Journal of Surgical Research最新文献

{"title":"Porcine Packed Red Blood Cells Demonstrate a Distinct Red Blood Cell Storage Lesion","authors":"Ryan C. Chae MD,&nbsp;Adam D. Price MD,&nbsp;Matthew R. Baucom MD,&nbsp;Lindsey J. Wattley MD,&nbsp;Christopher Q. Nguyen BS,&nbsp;Michael D. Goodman MD,&nbsp;Timothy A. Pritts MD, PhD","doi":"10.1016/j.jss.2024.09.024","DOIUrl":"10.1016/j.jss.2024.09.024","url":null,"abstract":"<div><h3>Introduction</h3><div>The red blood cell (RBC) storage lesion has been well described in mouse and human blood but not in swine. Understanding the porcine RBC storage lesion is necessary prior to evaluating transfusion of stored packed red blood cells (pRBCs) in polytrauma models. We hypothesized that porcine pRBCs would undergo a similar storage lesion severity after 42 d.</div></div><div><h3>Methods</h3><div>Whole blood was collected from female Yorkshire pigs and pRBCs were isolated in additive storage solution 3. Female human whole blood was obtained from our local blood bank and pRBCs prepared. Human and porcine pRBCs were stored for 42 d and sampled weekly and evaluated for markers of the RBC storage lesion including biochemical measurements, eryptotic RBCs, band-3 expression, erythrocyte-derived microvesicles, and free hemoglobin concentrations.</div></div><div><h3>Results</h3><div>Porcine pRBCs demonstrated a hematocrit similar to human pRBCs. Both human and porcine pRBC units developed a progressive storage lesion. However, over 42 d of storage, porcine pRBCs maintained their pH and had decreased glucose utilization. Porcine pRBCs also demonstrated decreased levels of eryptosis compared to human samples and generated less erythrocyte-derived microvesicles with lower free hemoglobin concentrations.</div></div><div><h3>Conclusions</h3><div>Porcine pRBCs stored in additive storage solution 3 demonstrate a progressive RBC storage lesion over 42 d of storage but with less severity than human controls. Given the differences in porcine erythrocyte metabolism, further study of the storage lesion in porcine blood is needed in addition to incorporating the use of stored porcine pRBCs in a swine model of hemorrhagic shock to more closely mimic clinical scenarios.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 396-404"},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445128","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":"Implications of Using a Clinical Practice Guideline on Outcomes in Pediatric Empyema","authors":"Brianna L. Spencer MD,&nbsp;Dimitra M. Lotakis MD,&nbsp;Anjali Vaishnav BS,&nbsp;Jessica Carducci BS,&nbsp;Lauren Hoff MD,&nbsp;Elizabeth Speck MD,&nbsp;Erin E. Perrone MD","doi":"10.1016/j.jss.2024.09.045","DOIUrl":"10.1016/j.jss.2024.09.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Various randomized control trials in the pediatric population have shown no therapeutic advantage of video-assisted thoracoscopic surgery over fibrinolytic therapy (tissue plasminogen activator [tPA]) for empyema management. However, literature detailing changes in practice management and protocol implementation is limited. In 2018, we instituted clinical practice guidelines (CPGs) for empyema management utilizing tissue plasminogen activatorinstillation via a small bore chest tube as initial therapy. Before standardization, surgeon preference drove management. Our aim was to determine differences in management and outcomes following institutional CPG implementation.</div></div><div><h3>Methods</h3><div>A single-institution retrospective study (2002-2022) examined patients 0-18 y of age diagnosed with pneumonia and associated empyema (loculated pleural fluid on ultrasound or computed-tomographic scan). The comparison groups were pre- and post-CPG implementation groups. Comparative statistics were performed, and the significance level was set at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Sixty-one patients met the inclusion criteria: 33 (54%) preimplementation and 28 (46%) postimplementation. The demographics and diagnostic imaging modalities were similar between groups. There were no significant differences in time to initiate antibiotics, antibiotic duration, intensive care unit length of stay (LOS), or total hospital LOS. The utilization of video-assisted thoracoscopic surgery as initial intervention significantly decreased from 66% to 10% after protocol implementation (<em>P</em> &lt; 0.01); the failure rates of initial therapy choice were similar (12% <em>versus</em> 10%, <em>P</em> = 0.87). Marked reduction in total patients undergoing operative intervention at any point during the course of therapy was observed, 76% preimplementation <em>versus</em> 21% postimplementation (<em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>In children treated for empyema, the overall incidence of operative intervention significantly decreased following CPG implementation. The changes in antibiotic usage, intensive care unit/total LOS, and initial therapy failure rates did not differ. In our experience, the implementation of a CPG was instrumental in adherence to national guidelines.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 390-395"},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445015","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":"Is Repeat Computed Tomography Angiography for Asymptomatic Grade 1 Blunt Cerebrovascular Injuries Cost-Effective?","authors":"Cynthia J. Susai MD,&nbsp;Nathan J. Alcasid MD,&nbsp;Kian C. Banks MD,&nbsp;April E. Mendoza MD,&nbsp;Camille Jackson MD,&nbsp;Shahram Aarabi MD,&nbsp;Lara Senekjian MD,&nbsp;Gregory P. Victorino MD","doi":"10.1016/j.jss.2024.09.015","DOIUrl":"10.1016/j.jss.2024.09.015","url":null,"abstract":"<div><h3>Introduction</h3><div>For all blunt cerebrovascular injuries (BCVIs), the standard recommendation is to obtain repeat computed tomography angiography (CTA) in approximately 7-10 d postinjury to evaluate for progression of BCVI. Given the low likelihood that repeat CTA would result in a change in management apart from continuing antithrombotic therapy in grade 1 BCVI, we hypothesized that repeat CTA in this subset of BCVI would not be cost-effective.</div></div><div><h3>Methods</h3><div>We performed a decision-analytic model to evaluate the cost-effectiveness of repeat CTA at 7-10 d in the base case of a 50-y-old blunt trauma patient with an asymptomatic grade 1 BCVI on antithrombotic therapy. Cost, probability estimates, and utilities in quality-adjusted life years (QALYs) were accessed from published literature. Deterministic analyses were performed.</div></div><div><h3>Results</h3><div>Decision-analytic model identified that repeating the CTA was the optimal strategy, with improved effectiveness offsetting a slightly higher cost. Although the strategy with the repeat CTA incurred a net cost of 694.20, the utility is significantly better, with QALYS of 0.94 (repeat CTA) <em>versus</em> 0.86 (no repeat CTA). Deterministic sensitivity analysis revealed most influential variables were the cost of CTA, utility of unnecessary antithrombotic treatment after resolved BCVI, cost of antithrombotic therapy, and utility of endovascular intervention reducing stroke risk.</div></div><div><h3>Conclusions</h3><div>In patients with asymptomatic grade I BCVI, repeating CTA for grade I BCVI is overall cost-effective, as the improvement in QALYs is substantial enough to offset a slightly higher cost. This supports repeating the CTA as the cost-effective management strategy for asymptomatic grade I BCVI.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 409-414"},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445129","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":"Thoracoscopic Repair for Kluth Type Ⅲb3 Esophageal Atresia and Distal TracheoesophagealFistula","authors":"Bing Li MD ,&nbsp;Wei Bing Chen MD ,&nbsp;Shun Lin Xia MD ,&nbsp;Shi Ting Li MD","doi":"10.1016/j.jss.2024.09.055","DOIUrl":"10.1016/j.jss.2024.09.055","url":null,"abstract":"<div><h3>Introduction</h3><div>This report aims to present our initial miniseries of successful thoracoscopic repair for esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) of Kluth type Ⅲb3 in accordance with Kluth's classification.</div></div><div><h3>Methods</h3><div>From January 2012 to January 2024, ten patients with Kluth type Ⅲb3 EA-TEF were treated by thoracoscopic surgery. The therapeutic methods and surgical outcomes were retrospectively reviewed.</div></div><div><h3>Results</h3><div>All procedures were completed thoracoscopically without conversions. A preoperative bronchoscopy assessment was conducted in four of the cases, revealing that the fistula from the distal segment was located high on the trachea at the level of T2 vertebral. The mean age of the patients at the time of operation was 2.0 ± 0.7 d (range, 1-3 d), and the mean weight at operation was 2.6 ± 0.4 kg (range, 1.8-3.0 kg). The mean operative time (skin to skin) for the entire series was 137.0 ± 8.9 min (range, 120-150 min). Oral feeding was initiated on the postoperative day 8.0 ± 1.9 (range, 6-12 d), and the mean duration for patients after surgery was 14.0 ± 2.4 d (range, 12-20 d). The postoperative period has been uneventful with no occurrences of mortality or morbidity to date. Three cases of formatted anastomotic stricture required at least one esophageal dilation after surgery.</div></div><div><h3>Conclusions</h3><div>Pediatric surgeons should be aware of the rare variants of EA-TEF to avoid the diagnostic and management pitfalls. Patients with Kluth type Ⅲb3 EA-TEF were amenable to repair by thoracoscopic surgery.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 405-408"},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445013","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":"How Many Sentinel Lymph Nodes Should We Excise in Patients With Melanoma?","authors":"Jason M. Lizalek MD,&nbsp;Collin E. Dougherty BS,&nbsp;Bradley N. Reames MD, MS,&nbsp;Jason Foster MD,&nbsp;Juan A. Santamaria MD,&nbsp;Joshua M.V. Mammen MD, PhD","doi":"10.1016/j.jss.2024.09.040","DOIUrl":"10.1016/j.jss.2024.09.040","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of many patients with early-stage melanoma includes sentinel lymph node (SLN) biopsy for prognostic and treatment planning purposes. While the minimum necessary number of SLNs to examine has been determined for patients with other malignancies, it has not been delineated in melanoma. The current study evaluates risk factors for SLN positivity and the associated number of SLNs that are necessary to examine for appropriate staging.</div></div><div><h3>Materials and methods</h3><div>The National Cancer Database participant user file from 2018 to 2020 was queried for clinically node-negative patients who underwent SLN biopsy. Descriptive statistics were obtained. Analysis of variance statistical analyses were performed.</div></div><div><h3>Results</h3><div>Eight thousand forty eight melanoma patients out of 48,748 were identified from 2018 to 2020 that had lymph node positivity on SLN biopsy. The median age of patients was 64. The male-to-female ratio was 1.47. Chi-squared analysis revealed that there was a statistically significant difference in positivity rate between at least two groups (<em>P</em> = 0.006) for primary melanoma site, male sex (<em>P</em> &lt; 0.01), race, age, histologic type, Breslow thickness, and lymphovascular invasion (<em>P</em> &lt; 0.001). SLN positivity rate increased with the number of SLNs examined until plateauing at 4 SLNs. There was no statistical difference between positivity for 3 SLNs and larger numbers of SLNs examined. Propensity matching revealed no statistically significant difference in positive rate when more than 2 SLNs were biopsied.</div></div><div><h3>Conclusions</h3><div>SLN positivity is proportionally related to the number of SLNs examined, suggesting that surgeons should attempt to remove a minimum of 2 SLNs for the optimal staging of patients with melanoma.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 371-380"},"PeriodicalIF":1.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445016","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":"By Any Other Name: Bowel Dysfunction After Proctectomy for Cancer and Its Predictive Factors in Administrative Databases","authors":"Ira L. Leeds MD, MBA, ScM ,&nbsp;Nathan A. Coppersmith MD ,&nbsp;Miranda S. Moore MPH ,&nbsp;Ahmad Saleh BS ,&nbsp;Kingsley Cruickshank BS ,&nbsp;Haddon Pantel MD ,&nbsp;Vikram Reddy MD, PhD ,&nbsp;Anne K. Mongiu MD, PhD","doi":"10.1016/j.jss.2024.09.027","DOIUrl":"10.1016/j.jss.2024.09.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnosis, outcomes, and costs of care associated with bowel dysfunction after proctectomy for cancer remain underexplored in population-based studies. The lack of administrative coding for bowel dysfunction or low anterior resection syndrome has historically limited secondary data set outcomes analysis. The purpose of this study was to identify a bowel dysfunction phenotype in administrative claims data and characterize its prevalence, predictive factors, and costs.</div></div><div><h3>Materials and methods</h3><div>Patients were identified with employer-sponsored commercial insurance (MarketScan research databases) undergoing proctectomy for cancer for a retrospective cohort study. Bowel dysfunction was defined as any patient with diagnostic codes for diarrhea, constipation, incontinence, pelvic floor diagnostic testing, or rehabilitative procedures that occurred in the 18 mo to follow surgery. We performed Poisson regression to identify statistically significant covariates of bowel dysfunction occurrence following low anterior resection. A secondary comparative analysis was also performed of total costs of healthcare utilization following gastrointestinal continuity.</div></div><div><h3>Results</h3><div>6426 proctectomy patients were identified, out of which 2131 had surgery for cancer. 847 patients undergoing proctectomy for cancer (39.7%) experienced bowel dysfunction during 18 mo of follow-up. The most common diagnoses were constipation (53.5%) and diarrhea (40.3%). Diagnostic procedures and rehabilitative procedures were performed in only 29.8% of those with symptoms. Neoadjuvant chemotherapy administration with radiation (incidence rate ratio = 1.23, 95% CI: 1.01-1.51) and without (incidence rate ratio = 1.20, 95% CI: 1.01-1.42) remained associated with postoperative bowel dysfunction when controlling for other factors. Chemoradiation therapy alone was not associated with bowel dysfunction. The median total follow-up costs with bowel dysfunction were $30,769 greater (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>More than one-third of patients have symptomatic bowel dysfunction within 18 mo after restored continuity, with multiagent chemotherapy being the strongest independent predictor. Bowel dysfunction is associated with more than twice healthcare costs postop.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 342-351"},"PeriodicalIF":1.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After Pectus Excavatum Repair: A Nationwide Comparison of Nuss Versus Ravitch Operations","authors":"Carlos Theodore Huerta MD ,&nbsp;Daniel M. Alligood MD ,&nbsp;Jenna K. Davis MD ,&nbsp;Walter A. Ramsey MD ,&nbsp;Michael D. Cobler-Lichter MD ,&nbsp;Larisa Shagabayeva MD ,&nbsp;Jessica M. Delamater MD, MPH ,&nbsp;Alexandra E. Hernandez MD ,&nbsp;Joshua P. Parreco MD ,&nbsp;Eduardo A. Perez MD ,&nbsp;Juan E. Sola MD ,&nbsp;Chad M. Thorson MD, MSPH","doi":"10.1016/j.jss.2024.09.025","DOIUrl":"10.1016/j.jss.2024.09.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Pectus excavatum is the most prevalent chest wall deformity. Repair may be offered via Nuss or Ravitch technique. This study aims to investigate the outcomes of these repairs using a national cohort.</div></div><div><h3>Methods</h3><div>The Nationwide Readmission Database was queried from 2016 to 2020 for patients aged 12-21 y old with pectus excavatum. Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. The results were weighted for national estimates.</div></div><div><h3>Results</h3><div>A total of 10,053 patients with pectus excavatum underwent repair (86% Nuss, <em>n</em> = 8673 and 14% Ravitch, <em>n</em> = 1380). Baseline characteristics were similar between cohorts. Nuss repair patients traveled more frequently out of state for repair (10.5% <em>versus</em> 8.7%) and were in the highest income quartiles (61.1% <em>versus</em> 57.3%), both <em>P</em> &lt; 0.05. Of reporting hospitals, 60% performed only the Nuss procedure. The Ravitch cohort experienced higher rates of complications during index admission, including chest tube placement (5.1% <em>versus</em> 2.2%), bleeding (2.4% <em>versus</em> 0.6%), air leak (0.9% <em>versus</em> 0.3%), and respiratory failure (1.0% <em>versus</em> 0.3%), as well as longer median length of stay (4 <em>versus</em> 3 d), all with a <em>P</em> value &lt; 0.05. While both cohorts had similar overall readmission rates, Ravitch repairs had higher rates of readmissions for bleeding (18.3% <em>versus</em> 4.5%), pain (32.9% <em>versus</em> 13.5%), and psychiatric complications (31.7% <em>versus</em> 21.2%), all with a <em>P</em> value &lt; 0.05. Ravitch repairs also incurred higher total hospital costs ($18,670 <em>versus</em> 17,462, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Nuss repairs were associated with fewer index complications with no increase in readmissions compared to Ravitch procedures. However, disparities may exist in access to Nuss repair.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 381-389"},"PeriodicalIF":1.8,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445014","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":"History of Preoperative Use of Gabapentin Before Lower Extremity Bypass Predisposes Patients to a High Risk of Opioid Use and Dependence in a Dose-dependent Manner","authors":"Fadi Samaan BS ,&nbsp;Ahsan Zil-E-Ali MBBS, MPH ,&nbsp;Billal Alamarie BS ,&nbsp;Abdul Wasay Paracha BS ,&nbsp;Nkemjika Nwaneri BS, MS ,&nbsp;Faisal Aziz MD, FACS, DFSVS","doi":"10.1016/j.jss.2024.09.026","DOIUrl":"10.1016/j.jss.2024.09.026","url":null,"abstract":"<div><h3>Introduction</h3><div>This study assesses the association of preoperative use of gabapentinoids (GBPs) with postoperative risk of opioid-related disorders in peripheral artery disease patients undergoing lower extremity bypass operation.</div></div><div><h3>Methods</h3><div>This is a retrospective propensity score-matched analysis of patients undergoing peripheral artery bypass in TriNetX, a multicenter national database. Two study groups were constituted based on the preoperative history of prescribed GBPs. Primary outcomes were opioid-related disorders and mortality. The outcomes were reported at two-time endpoints that is, at 1 and 5 y.</div></div><div><h3>Results</h3><div>This study population included a total of 23,706 patients. After propensity score-matched analysis, each group contained 5130 patients. The primary outcomes showed a significant increase in postoperative opioid-related disorders at the 1 and 5-y time points between GBPs and no GBPs groups: 1-y outcome (2.0% <em>versus</em> 1.1%; adj. <em>P</em> = 0.007) and 5-y outcome (4.5% <em>versus</em> 3.5%; adj. <em>P</em> = 0.035). Logistic regression analysis revealed an increase in the 1-y (adjusted odds ratio= 1.664; 95% CI [1.217, 2.273], <em>P</em> = 0.001) and 5-y (OR = 1.353; 95% CI [1.107, 1.653], <em>P</em> = 0.003) odds of opioid-related disorders in patients on GBPs. A secondary analysis showed a significant dose-dependent increase in the associated risk of 5-y opioid-related disorders in patients with a history of prescribed gabapentin.</div></div><div><h3>Conclusions</h3><div>In patients undergoing lower extremity bypass with a history of gabapentin use, there is an associated increased long-term risk of opioid-related disorders in a dose-dependent fashion. Overall, this study highlights weighing risks and benefits of prescribing GBPs for pain control versus their long-term associated risk of opioid-related disorders among other adverse outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 352-360"},"PeriodicalIF":1.8,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142434120","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":"When Is Diversion Indicated After Right-Sided Colon Resections?","authors":"Richard Sassun MD ,&nbsp;David W. Larson MD, MBA ,&nbsp;Katherine A. Bews MS ,&nbsp;Scott R. Kelley MD ,&nbsp;Kellie L. Mathis MD ,&nbsp;Elizabeth B. Habermann PhD ,&nbsp;Nicholas P. McKenna MD, MS","doi":"10.1016/j.jss.2024.09.056","DOIUrl":"10.1016/j.jss.2024.09.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Ileocolonic anastomoses have a low anastomotic leak (AL) risk, resulting in infrequent diverting loop ileostomy use. Identifying patients who warrant diverting loop ileostomy with right-sided resection is challenging due to this low incidence of AL. Therefore, a multicenter database was used to develop an AL risk score to help inform when diversion should be strongly considered after right-sided resections.</div></div><div><h3>Materials and methods</h3><div>Patients undergoing elective right-sided resections within the 2012-2020 American College of Surgeons National Surgical Quality Improvement Program-targeted colectomy participant user files were identified. Multivariable logistic regression identified AL risk factors that were then converted to point values to develop an AL risk score. The developed AL risk score was then assessed for visual correspondence and analyzed for internal validity.</div></div><div><h3>Results</h3><div>42,176 patients underwent right-sided resection without diversion, and the incidence of AL was 2.4%. The risk calculator exhibited excellent calibration and fair discrimination. Strong visual correspondence was observed for predicted and actual AL rates within the 95% confidence interval for nine of ten risk score deciles.</div></div><div><h3>Conclusions</h3><div>An internally validated AL risk score for elective ileocolic resections was developed. Most patients had scores that categorized them at a low risk of AL. The diversion after elective right-sided resections should be reserved for extreme cases.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 361-370"},"PeriodicalIF":1.8,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445012","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":"Pediatric Ewing Sarcoma Presentation, Treatment, and Outcomes Across Sociodemographic Groups","authors":"Connor D. Fritz MS ,&nbsp;Anthony V. Basta BA ,&nbsp;Jonathan Gill MD ,&nbsp;Valerae O. Lewis MD ,&nbsp;Justin E. Bird MD ,&nbsp;Mary T. Austin MD, MPH","doi":"10.1016/j.jss.2024.09.037","DOIUrl":"10.1016/j.jss.2024.09.037","url":null,"abstract":"<div><h3>Introduction</h3><div>In this study, we evaluate the association between sociodemographics and disease presentation, treatment, and survival for children, adolescents, and young adults with Ewing sarcoma.</div></div><div><h3>Methods</h3><div>Case-level data were downloaded from The Surveillance, Epidemiology, and End Results database. Cases included patients ages 0-24 who were diagnosed with Ewing sarcoma between 2004 and 2020.</div></div><div><h3>Results</h3><div>One thousand two hundred forty four patients were included in the analysis. When compared to non-Hispanic White (NHW) patients, Hispanic patients were more likely to present with tumors ≥8 cm (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.24-2.36) and metastases (OR = 1.65, 95% CI = 1.23-2.20). Black patients were less likely to receive chemotherapy (OR = 0.25, 95% CI = 0.07-0.97). The 5-year disease-specific survival rate was 73% for NHW patients, 65% for Black patients, 67% for Asian patients and 66% for Hispanic patients. When accounting for confounding factors, Hispanic and Asian patients had higher probabilities of death due to cancer compared to NHW patients (HR = 1.41, 95% CI = 1.10-1.81; HR = 1.64, 95% CI = 1.09-2.48, respectively). Young adults and adolescents were significantly more likely to present with metastases, experience ≥1 month between diagnosis and treatment, and had lower survival.</div></div><div><h3>Conclusions</h3><div>Significant differences in Ewing sarcoma presentation, treatment, and survival were observed across age groups and race/ethnicity. Future work should focus on expanding access to care in underserved groups. Further qualitative studies could assist in determining the exact factors that prevent patients from accessing care or examine how genetic factors that contribute to Ewing sarcoma severity differ across demographic groups.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 322-331"},"PeriodicalIF":1.8,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427917","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}