Journal of Surgical Research最新文献

{"title":"Clinical Outcomes Following Component Therapy Only Versus Whole Blood Plus Component Versus Whole Blood Only in Geriatric Trauma Patients With Isolated Chest or Abdominal Injuries With or Without Traumatic Brain Injury.","authors":"Hazem Nasef, Nikita Nunes Espat, Brian Chin, Alaina Werling, Quratulain Amin, Caitlin Tweedie, William S Havron, Chadwick Smith, Adel Elkbuli","doi":"10.1016/j.jss.2024.11.046","DOIUrl":"10.1016/j.jss.2024.11.046","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to evaluate clinical outcomes in geriatric trauma patients with isolated chest or abdominal injuries with or without traumatic brain injury (TBI) receiving whole blood (WB), component (COMP), or WB and component therapy (WB + COMP).</p><p><strong>Methods: </strong>This retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program Participant Use File dataset from 2017 to 2021 evaluated geriatric (age ≥65) trauma patients with moderate-to-severe isolated chest (abbreviated injury scale (AIS) chest ≥2) or abdominal (AIS abdomen ≥2) injuries with or without TBI (AIS head ≥2) receiving WB, COMP, or WB + COMP. Outcomes included emergency department and 24-h mortality, blood product volume (mL) at 4 hs, and intensive care unit-length of stay.</p><p><strong>Results: </strong>Among non-TBI patients with isolated chest injuries, COMP patients required significantly less plasma (regression coefficient β = -428 mL, 95% confidence interval (CI): 604 mL-249 mL, P < 0.001), and had 48% lower odds of 24-h mortality than WB patients (odds ratio = 0.519, 95% CI: 0.285-0.946, P = 0.032). Among TBI patients with isolated chest injuries, there was no significant association between receiving COMP and plasma volume requirement (β = -166.227, 95% CI: -366.370 to 33.916, P = 0.104) or 24-h mortality (odds ratio = 0.606, 95% CI: 0.301-1.220, P = 0.161) when compared to WB patients.</p><p><strong>Conclusions: </strong>Compared to WB or WB + COMP, COMP therapy significantly reduced transfusion requirements in non-TBI patients. Additionally, COMP therapy was associated with lower 24-h mortality in geriatric patients with isolated chest injuries. TBI patients with isolated chest injuries had no significant differences in clinical outcomes. Further research is warranted to explore the potential benefits of COMP therapy on mortality outcomes in TBI patients.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"337-348"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903368","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":"Implementation of Music in the Perioperative Standard Care of Colorectal Surgery: A Cost-Effectiveness Analysis.","authors":"Saskia H Van Bergen, Jorrit G Verhoeven, Ellaha Kakar, Johannes Jeekel, Erwin Birnie, Markus Klimek","doi":"10.1016/j.jss.2024.10.052","DOIUrl":"10.1016/j.jss.2024.10.052","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized controlled trials and meta-analyses have provided evidence of the positive effects of perioperative music interventions on pain, anxiety, and stress. However, the cost-effectiveness is unknown. The objective of this study was to analyze the cost-effectiveness of the implementation of a music intervention in the perioperative care of patients undergoing colorectal surgery.</p><p><strong>Methods: </strong>A post hoc analysis was performed on patients included in the Implementation of Music Intervention in the PeRiOperatiVe standard care study: a clinical implementation study comparing the effects of perioperative music interventions (post-implementation group, N = 50) to standard care in colorectal surgery (pre-implementation group, N = 50). Main outcomes analyzed were postoperative pain scores and healthcare costs. Propensity score matching with inverse probability weighting was applied. Incremental costs and cumulative pain score differences were estimated using bootstrap analysis with 1000 replications.</p><p><strong>Results: </strong>Median age of the entire patient population was 62.5. Mean sum of postoperative pain scores on postoperative days 0 to 3 was 9.8 (range 0-40) (95% confidence interval [CI] 8.3-11.4) and 9.9 (95% CI; 7.0-12.9) in the pre- and post-implementation group, respectively (P = 0.970). The total costs were not significantly different between the pre- and post-implementation group in the entire group (€7000 versus €8,070, mean difference of €1070 (bootstrap 95% CI - €1190 - €3336), P = 0.353). Incremental costs were €1288 and €5030 (intention-to-treat and per protocol analysis, respectively) per clinically relevant decrease in pain during postoperative day 0-3.</p><p><strong>Conclusions: </strong>The implementation of music intervention does not lead to a significant difference in costs. These results can aid clinicians considering the implementation of perioperative music.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"47-55"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792042","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":"Anterior Transversus Abdominis Plane Block for Lower Extremity Revascularization.","authors":"Carmelina Gurrieri, Ghaith Almhanni, Indrani Sen, Jason Beckermann, Thomas Carmody, Tiziano Tallarita","doi":"10.1016/j.jss.2024.11.004","DOIUrl":"10.1016/j.jss.2024.11.004","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia remains underutilized in vascular surgery; therefore, we retrospectively reviewed and compared the usage of perioperative opioids in patients undergoing lower extremity revascularization surgery, who received the anterior transversus abdominis plane (TAP) block along with local anesthesia at the incision site versus who did not receive any regional anesthesia.</p><p><strong>Methods: </strong>We conducted a retrospective review of 107 patients undergoing open or hybrid lower extremity revascularization under general anesthesia at a single institution between 2017 and 2022. Patients were divided into two groups. Regional block group (n = 41 [38%]) (femoral endarterectomy 27%; femoral endarterectomy + endovascular intervention 51%; infrainguinal bypass 22%) received both an intraoperative anterior TAP block and local anesthesia at the incision site; No regional block group (n = 66 [62%]) (femoral endarterectomy 29%; femoral endarterectomy + endovascular intervention 13%; infrainguinal bypass 58%) did not receive either regional or local anesthesia.</p><p><strong>Results: </strong>There were no significant differences in either the procedural metrics or intraprocedural complications between the two groups. The in-hospital stay was shorter in the Regional group, 1 (1, 3) versus the No regional group, 3 (2, 7), P < 0.001. The median intraoperative morphine milliequivalents use was 20 (15, 25) in the Regional block group and 25 (20, 35) in the No regional block group, P = 0.008. The median postoperative opioids use at 24h was 75 (60, 98) in the Regional block group and 113 (83, 151) in the No regional block group, P < 0.001; at 48h was 103 (70, 118) in the Regional block group and 148 (90, 210) in the No regional block group, P = 0.027; at 72h was 105 (70, 138) in the Regional block group and 196 (113, 263) in the No regional block group, P = 0.010.</p><p><strong>Conclusions: </strong>Anterior TAP block combined with local anesthesia at the incision site seems to be a safe postoperative analgesia option for patients undergoing lower extremity revascularization surgery that could potentially help reducing both intra and postoperative opioids requirement.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"93-99"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813566","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":"Preferences in Suture Skills Instruction: Virtual Versus In-Person Instruction.","authors":"Daniela Lee, Angelica Hernandez Alvarez, Jose A Foppiani, Kirsten Schuster, Iulianna C Taritsa, Rachel Akintayo, Jacob Kuba, Samuel Manstein, Samuel J Lin","doi":"10.1016/j.jss.2024.11.025","DOIUrl":"10.1016/j.jss.2024.11.025","url":null,"abstract":"<p><strong>Introduction: </strong>As medical education increasingly incorporates digital methods such as video lectures, e-learning, and virtual meetings, it becomes crucial to evaluate the effectiveness of virtual classrooms in teaching surgical techniques. This study aims to assess whether live virtual classrooms can effectively convey surgical skills to medical students.</p><p><strong>Methods: </strong>First- and second-y medical students were randomized to in-person or live-video sessions once a week, for 2 wk. Students were taught how to perform simple interrupted sutures with instrument-tying. At the end of the workshop, participants were recorded performing simple interrupted sutures. Postinstruction skills videos, blinded to student group placement, were graded from 1 to 5 based on instrument handling, time, efficiency, tissue handling, wound closure, and overall technique.</p><p><strong>Results: </strong>Out of 114 enrolled students, 42 completed the workshop. Notably, the virtual group had a significantly higher proportion of dropouts than the in-person group. Rubric scores showed no significant differences in various skill categories between the two groups. While both groups acknowledged the helpfulness of their respective methods, a majority expressed a preference for in-person instruction. The postcourse survey revealed that students valued in-person instruction for real-time feedback and multiple-angle demonstrations.</p><p><strong>Conclusions: </strong>This study demonstrates that video instruction may be equally effective in improving students' surgical technique compared to live sessions. However, it also highlights a clear personal preference among students for in-person instruction, emphasizing the value of a personalized, hands-on approach and enhanced visibility provided by in-person teaching methods.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"214-221"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895505","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":"Estrogen Alleviates Oxidative Bowel Injury and Neuroinflammation in Necrotizing Enterocolitis.","authors":"Kıvılcım Karadeniz Cerit, Türkan Koyuncuoğlu, Beyza Akcan, Nur Sena Çağatay, Selen Üçem, Ömer Erdoğan, Özge Çevik, Damla Gökçeoğlu Kayalı, Dilek Akakın, Berrak Ç Yeğen","doi":"10.1016/j.jss.2024.12.003","DOIUrl":"10.1016/j.jss.2024.12.003","url":null,"abstract":"<p><strong>Introduction: </strong>High mortality and morbidity of neonates with necrotizing enterocolitis (NEC) necessitates the investigation of novel therapies to improve outcomes. It was aimed to elucidate the potential therapeutic effect of estrogen receptor agonists on NEC-induced intestinal and brain injury in rats.</p><p><strong>Methods: </strong>Sprague-Dawley pups of both sexes were separated from their mothers at postnatal 5^th d. Feeding with formula along with a single session of hypoxia was applied to induce NEC, while control pups were kept with their mothers. The NEC rats received either vehicle, estrogen receptor α (ERα) agonist propyl pyrazole triol (1 mg/kg/day), ERβ agonist diarylpropionitrile (1 mg/kg/day), or 17β-estradiol (1 mg/kg/day) during maternal separation. All pups were decapitated on postnatal 9^th d to collect intestinal and brain tissue samples.</p><p><strong>Results: </strong>Elevation in proinflammatory cytokines, apoptosis, and microscopically and biochemically evident oxidative injury in both the intestinal and brain tissues were observed in NEC-induced pups. In both the intestinal and brain tissues, nerve growth factor and brain-derived neurotrophic factor protein levels were depleted, expressions of both the ESR1 and ESR2 genes were downregulated, while treatment with 17β-estradiol or ER agonists alleviated extent of oxidative injury of the intestines and brain tissue, upregulated nerve growth factor, brain-derived neurotrophic factor, and ER gene expressions, abolished NEC-induced decrease in claudin-3 expression, increased the survival rates, improved the clinical states of the survived pups at varying degrees.</p><p><strong>Conclusions: </strong>Activation of estrogen signaling by receptor agonists alleviated NEC-induced intestinal and cerebral injury, implicating that estrogen agonists could be regarded as promising preventive/therapeutic agents for NEC.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"367-384"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902621","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":"Onlay Resorbable Biosynthetic Versus Underlay Biologic Mesh Ventral Hernia Repair in Contaminated Fields.","authors":"Chris Amro, Jane N Ewing, Dominic J Romeo, Isaiah J Rhodes, Zachary Gala, Mehdi S Lemdani, J Reed McGraw, Robyn B Broach, Stephen J Kovach, John P Fischer","doi":"10.1016/j.jss.2024.10.044","DOIUrl":"10.1016/j.jss.2024.10.044","url":null,"abstract":"<p><strong>Introduction: </strong>Abdominal wall reconstruction (AWR) with ventral hernia repair (VHR) in the setting of contamination poses unique and controversial challenges. The purpose of this study was to examine the efficacy of onlay resorbable biosynthetic mesh against underlay biologic mesh in contaminated VHR with AWR.</p><p><strong>Methods: </strong>A single-center retrospective review from 2015 to 2021 was performed examining subjects who underwent VHR with AWR in contaminated fields (Centers for Disease Control wound class II-IV). A matched paired analysis based on age, body mass index, and Centers for Disease Control wound class was conducted among patients who utilized resorbable biosynthetic mesh in an onlay fashion and biologic mesh in an underlay fashion.</p><p><strong>Results: </strong>A total of 94 patients (47 per group) underwent VHR with AWR in contaminated fields. Patients who utilized biosynthetic mesh had an average defect size of 314.56 ± 214.65 cm², required component separation (57.4%), and were often recurrent (61.7%). Majority of contamination were clean-contaminated (68.1%), followed by dirty/infected (19.1%), and contaminated (12.8%). Patients utilizing resorbable biosynthetic mesh experienced fewer surgical site occurrences (SSOs) (46.8% versus 72.3%, P < 0.05) and fewer SSO procedural interventions (19.1% versus 38.4%, P < 0.05). Patients with biosynthetic mesh had fewer hernia recurrences compared to biologic mesh use; however, was not statistically significant (14.9% versus 30.4%, P = 0.07), with a mean follow-up of 25.73 ± 18.66 mo.</p><p><strong>Conclusions: </strong>Utilization of resorbable biosynthetic mesh may be preferable to biologic mesh in contaminated fields due to lower rates of SSOs and interventions, ultimately reducing the postoperative clinical and financial burden for this patient population.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"398-405"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932092","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":"Adolescent Hyperparathyroidism: An Updated Contemporary Surgical Experience at a Tertiary Center.","authors":"Sara Abou Azar, Joseph Tobias, Rachel Nordgren, Edwin L Kaplan, Peter Angelos, Xavier M Keutgen, Megan K Applewhite","doi":"10.1016/j.jss.2024.11.007","DOIUrl":"10.1016/j.jss.2024.11.007","url":null,"abstract":"<p><strong>Introduction: </strong>Primary hyperparathyroidism (pHPT) in children is uncommon, resulting in a paucity of data describing the disease process in this population. Herein, in an effort to bridge the information gap, we review our experience with pHPT in adolescent patients under 20 y of age at a specialized tertiary referral center.</p><p><strong>Methods: </strong>A retrospective chart review included all adolescent patients with pHPT, who underwent surgery at our institution between 2004 and 2023. Presenting symptoms, biochemical workup, intraoperative findings, and outcomes were collected and analyzed.</p><p><strong>Results: </strong>Forty-nine adolescent patients were included, with 45% (n = 22) being male. The median age at diagnosis was 16.6 y (14.1-20). On presentation, 71% (n = 35) were symptomatic, most commonly nephrolithiasis (35%, n = 17). The median preoperative calcium and parathyroid hormone were 12 mg/dL (11.3-12.6) and 128pg/mL (105-170.5), respectively. Focused parathyroidectomy was performed in 61% (n = 30) and four-gland exploration in 39% (n = 19) of patients. Eighty-six percent were found to have a single adenoma and 14% had multigland disease. Preoperative localization with ultrasound and Sestamibi had a sensitivity of 57% and 59%, respectively. When combining both imaging modalities, sensitivity increased to 78% (positive predictive value 91%). There were no surgical complications. At the median follow-up of 61.0 mo, 4% of patients were found to have recurrent pHPT. Younger age (OR 0.64, P = 0.038) and sporadic disease (OR 0.04, P = 0.050) had less likelihood of recurrence.</p><p><strong>Conclusions: </strong>Most adolescent patients with pHPT present with symptoms and have single gland disease. Adolescent pHPT should be treated like adult pHPT, utilizing intraoperative PTH and two preoperative imaging modalities.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"150-155"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854627","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":"Delays in Care for Children With Low Anorectal Malformations in Southwestern Uganda.","authors":"Felix Oyania, Caroline Q Stephens, Sarah Ullrich, Meera Kotagal, Daniel Kisitu, Francis Bajunirwe, Doruk E Ozgediz, Dan Poenaru","doi":"10.1016/j.jss.2024.11.013","DOIUrl":"10.1016/j.jss.2024.11.013","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in anorectal malformation (ARM) outcomes between high- and low-income countries may be due to delayed diagnosis in the latter setting. The Three Delays model, comprising delays in seeking, accessing, and receiving care, provides a framework for exploring these challenges. We sought to examine the frequency and nature of the preoperative delays in children presenting for surgical correction of low ARMs.</p><p><strong>Methods: </strong>We conducted a cross-sectional study examining the delays in care among children with low ARMs in Southwestern Uganda between June 2021 and July 2023. Delayed diagnosis was defined as a diagnosis made >48 h of life. Potential associated factors such as caregiver, community, and aspect of health-care system factors were examined. Statistical significance was set at P < 0.05.</p><p><strong>Results: </strong>A total of 80 patients were included in the study. The median age at diagnosis was 29.2 d. In 82% of patients, the parents diagnosed the abnormality and 74% experienced delayed diagnosis. Among delays in seeking care, 23% of caregivers reported no knowledge of their child's disease. For delays in reaching care, 37% encountered financial problems, and 28% lacked an appropriate diagnosis from a health center, contributing to delays in receiving care.</p><p><strong>Conclusions: </strong>Delays in care are frequent for children with low ARMs. Finances and caregivers' and health-care workers' knowledge contribute significantly to these delays. To mitigate these delays, we recommend improving referral processes, prioritizing newborn screening examinations, advocating for a national child health insurance policy, and enhancing the training of primary health-care providers.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"156-162"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864646","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":"Transcatheter Versus Surgical Aortic Valve Replacement for Patients With Pulmonary Hypertension.","authors":"Divyaam Satija, Doug A Gouchoe, Julia Monasterio, Ervin Y Cui, Scott Lilly, Konstantinos Dean Boudoulas, Nancy Matre, Bryan A Whitson, John Bozinovski, Nahush A Mokadam, Asvin M Ganapathi, Matthew C Henn","doi":"10.1016/j.jss.2024.11.026","DOIUrl":"10.1016/j.jss.2024.11.026","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR) has become a viable alternative to surgical aortic valve replacement (SAVR) for high-risk patients with aortic stenosis. One such high-risk group is patients with pulmonary hypertension (PH), which is known to increase surgical risk and adversely affect outcomes. This study aims to compare midterm and long-term survival in TAVR and SAVR among patients with PH.</p><p><strong>Methods: </strong>A retrospective review of patients with PH undergoing an aortic valve replacement was conducted at a single institution. From May 2012 to June 2020, 427 patients with PH underwent a primary isolated TAVR (n = 249) or SAVR (n = 178). PH was assessed using an estimated pulmonary artery systolic pressure ≥40 mmHg. Propensity score matching was used to adjust for confounders.</p><p><strong>Results: </strong>Before matching, Kaplan-Meier estimated survival was significantly lower for TAVR compared to SAVR (P < 0.01). After matching, 87 well-balanced pairs remained. Post propensity score matching, Kaplan-Meier estimated survival was still significantly lower for the TAVR group as compared to the SAVR group (P = 0.045).</p><p><strong>Conclusions: </strong>These data support the feasibility and safety of SAVR in selected patients with PH, and the presence of PH should not preclude consideration of SAVR in appropriate surgical candidates. Further multicenter research is needed to explore confounders and deepen our understanding of the long-term outcomes in this high-risk population.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"222-230"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895525","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":"Housing Instability and Outcomes Among Patients With Access-Sensitive Surgical Conditions.","authors":"Emily E Evans, Nicholas Kunnath, Esther J Oh, John W Scott, Megan Janeway","doi":"10.1016/j.jss.2024.10.050","DOIUrl":"10.1016/j.jss.2024.10.050","url":null,"abstract":"<p><strong>Introduction: </strong>Housing instability is a significant contributor to poor health but remains understudied among surgical patients. We evaluated the association between housing instability and rates of unplanned surgical procedures, as well as resultant health and financial outcomes, for patients with access-sensitive conditions.</p><p><strong>Methods: </strong>Using the Healthcare Cost and Utilization Project National Inpatient Sample, we identified patients who underwent one of four selected procedures for access-sensitive surgical conditions (abdominal aortic aneurysm repair, colectomy, incisional hernia repair, and lower extremity bypass). Housing status was determined using International Classification of Disease, 10th Revision, Clinical Modification codes Z59.0 (homelessness) and Z59.1 (lack of adequate housing). Risk-adjusted multivariable logistic regression compared outcomes between patients with and without housing instability.</p><p><strong>Results: </strong>Of 1,761,965 individuals admitted for access-sensitive surgical conditions, 2280 were experiencing housing instability. Housing-unstable individuals had more than four times the odds of undergoing unplanned surgery than housing-stable individuals (odds ratio 4.41, P < 0.001). Across all procedures, individuals with housing instability experienced longer lengths of stay (planned: 5 d versus 4 d, P < 0.001; unplanned: 8 d versus 7 d, P < 0.001) and higher costs per admission following planned surgery ($20,379 versus $18,152, P < 0.001) than housing-stable individuals. Housing-unstable individuals had lower odds of complications and in-hospital mortality following planned surgeries. No differences in morbidity or mortality were identified following unplanned surgeries.</p><p><strong>Conclusions: </strong>Patients experiencing housing instability had higher odds of undergoing unplanned surgical procedures, had longer hospital stays and higher costs, and had similar or better outcomes following surgery. Efforts to expand affordable housing opportunities may improve access to timely surgical care.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"56-64"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794783","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}