Journal of Surgical Research最新文献

{"title":"Letter Regarding: \"Comparing How Three Frailty Scales Predict Negative Outcomes in Trauma Patients With Rib Fractures\".","authors":"Shayan Shabani Samghabadi, Amirmohammad Masoumi","doi":"10.1016/j.jss.2025.05.029","DOIUrl":"https://doi.org/10.1016/j.jss.2025.05.029","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667900","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 Predictive Value of Prehospital Simple Shock Index for Hypoperfusion in Trauma Patients","authors":"Jianbang Chen BM ,&nbsp;Zhonghou Lin BM ,&nbsp;Xiaoli Guan BM ,&nbsp;Mingyuan Sun BM ,&nbsp;Tianyu Liang BM ,&nbsp;Qiaoxian Zhang BM","doi":"10.1016/j.jss.2025.06.044","DOIUrl":"10.1016/j.jss.2025.06.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma ranks as a leading cause of death among individuals under the age of 40 globally, with 30% to 40% of these fatalities resulting from excessive hemorrhage. This study aims to evaluate the predictive value of simple shock index (sSI) for detecting hypoperfusion in trauma patients in prehospital contexts.</div></div><div><h3>Methods</h3><div>This retrospective study included a total of 303 prehospital trauma patients from January 2020 to August 2023, comprising 191 males and 112 females. The patients were categorized into a hypoperfusion group and a nonhypoperfusion group based on the presence of shock during their stay in the resuscitation room. We further compared the two groups in terms of age, gender, prehospital fluid administration, prehospital transport duration, response time in prehospital care, shock index (SI), sSI and their correlation with hypoperfusion.</div></div><div><h3>Results</h3><div>The nonparametric test for two independent samples (Mann–Whitney U test) revealed that age, SI, and sSI hold predictive value for hypoperfusion in prehospital trauma patients. The area under the receiver operating characteristic curve (AUC) illustrated their predictive sensitivity and specificity. The AUC for the SI was 0.819 (95% confidence interval: 0.769-0.868), with a sensitivity of 77.70% and specificity of 84.2%. For the sSI, the AUC was 0.817 (95% confidence interval: 0.767-0.866), with a sensitivity of 77.70% and specificity of 83.20%, demonstrating a statistically significant difference in predictive value compared to age.</div></div><div><h3>Conclusions</h3><div>Both the SI and the sSI effectively predict hypoperfusion in prehospital trauma patients. However, the sSI offers a more straightforward calculation, making it particularly suitable for assessing the condition of trauma patients in prehospital settings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 285-290"},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response Regarding: \"Comparing How Three Frailty Scales Predict Negative Outcomes in Trauma Patients With Rib Fractures\".","authors":"Lawrence R Feng, Colette Galet, Dionne A Skeete","doi":"10.1016/j.jss.2025.06.038","DOIUrl":"https://doi.org/10.1016/j.jss.2025.06.038","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667901","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":"Study of Insurance Type on Operative Approach and Time to Operation of Elective Inguinal Hernia Repairs","authors":"Keouna Pather MD,&nbsp;Erin M. Mobley PhD, MPH,&nbsp;Reed Popp BSc,&nbsp;Joshua Welden BSc,&nbsp;Yordan Penev MTM,&nbsp;Austin Eason BSc,&nbsp;Daniel Mestre BSc,&nbsp;Ryan Dowdall BSc,&nbsp;T Shane Hester DO,&nbsp;Leigh Neumayer MD, MS, MBA,&nbsp;Jana Sacco MD,&nbsp;Ruchir Puri MD","doi":"10.1016/j.jss.2025.06.020","DOIUrl":"10.1016/j.jss.2025.06.020","url":null,"abstract":"<div><h3>Introduction</h3><div>This study examined whether insurance type is associated with operative approach and delays in elective inguinal hernia repairs.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective review of elective inguinal hernia repairs from 2012 to 2021. Outcomes included operative approach and time from clinic visit to operation. Univariable associations with each outcome and insurance type (primary independent variable), as well as demographic, clinical, hernia, operative, and postoperative characteristics that were significant (<em>P</em> &lt; 0.05), were entered into multivariable models. A multivariable logistic regression model predicting the odds of greater than the median number of days to operation (odds ratio; 95% confidence interval) and a multivariable time-to-event Cox proportional hazards model (hazard ratio; 95% confidence interval) were used.</div></div><div><h3>Results</h3><div>One thousand two hundred six patients underwent inguinal hernia repairs (93% male, median age 58 y) with a median of 39 d to operation. On univariable analysis, privately insured patients more frequently underwent minimally invasive procedures (80%) compared to uninsured patients (43%; <em>P</em> &lt; 0.001). The median time to operation differed for Medicaid (51 d), Medicare (41), and uninsured (37) patients versus private (34; <em>P</em> &lt; 0.001). The multivariable logistic regression model demonstrated that Medicaid insurance coverage (1.79; 1.25-2.58) and robotic approach (1.70; 1.25-2.32) were associated with increased time to operation greater than the median of 39 d. The multivariable time-to-event model revealed that patients covered by Medicaid (0.78; 0.65-0.92) and uninsured patients (0.75; 0.62-0.91) experienced increased time to operation.</div></div><div><h3>Conclusions</h3><div>Medicaid and uninsured patients experienced longer time from clinic to operation. In addition, uninsured patients were more likely to have open repairs. Inequities in access to surgery need further investigation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 277-284"},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654834","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 Potential of Precision: A Scoping Review of Patient Metabolic Patterns After Traumatic Brain Injury","authors":"Estelle Brugere BS ,&nbsp;Joshua Preston BS ,&nbsp;Flor Durazo BS ,&nbsp;Sumudu Rajakaruna PhD ,&nbsp;Malak Tfaily PhD ,&nbsp;Bellal Joseph MD ,&nbsp;Elizabeth Benjamin MD, PhD ,&nbsp;Tanya Anand MD, MPH, MT (ASCP)","doi":"10.1016/j.jss.2025.06.033","DOIUrl":"10.1016/j.jss.2025.06.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the injury burden, categorization and prognostication of traumatic brain injury (TBI) severity is primarily based on a combination of clinical examination, imaging, and certain adjuncts such as electroencephalogram and intracranial pressure monitors. Understanding metabolite patterns after TBI may serve as a more precise method to describe and prognosticate injury severity, guide treatment, and serve as a valuable adjunct to current diagnostic and treatment modalities. In this review, we aim to consolidate current metabolomics research on patients sustaining a TBI, describing how metabolite changes are associated with TBI severity, treatment, and outcomes, with a specific focus on studies of clinically accessible samples (blood and/or urine).</div></div><div><h3>Materials and methods</h3><div>We performed a scoping review of the literature and screened articles using Covidence software. Articles detailing post-TBI metabolites in patient blood and/or urine samples were included, while studies describing data solely from cerebrospinal fluid samples, pediatric populations, or animal studies were excluded.</div></div><div><h3>Results</h3><div>We included 28 articles from our initial search yield of 771. Commonly increased metabolites in the acute phase included decanoic acid, lysophosphatidylcholine (LPC), 2-hydroxybutyrate (all increased in moderate to severe TBI), certain amino acids, and various LPCs (decreased in moderate to severe TBI). After 48 h, octanoic acid, decanoic acid, and LPC increased while glucose, pyruvate, and <em>N</em>-acetylaspartate decreased. LPC and methionine were associated with improved prognosis, while glutamate and octanoic acid were associated with worse prognosis.</div></div><div><h3>Conclusions</h3><div>Based on our review, amino acids generally decline with greater injury severity, while lipids increase early in severe TBI patients. Choline phospholipids are strong predictors of TBI patient outcomes. Early metabolically targeted TBI therapies may result in improved outcomes in moderate to severely injured patients. Further research is warranted to examine if metabolite biomarkers can serve as prognostication tools or guides for therapy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 210-221"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633732","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":"Global Utilization of Minimally Invasive Surgery: Practice and Challenges","authors":"Olivia C. McGinnis PhD ,&nbsp;Anne S. Wesonga MD ,&nbsp;Hizuru Amano MD ,&nbsp;Amos Loh MD ,&nbsp;Arushi Biswas BSE, BA ,&nbsp;Pierce Hollier BS ,&nbsp;Robert T. Ssekitoleko MEng ,&nbsp;Jenna L. Mueller PhD ,&nbsp;Tamara N. Fitzgerald MD, PhD","doi":"10.1016/j.jss.2025.06.024","DOIUrl":"10.1016/j.jss.2025.06.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Uptake of minimally invasive surgery (MIS) in low- and middle-income countries (LMICs) has been slow due to various barriers. This study examined the experiences of surgeons across multiple countries, highlighting the complications and challenges that arise with MIS.</div></div><div><h3>Methods</h3><div>Forty-one surgeons from Japan, Singapore, Uganda, the United States, Cambodia, Vietnam, and Malaysia completed 12-question surveys detailing the challenges of their MIS cases. Data were collected from April 2021 to February 2023, and descriptive statistics were generated.</div></div><div><h3>Results</h3><div>A total of 198 MIS cases were reported by 36 surgeons during the study period. In LMICs, patients tended to be older (<em>P</em> &lt; 0.001), more likely to be female (<em>P</em> &lt; 0.001), and have fewer comorbidities (<em>P</em> &lt; 0.01) than in high-income countries (HICs). Antireflux procedures, appendectomies, and cholecystectomies were the most common MIS performed. Surgical assistants varied, with Japanese surgeons reporting the highest usage of experienced surgeons as assistants (<em>n</em> = 53, 56%). Minimal blood loss was perceived for 80% of cases in HICs (<em>n</em> = 99), whereas greater than minimal blood loss was perceived in LMICs (<em>n</em> = 41, 55%; <em>P</em> &lt; 0.001). While most HIC surgeons found cases easy (<em>n</em> = 93, 75%) with no technical challenges, a higher percentage of LMIC surgeons considered converting to open procedures (<em>n</em> = 5, 7%) or had to convert (<em>n</em> = 6, 8%; <em>P</em> &lt; 0.001). Thematic grouping identified four key barriers in LMICs: access to resources, maintenance of equipment, difficult intraoperative pathology, and surgical training availability.</div></div><div><h3>Conclusions</h3><div>This study highlights significant differences in the MIS experience between HICs and LMICs. Technical difficulties and intraoperative challenges were more frequent in LMICs, and all cases converted to open procedures originated from these regions. The identified barriers—access to resources, equipment maintenance, difficult intraoperative pathology, and surgical training—are critical areas that need targeted interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 198-209"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633733","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":"Rectus Femoris Ultrasound to Evaluate Muscle During Prehabilitation for Patients With Cancer","authors":"Wariya Vongchaiudomchoke MD, MSc ,&nbsp;José A. Morais MD ,&nbsp;Do Jun Kim MSc ,&nbsp;Ah-Reum Cho MD, PhD ,&nbsp;Janius Tsang MD, MSc ,&nbsp;Francesco Carli MD, MPhil","doi":"10.1016/j.jss.2025.06.036","DOIUrl":"10.1016/j.jss.2025.06.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Skeletal muscle wasting is prevalent in patients awaiting cancer surgery. In preparation for surgery, prehabilitation has been shown to enhance functional capacity; however, its impact on muscle remains inconsistent. This exploratory study evaluated muscle changes using ultrasound of rectus femoris before and after prehabilitation in patients with cancer scheduled for surgery.</div></div><div><h3>Methods</h3><div>Adults referred to a prehabilitation clinic before elective cancer surgery, with a preoperative window of ≥4 wk, were prospectively enrolled in this pre-post interventional study. Participants completed a 4-6 wk prehabilitation program consisting of exercise, nutritional, and psychosocial interventions. Ultrasound assessments of the rectus femoris thickness and echo intensity of the dominant thigh were conducted at baseline and post intervention, alongside physical function assessments.</div></div><div><h3>Results</h3><div>Forty-seven participants (53% female) with a mean age of 69 y were included in the analysis. The most common cancer types were lung (34%) and esophagogastric (28%). Nineteen participants (40%) were receiving neoadjuvant therapy. No significant changes were observed in muscle thickness (0.3 mm; 95% confidence interval [CI], −0.3 to 0.9; <em>P</em> = 0.311) or echo intensity (0.5 arbitrary units; 95% CI, −3.7 to 4.7; <em>P</em> = 0.807) following prehabilitation. However, the 6 minute walk distance increased by 19 m (95% CI, 2 to 37; <em>P</em> = 0.031), reflecting a clinically meaningful improvement in functional capacity. Participants who demonstrated maintenance or improvement in muscle thickness and echo intensity exhibited significant improvements in leg strength and walking capacity.</div></div><div><h3>Conclusions</h3><div>Ultrasound assessment of rectus femoris is feasible and reliable for monitoring muscle changes during prehabilitation. Prehabilitation may help preserve muscle in patients with cancer during the preoperative period.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 187-197"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633737","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":"A Multimetric Health Literacy Analysis of Online Resources for Nipple Reconstruction","authors":"Audrey K. Mustoe BA,&nbsp;Agustin N. Posso MD,&nbsp;Maria J. Escobar-Domingo MD,&nbsp;Micaela J. Tobin BA,&nbsp;James E. Fanning BS,&nbsp;Bernard T. Lee MD, MBA, MPH","doi":"10.1016/j.jss.2025.06.019","DOIUrl":"10.1016/j.jss.2025.06.019","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to evaluate the accessibility of online health resources for nipple reconstruction in English and Spanish to identify areas of improving information access.</div></div><div><h3>Methods</h3><div>A deidentified Google search was conducted using the search phrase “nipple reconstruction” in English and “reconstrucción del pezón” in Spanish. The first ten websites in English and Spanish were included. A quality assessment of these websites was performed using the Patient Education and Materials Assessment Tool, Cultural Sensitivity Assessment Tool, and Simple Measure of Gobbledygook to evaluate understandability and actionability, cultural sensitivity, and readability, respectively. Unpaired <em>t</em>-tests and Chi-square tests were used to analyze differences between the groups.</div></div><div><h3>Results</h3><div>English sites scored similarly to Spanish sites on understandability (70.1% <em>versus</em> 71.0%, <em>P</em> = 0.82) and actionability (46.3% <em>versus</em> 37.5%, <em>P</em> = 0.27), although actionability scores were below the acceptable threshold (70%) in both groups. English sites were significantly more culturally sensitive than Spanish sites (60% <em>versus</em> 10%, <em>P</em> &lt; 0.001). English sites had a statistically significant higher average reading grade level compared to Spanish sites (12.3 <em>versus</em> 10.4, <em>P</em> = 0.005); however both groups exceeded recommended reading grade levels for online health resources. For websites from the same organization, English websites tended to be difficult to read; however, more culturally sensitive, compared to Spanish ones.</div></div><div><h3>Conclusions</h3><div>These findings suggest areas of improvement for culturally competent care for reconstruction patients. Improving the readability of online health resources for nipple reconstruction is essential in enabling patients to create informed decisions about their reconstructed breast.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 222-229"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633736","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":"Risk of Cardiovascular Complications in Thyrotoxicosis: Thyroidectomy Versus Nonoperative Management","authors":"Zhixing Song MD ,&nbsp;Niranjna Swaminathan MD ,&nbsp;Julia Kasmirski MD,&nbsp;Sanjana Balachandra MD,&nbsp;Christopher Wu MD,&nbsp;Andrea Gillis MD, MSPH,&nbsp;Jessica Fazendin MD,&nbsp;Brenessa Lindeman MD, MEHP,&nbsp;Herbert Chen MD","doi":"10.1016/j.jss.2025.06.046","DOIUrl":"10.1016/j.jss.2025.06.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Thyrotoxicosis is a hypermetabolic state that can be managed with antithyroid drugs, radioactive iodine (RAI), or thyroidectomy. However, the long-term cardiovascular effects of these treatments remain unclear. This study evaluates surgical <em>versus</em> nonsurgical approaches on new-onset cardiovascular complications in thyrotoxicosis patients.</div></div><div><h3>Method</h3><div>A retrospective analysis of electronic medical records (2005-2024) using TriNetX data identified patients diagnosed with thyrotoxicosis. Propensity score matching (1:1) balanced surgical and nonsurgical cohorts. Kaplan–Meier analysis was performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular and other outcomes.</div></div><div><h3>Results</h3><div>The initial cohort included 161,677 thyrotoxicosis patients, of whom 21,450 (12.5%) underwent thyroidectomy, 26,848 (15.7%) received RAI, and 122,838 (71.8%) were treated medically. After matching, thyroidectomy was associated with a lower risk of the primary composite cardiovascular outcome (HR 0.82, 95% CI 0.76-0.87) and all-cause mortality (HR 0.60, 95% CI 0.54-0.66) compared to medical therapy. Thyroidectomy was also associated with lower risks of incident cerebral infarction (HR 0.78, 95% CI 0.68-0.90), atrial fibrillation/flutter (HR 0.57, 95% CI 0.50-0.64), and heart failure (HR 0.71, 95% CI 0.64-0.78). Compared with RAI, thyroidectomy was associated with a lower risk of the composite cardiovascular outcome (HR 0.81, 95% CI 0.75-0.87), although no significant difference in mortality was observed (HR 0.93, 95% CI 0.83-1.03). As expected, thyroidectomy was associated with higher risks of hypoparathyroidism (HR 12.4, 95% CI 9.8-15.6) and vocal cord palsy (HR 11.2, 95% CI 8.49-14.76).</div></div><div><h3>Conclusions</h3><div>Thyroidectomy, a definitive treatment, is associated with lower cardiovascular risks compared with medical or RAI therapies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 230-238"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633731","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":"Trends and Outcomes of Same-Day Discharge After Pediatric Laparoscopic Pyloromyotomy","authors":"John M. Woodward MD, MS-HPEd ,&nbsp;Michael LaRock BS ,&nbsp;Stephanie F. Brierley MD ,&nbsp;Krystle Bittner MPH ,&nbsp;Hector Osei MD ,&nbsp;Carroll M. Harmon MD, PhD ,&nbsp;P. Benson Ham 3rd MD, MS","doi":"10.1016/j.jss.2025.06.025","DOIUrl":"10.1016/j.jss.2025.06.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Enhanced recovery after surgery protocols following pediatric pyloromyotomy have been published; however, literature evaluating same-day discharge (SDD) is lacking. This analysis aimed to evaluate SDD outcomes following laparoscopic pyloromyotomy.</div></div><div><h3>Materials and Methods</h3><div>The American College of Surgeons National Surgical Quality Improvement Program Pediatrics database (2017-2021) was queried for patients with pyloric stenosis who underwent laparoscopic pyloromyotomy. Preterm infants, patients aged &lt;4 wk or &gt;6 mo, and open operations were excluded. Patients discharged same day postoperatively (SDD) were compared to those discharged 1-2 d postoperatively (non-SDD). Regression analysis was performed.</div></div><div><h3>Results</h3><div>Of 5851 patients, 367 (6.3%) were SDD. There were significant differences between SDD and non-SDD in weight (4.29 kg <em>versus</em> 4.20 kg; <em>P</em> = 0.035), and operative time (23.30 min <em>versus</em> 29.43 min, <em>P</em> &lt; 0.001). Overall, 34 patients (0.6%) required readmission within 2 d of discharge, with a higher rate in the SDD cohort for emesis (1.1% <em>versus</em> 0.2%; <em>P</em> = 0.012), but no difference in 2-d readmission overall (1.4% <em>versus</em> 0.5%, <em>P</em> = 0.059). There were no significant differences between cohorts for other outcomes. Regression demonstrated American Society of Anesthesiologists (ASA) classes (2-4) increased odds of 30-d readmission (ASA 4: odds ratio 8.89, 95% confidence interval 2.38-33.26, <em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Most laparoscopic pyloromyotomy patients are not eligible for SDD; however, it can be reasonable in select patients tolerating feeds with lower ASA classes. SDD results in a 1% increase in early readmission for emesis without an increase in overall readmissions or other complications, which occur at low single-digit percentages.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 96-103"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632127","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}