BEE in PD within enhanced recovery protocols was associated with lower rates of severe DGE and major complications. Further studies should confirm its benefits across diverse surgical settings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Pages 312-317"},"PeriodicalIF":1.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810296","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":"Equity of Access to Care in an Urban Trauma System.","authors":"Allan E Stolarski, Sophia M Smith, Michael Poulson, Daniel Holena, Sandro Galea, Danby Kang, Crisanto Torres, Noelle Saillant, Dane Scantling","doi":"10.1016/j.jss.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.jss.2025.07.010","url":null,"abstract":"<p><strong>Introduction: </strong>Every minute of prehospital transport-time (TT) is critical to survival. Our objective was to assess granular urban community-level access to trauma centers.</p><p><strong>Methods: </strong>We utilized 2020 Decennial Census data at the block group (BG) level. BG centroids were calculated and a network analysis of historic traffic data was used to determine the predicted TT to the nearest trauma center.</p><p><strong>Results: </strong>A total of 581 Boston BGs with 273,188 households and 675,647 individuals were identified. Five hundred sixty-six (97%) met inclusion criteria. Of households, 48,711 (17.8%) received cash/food assistance. Furthermore, 278 (49%) of BGs had a White non-Hispanic majority, 80 (14%) had a Black non-Hispanic majority and 27 (5%) had a Hispanic majority population. Household income quartiles ranged from $32,394 to $157,283 and White non-Hispanic majority BGs had more than double the median income of other BGs. Relative to the highest income BGs, TT increased as income decreased for the middle quartiles (β 1.7, 95% confidence interval [CI] 0.48 to 2.90, P < 0.01) and (β 2.6 95% CI 1.4 to 3.8, P < 0.01 respectively) but not in the lowest income quartile BGs. Public assistance was not associated with TT. An increased proportion of the population that was Black (β 0.10, 95% CI 0.07 to 0.11, P < 0.01) or Hispanic (β 0.04, 95% CI 0.01 to 0.07, P < 0.01) related to increased TT. Majority White communities had TTs nearly half that of majority Black communities (8.8 min vs. 15.6 min; P < 0.01).</p><p><strong>Conclusions: </strong>Communities with higher non-White populations have reduced access to trauma care while some available poverty metrics relate to TT (household income) and others do not.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"298-304"},"PeriodicalIF":1.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817027","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":"Racial and Sex Disparities in US Kidney Transplant Clinical Trials: A Comparative Analysis With National Transplant Registry Data.","authors":"Inbar Hazan, Rahim Hirani, Shreeya Agrawal, Joanna Yao, Emily Zhang, Tammy Liu, Ryan Chan, Devon John, Mill Etienne","doi":"10.1016/j.jss.2025.07.036","DOIUrl":"https://doi.org/10.1016/j.jss.2025.07.036","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease and kidney failure disproportionately affect racial and ethnic minorities in the United States, yet these populations remain underrepresented in clinical trials, especially in kidney transplantation research. The objective of this study was to analyze the representation of racial, ethnic, and sex groups in US-based kidney transplant clinical trials and assess whether participant demographics reflect the population receiving transplants, using national registry data.</p><p><strong>Methods: </strong>A total of 188 completed interventional trials related to kidney transplantation (1995-2022) were extracted from clinicaltrials.gov. Demographic data-including race, ethnicity, and sex-were compared against national data from the Organ Procurement and Transplantation Network. Chi-square tests and logistic regressions were performed to assess representation trends and predictors of demographic data reporting.</p><p><strong>Results: </strong>Only 58.51% of trials reported race or ethnicity (P < 0.01). White participants were consistently overrepresented across all time periods, while Black, Asian, multiracial, and Indigenous participants were underrepresented, despite elevated disease burdens (P < 0.0001). From 2011 to 2015 to 2016-2020, Black representation increased significantly (P < 0.001), though still fell short of parity. Multiracial and Asian participants remain markedly underrepresented. Trials with pharmaceutical sponsorship were significantly less likely to report racial or ethnic data (P = 0.008). Females were also underrepresented, comprising only 35.88% of trial participants (P < 0.0001).</p><p><strong>Conclusions: </strong>The persistent underrepresentation of minority groups and females in kidney transplant trials undermines the generalizability of findings and perpetuates inequities in care. Comprehensive and intersectional demographic reporting should be mandated, and recruitment strategies must prioritize inclusivity to ensure that clinical research equitably serves all affected populations.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"305-311"},"PeriodicalIF":1.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817028","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":"https://doi.org/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":"2025-08-09","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}