Journal of Surgical Research最新文献

{"title":"Characterizing a Common Phenomenon: Why do Trauma Patients Re-Present to the Emergency Department?","authors":"Wang Pong Chan MS ,&nbsp;Sophia M. Smith MD, MS ,&nbsp;Cara Michael BA ,&nbsp;Kendall Jenkins MS ,&nbsp;Yorghos Tripodis PhD ,&nbsp;Dane Scantling DO, MPH ,&nbsp;Crisanto Torres MD, MPH ,&nbsp;Sabrina E. Sanchez MD, MPH","doi":"10.1016/j.jss.2024.09.068","DOIUrl":"10.1016/j.jss.2024.09.068","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma patients return to the emergency department (ED) at alarmingly high rates, despite not all patients requiring hospital resources. Reasons for ED re-presentation and associated risk factors have not been fully investigated.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of adult trauma admissions at an urban safety net level 1 trauma center (1/12018-12/312021). Risk factors for ED re-presentation were identified using purposeful selection and modeled using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Of 2491 patients, 19% returned within 30 d (<em>N</em> = 475). Most patients presented for uncontrolled pain (37%, <em>N</em> = 175), medical concerns (25%, <em>N</em> = 119), and infection (10%, <em>N</em> = 49). The readmission rates varied as follows: 18% for uncontrolled pain (<em>N</em> = 32), 42% for medical concerns (<em>N</em> = 50), and 67% for infection (<em>N</em> = 33). Risk factors for uncontrolled pain included depression/anxiety (adjusted odds ratio [aOR] 2.06, 95% confidence interval [CI] 1.39-3.05), substance use disorder (SUD) (aOR 1.65, 95% CI 1.12-2.43), and penetrating mechanism of injury (aOR 2.25, 95% CI 1.59-3.18). Risk factors for medical concerns included number of medical comorbidities (aOR 1.34, 95% CI 1.18-1.52), depression/anxiety (aOR 1.97, 95% CI 1.28-3.01), SUD (aOR 2.48, 95% CI 1.65-3.74), and nonhome discharge disposition (aOR 1.56, 95% CI 1.07-2.28). Risk factors for infection included non-English primary language (aOR 3.41, 95% CI 1.82-6.39), SUD (aOR 2.00, 95% CI 1.03-3.88), and nonhome discharge disposition (aOR 2.06, 95% CI 1.15-3.67).</div></div><div><h3>Conclusions</h3><div>Uncontrolled pain was the most common reason for re-presentation, although only a small fraction required readmission. Patients with penetrating injury may benefit from improved pain control. Primary care provider follow-up may help mitigate risk of medical disease exacerbation, and wound care instructions for non–English speaking patients may decrease re-presentation for infection.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 489-498"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468427","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":"Piloting an Assessment Tool to Organize Surgical Care in Armed Conflicts: Findings From Cameroon","authors":"Kevin Gianaris BA ,&nbsp;Ghyslaine Bruna Djeunang Dongho PhD ,&nbsp;Nkengafac Nyiawung Fobellah MD ,&nbsp;Ronald M. Gobina MD ,&nbsp;Denis A. Foretia MD, MPH, MBA, FACS","doi":"10.1016/j.jss.2024.09.061","DOIUrl":"10.1016/j.jss.2024.09.061","url":null,"abstract":"<div><h3>Introduction</h3><div>Armed conflict is increasing globally and is dramatically disrupting surgical care more than ever before. To address this, the PIPESS (Personnel, Infrastructure, Procedures, Equipment, Supplies, and Standard) tool was designed to facilitate assessment of hospital capacity. It assesses 6 key categories at 3 timepoints: preconflict, during conflict, and postconflict. This tool was piloted to assess the impact of conflict and COVID-19 on surgical care delivery at the Buea Regional Hospital in Cameroon.</div></div><div><h3>Methods</h3><div>This was a cross-sectional, qualitative study combining in-depth interviews and on-site observations of the surgical care unit. The data collected during the interviews were then applied to the modified PIPESS tool to calculate a preconflict score based on recall and a during conflict score to quantify differences before and during conflict.</div></div><div><h3>Results</h3><div>We interviewed 12 key informants: 6 patients, 3 doctors, and 3 other staff. The themes extracted from the preconflict period highlight major barriers including rudimentary prehospital care and referral limitations from remote areas, lack of funding and training, and a demand exceeding the supply of care. COVID-19 resulted in an influx of resources into the region and did not disrupt care to the extent of the conflict. Quantitatively, the PIPESS score for preconflict was 110, and the PIPESS score during conflict was 115, showing an increase in resources, specifically in personnel and infrastructure during conflict.</div></div><div><h3>Conclusions</h3><div>The conflict increased the burden on existing health centers and strained resources for trauma care. Paradoxically, surgical resources increased during the conflict likely because of increased international support along with local displacement of staff toward the hospital. Further data should be collected during the postconflict setting.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 446-453"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468433","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":"The Thermal Signature of Wound Healing","authors":"Haggai Benvenisti MD ,&nbsp;Omer Cohen Msc ,&nbsp;Eti Feldman NP ,&nbsp;Dan Assaf MD ,&nbsp;Moran Jacob Bsc ,&nbsp;Eran Bluestein MBA ,&nbsp;Gal Strechman Msc ,&nbsp;Boris Orkin MD ,&nbsp;Hezi Nachman-Farchy Msc ,&nbsp;Aviram Nissan MD","doi":"10.1016/j.jss.2024.09.043","DOIUrl":"10.1016/j.jss.2024.09.043","url":null,"abstract":"<div><h3>Background</h3><div>Despite major efforts in prevention, surgical site infections (SSIs) remain a burden on patients and the healthcare system and are associated with significant morbidity. SSIs are one of the costliest healthcare-associated infections. The diagnosis of SSIs is based mainly on clinical assessment, which may result in a delay in detection. The ability to detect SSIs in subclinical phase and initiate effective therapy earlier may reduce morbidity and hospital stay. In this study, we attempted to utilize long-wave infrared (LWIR) imaging to define the healing process of the surgical site and to detect abnormal healing.</div></div><div><h3>Methods</h3><div>In this prospective study, 50 patients undergoing elective abdominal surgery had LWIR images of their incision obtained at determined intervals from their operation to discharge. Images were processed with proprietary algorithms to create a thermal topograph used to define the healing process.</div></div><div><h3>Results</h3><div>Images of 45 patients were available for a final review. Of these 45 patients, 10 patients developed SSIs. Using the thermal topograph, 10 criteria for image analysis were defined, yielding a prediction of six out of the 10 SSIs and 35 out of the 35 normal healing wounds. Sensitivity was 60%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 90.1%, with 92% accuracy. A preliminary program was created that allows trained users to methodically evaluate images providing them with a risk estimate.</div></div><div><h3>Conclusions</h3><div>In this preliminary study, LWIR analysis of surgical wounds was able to identify normal and abnormal wound healing. Further large-scale studies are needed to validate results.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 468-475"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468446","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":"The Initial Experience After Pediatric Firearm Injury: A Multifaceted Qualitative Approach","authors":"Jennifer M. Schuh MD ,&nbsp;Christina Georgeades MD ,&nbsp;Taylor Schleusner BS ,&nbsp;Carisa Bergner PhD ,&nbsp;Samantha Leonard MD ,&nbsp;Patricia Marik PsyD ,&nbsp;Matthew Jandrisevits PhD ,&nbsp;David Gourlay MD, FAAP, FACS ,&nbsp;Katherine Flynn-O’Brien MD, MPH, FAAP, FACS","doi":"10.1016/j.jss.2024.09.057","DOIUrl":"10.1016/j.jss.2024.09.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Firearm victims sustain a disproportionate mental health burden. Inpatient pediatric psychology consult liaison (CL) services provide comprehensive evaluation after injury. We aim to explore CL documentation qualitatively to better understand the initial psychological experience after firearm injury in children compared to motor vehicle crash (MVC) injury. We hypothesized that meaningful differences between the cohorts would be evident by thematic, sentiment, and word cloud analyses of CL notes.</div></div><div><h3>Materials and methods</h3><div>This single-institution, retrospective study at a level I pediatric trauma center identified 5-17-y-old children who sustained firearm injuries and were admitted for ≥48 h from January 1, 2016 to March 31, 2021. Firearm-injured children were propensity score-matched to MVC-injured children. Thematic, sentiment, and word cloud analyses were completed for all CL notes.</div></div><div><h3>Results</h3><div>98 firearm-injured children were identified. The CL service evaluated 71% of firearm-injured children and 65% of MVC-injured children. Domains of resources, encountering the medical system, prior psychological and legal influences, immediate cognitive reactions, and social influences were identified based on extracted themes. Sentiment analysis revealed more negative than positive words for both firearm- (3318 <em>versus</em> 2190 words) and MVC-injured children (2225 <em>versus</em> 1994 words). Word cloud showed that firearm-injured child notes more frequently mentioned “trauma”, while MVC-injured child notes more frequently mentioned “family” and “support”.</div></div><div><h3>Conclusions</h3><div>The pediatric CL note analysis suggests that the experience after firearm injury differs from that after MVC injury in reference to family and support. CL notes covered a breadth of topics beyond the psychological impact alone. Understanding the experiences of injured children in relation to injury mechanism offers opportunity for focused intervention strategies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 519-531"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468445","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":"Mental and Physical Readiness for Weight Loss After Abdominal Organ Transplant","authors":"Maria P. Cote MD,&nbsp;Srilakshmi Atthota MD,&nbsp;Anne MacDonald BS,&nbsp;Jennie Cataldo MS, RD,&nbsp;Anushi Shah MD,&nbsp;Flor Flores BS, MS,&nbsp;Ruby Singh MD, MPH,&nbsp;Nahel Elias MD,&nbsp;Leigh Anne Dageforde MD, MPH","doi":"10.1016/j.jss.2024.09.009","DOIUrl":"10.1016/j.jss.2024.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Readiness to incorporate healthy lifestyle practices is not studied in posttransplant patients. We evaluate physical and mental readiness for a weight-loss guided lifestyle intervention.</div></div><div><h3>Methods</h3><div>12 kidney and 12 liver transplant patients were given a Fitbit and weighing scale for 12 mo. Twelve patients received group sessions on lifestyle modifications. Mental readiness was assessed using <em>Patient Activation Measurement-13</em>, <em>Physical Activity, Process of Change,</em> and <em>Weight Stages of Change</em>. Physical readiness was assessed using Fatigue, Resistance, Ambulation, Illness, and Loss of Weight<em>,</em> and Short Physical Performance Battery questionnaires. Weight change, group session attendance, device usage, and readiness were analyzed.</div></div><div><h3>Results</h3><div>23 patients (12 kidney, 11 liver), 57 y (46.2-67.5), 75% male, 24.9 (15.7-43.2) months posttransplant) completed the study. Twenty-two patients had robust physical readiness, and high Fitbit usage (&gt;80%). Ten patients (43%) lost ≥2.5% (moderate) of body weight, including 4 (17.3%) losing &gt;5% total weight (high). 13 patients lost ≤2.5% or gained weight (maintenance). High loss and target group session attendance groups had the highest use of Processes of Change.</div></div><div><h3>Conclusions</h3><div>Posttransplant patients are physically ready for a weight-loss guided lifestyle intervention and show high usage of the Fitbit device. Higher mental readiness associates with higher weight loss.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 420-428"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445017","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":"Cardiothoracic Surgery Interviews and Selection in a Pandemic Era – Lessons to Learn","authors":"Naima A. Alver MD ,&nbsp;Jay D. Pal MD, PhD ,&nbsp;Castigliano M. Bhamidipati DO, PhD, MSc, FACS, FACC","doi":"10.1016/j.jss.2024.09.039","DOIUrl":"10.1016/j.jss.2024.09.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Candidate selection for cardiothoracic surgery (CTS) training programs is challenging. The recent pandemic has impacted a program's ability to meet matriculants in-person. We hypothesized that a central venue at the CTS annual meeting could prove as a favorable supplement for programs and applicants.</div></div><div><h3>Methods</h3><div>Surveys were sent to adult cardiothoracic and congenital cardiac surgery training program directors (PD) and department chairs or division chiefs. Separately, surveys were sent to applicants from the 2018 through 2023 electronic residency application service match process.</div></div><div><h3>Results</h3><div>A total of 166 individuals (PDs and department chairs or division chiefs) were contacted. This represented 94 unique programs, and 45 programs responded. The majority of these programs (88.9%) felt that social gatherings were valuable in evaluating applicants and 86.7% would be interested in a social event at an Society of Thoracic Surgery annual meeting. 54% of applicants did not get an accurate impression of the programs to inform their rank list through virtual interviews, 70% would not be able to accept the same number of interviews in-person <em>versus</em> virtual, and 94% would be interested in attending an annual conference to meet program faculty.</div></div><div><h3>Conclusions</h3><div>A centralized in-person interview event allows for fiscal and scheduling efficiencies, while creating an opportunity for an equitable exchange between potential candidates and PDs in an efficient manner. Such an event would cost a fraction of what our profession has been incurring, could diversify our workforce, would create early mentoring linkages, and perhaps remodel the way we select trainees.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 454-460"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468425","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":"Amitriptyline Decreases Mouse Lung Endothelial Cell Inflammatory Responses to Packed Red Blood Cell Microparticles","authors":"Lindsey Wattley MD,&nbsp;Ryan Chae MD,&nbsp;Christopher Nguyen BS,&nbsp;Rebecca Schuster MS,&nbsp;Alex Lentsch PhD,&nbsp;Charles Caldwell PhD,&nbsp;Michael Goodman MD,&nbsp;Timothy A. Pritts MD, PhD","doi":"10.1016/j.jss.2024.09.042","DOIUrl":"10.1016/j.jss.2024.09.042","url":null,"abstract":"<div><h3>Introduction</h3><div>Large-volume packed red blood cell (pRBC) transfusion is associated with lung injury and worsened outcomes. Amitriptyline reduces lung injury and inflammation in a murine sepsis model. We hypothesized that red cell microparticles (MP) activate endothelial cells, leading to lung injury and that treatment with amitriptyline would blunt the inflammatory response MPs through inhibition of acid sphingomyelinase (ASM).</div></div><div><h3>Methods</h3><div>Murine pRBCs were obtained from C57Bl/6 mice and stored in AS3 for 14 d. The MPs were isolated from pRBCs by serial centrifugation. Mouse lung endothelial cells (MLECs) were pretreated with amitriptyline (0, 2.5, 25, 27 μM, <em>n</em> = 5) for 30 min prior to MP treatment. Chemokine secretion and adhesion molecule shedding was assessed. ASM activity was measured from cell lysates.</div></div><div><h3>Results</h3><div>MPs increased the secretion of chemokines and shedding of adhesion molecules in MLECs at both four and 24 h. Amitriptyline treatment of MLECs decreased ASM activity in the setting of MPs. Amitriptyline pretreatment decreased the secretion of chemokines and shedding of adhesion molecules in response to MPs at 4 h but did not decrease adhesion molecule shedding at 24 h</div></div><div><h3>Conclusions</h3><div>Endothelial cell treatment with MPs induces secretion of chemokines responsible for chemotaxis (keratinocyte chemoattractant, regulated upon activation normal T cell expressed and presumably secreted, and G-granulocyte colony-stimulating factor) as well as many downstream proinflammatory effects (interleukin-6). Additionally, MPs induce adhesion molecule shedding (vascular cell adhesion molecule-1, intracellular adhesion molecule-1, P-selectin, and E-selectin), which has been shown to be associated with endothelial cell activation. Amitriptyline pretreatment decreases MLEC inflammatory response and ASM activity is decreased. These data suggest that ASM inhibition in MLECs is a potential strategy to blunt the inflammatory response to the red blood cell storage lesion.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 429-438"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445130","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":"Screening Mammography Adherence Improves After Bariatric Surgery","authors":"Abigail Alexander MD ,&nbsp;Noah Brown MD ,&nbsp;Joshua John Horns PhD ,&nbsp;Sheetal Hardikar MBBS, PhD, MPH ,&nbsp;Mary Playdon PhD, MPH ,&nbsp;Rupam Das MS, MBA ,&nbsp;Nathan Driggs BS ,&nbsp;Niraj Paudel MS ,&nbsp;Cindy Matsen MD, MS ,&nbsp;Anna Ibele MD","doi":"10.1016/j.jss.2024.09.067","DOIUrl":"10.1016/j.jss.2024.09.067","url":null,"abstract":"<div><h3>Introduction</h3><div>Poor adherence to mammography screening guidelines has been reported in women with obesity. However, bariatric surgery has been associated with lower incidence of breast cancer postoperatively. The mechanisms for this protective effect are unknown. We examined the relationship between bariatric surgery and screening mammography adherence.</div></div><div><h3>Methods</h3><div>Using a commercial health insurance claims database, all female patients between ages 40 and 64 who underwent bariatric surgery were identified and compared to three control groups who did not undergo bariatric surgery stratified across obesity-related billing codes. Screening mammography rates were calculated as the total number of screenings divided by the total person-years of follow-up. THe screening rate was standardized to a frequency of 1 exam every 2 y based on United States Preventative Services Taskforce guidelines. We ran multivariable Poisson regression models of the rate of mammography screening, adjusting for sociodemographic factors and comorbidities.</div></div><div><h3>Results</h3><div>The rates of screening were 0.91 of the recommended frequency in bariatric surgery patients prior to surgery and 1.22 of the recommended frequency after surgery (<em>P</em> &lt; 0.001). In multivariable models, bariatric surgery patients had a significantly lower rate of mammogram screening in the presurgical period (incidence rate ratio 0.99, 95% CI 0.98-0.99, <em>P</em> = 0.025) and a significantly higher rate in the postsurgical period (incidence rate ratio 1.34, 95% CI 1.32-1.35, <em>P</em> &lt; 0.001) relative to the “no obesity” control group.</div></div><div><h3>Conclusions</h3><div>The rate of adherence to recommended mammography screening for breast cancer increased following bariatric surgery. This suggests that women with obesity may experience improved mammography screening adherence following bariatric surgery.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 476-481"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468434","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":"Patient Neighborhood Adversity Associated With Access Not Wait Time to Parathyroidectomy","authors":"Markayle Schears MPH ,&nbsp;Courtney Balentine MD ,&nbsp;Rebecca Sippel MD ,&nbsp;David Schneider MD ,&nbsp;Dawn Elfenbein MD ,&nbsp;Kristin Long MD ,&nbsp;Amy Kind MD, PHD ,&nbsp;Alexander Chiu MD, MPH","doi":"10.1016/j.jss.2024.09.029","DOIUrl":"10.1016/j.jss.2024.09.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Delays to treatment of primary hyperparathyroidism (PHPT) escalates patient morbidity, which particularly affects individuals from under-resourced areas already facing health disparities. We hypothesized that PHPT patients from socially and economically deprived areas encounter longer waits to surgery.</div></div><div><h3>Methods</h3><div>Utilizing a prospectively maintained database, we identified PHPT patients aged ≥18 undergoing initial parathyroidectomy between 2013 and 2022 at an academic, tertiary care center. Patient's social and economic advantage levels were classified into deciles using the Area Deprivation Index (ADI), which accounts for 17 social determinants of health. The time from first hypercalcemic value to surgery was compared across ADI groups via linear regression, controlling for pertinent care process factors.</div></div><div><h3>Results</h3><div>Among 1132 patients, 68.9% were from low, 19.1% from medium, and 12.0% from high-disadvantage areas, diverging from the hospital's catchment population (55.2%, 26.6%, and 18.1%, respectively, <em>P</em> &lt; 0.01). Patients from high-disadvantage areas exhibited higher comorbidity rates (55.2% <em>versus</em> 38.2%, <em>P</em> &lt; 0.01) and were predominantly rural residents (66.2% vs. 5.8%, <em>P</em> &lt; 0.01) compared to low-disadvantage areas. Similar biochemical and clinical features were shown across ADI groups. The median time from abnormal calcium to surgery was 648 d (IQR 543-753), with high-disadvantage patients experiencing a median treatment delay of 527 d, compared to 657 and 633 d for medium and low-disadvantage patients, respectively (<em>P</em> = 0.38). Linear regression analysis showed no association between ADI and treatment delay.</div></div><div><h3>Conclusions</h3><div>The high-disadvantage group underwent parathyroidectomy at lower rates than expected, but there were no significant delays in surgery among disadvantaged patients who were ultimately treated. This suggests that while social determinants may correlate to care access, they do not necessarily prolong treatment for those with established care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 439-445"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468431","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":"Are Adolescents With Chest Wall Deformity Potential Primary Spontaneous Pneumothorax Patients?","authors":"Busra Ozdemir Ciflik MD ,&nbsp;Kadir Baturhan Ciflik MD ,&nbsp;Anil Gokce MD ,&nbsp;Suleyman Anil Akboga MD ,&nbsp;Yucel Akkas MD","doi":"10.1016/j.jss.2024.09.050","DOIUrl":"10.1016/j.jss.2024.09.050","url":null,"abstract":"<div><h3>Introduction</h3><div>Chest wall deformities often become apparent with growth spurts during adolescence. Alterations in the structure of the chest wall can result in the development of pulmonary bullae and blebs, which may lead to spontaneous pneumothorax. There are limited data on this subject in the literature. In this study, it is aimed to investigate the presence of bullae and bleb in patients with anterior and posterior chest wall deformities.</div></div><div><h3>Methods</h3><div>Computed tomography scans of adolescent idiopathic scoliosis, pectus carinatum, and pectus excavatum patients were analyzed. The presence of bullae and/or bleb (BB) was recorded as “present” or “absent.”</div></div><div><h3>Results</h3><div>One hundred fifty patients with chest wall deformity have been included in the study. BB has been detected in 55 (36.7%) of the patients. Surgical procedures were performed in 45 (30%) of the patients due to chest wall deformity. BB was present in 12 (26.7%) of these patients. A statistically significant difference has been found between the presence of complications and the presence of BB in surgical patients (<em>P</em> &lt; 0.001). In patients who developed complications, there was a statistically significant difference between the presence of BB and the duration of chest tube follow-up (<em>P</em> = 0.031), as well as between the presence of BB and the length of hospitalization (<em>P</em> = 0.006).</div></div><div><h3>Conclusions</h3><div>A significant proportion (36.7%) of patients with chest wall deformity had BB. Chest wall deformities and primary spontaneous pneumothorax (PSP) may have common etiologic factors. It should be kept in mind that patients with chest wall deformities may be potential PSP patients. Medical counseling about PSP should be considered for these patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 415-419"},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445127","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}