Journal of Surgical Research最新文献

{"title":"Cover 1: Update","authors":"","doi":"10.1016/S0022-4804(25)00596-7","DOIUrl":"10.1016/S0022-4804(25)00596-7","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"314 ","pages":"Page OFC"},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219607","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":"Novel Low-Cost Low-Fidelity Abdominal Wall Simulation is Effective for Surgical Education","authors":"Olivia Ziegler MD ,&nbsp;Alicia C. Greene DO ,&nbsp;Laura Fiorini MD ,&nbsp;Eric D. Moyer MD ,&nbsp;Mckell Quattrone MD ,&nbsp;Neekita Jikaria MD ,&nbsp;Mary C. Santos MD, Med ,&nbsp;Rushin D. Brahmbhatt MD ,&nbsp;Audrey S. Kulaylat MD, MSc","doi":"10.1016/j.jss.2025.08.014","DOIUrl":"10.1016/j.jss.2025.08.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical training increasingly employs simulation to facilitate resident education. However, simulations are often costly or use animal tissues, with attendant challenges in their financial and logistical feasibility. We present a foam abdominal wall model for abdominal access and ostomy creation.</div></div><div><h3>Methods</h3><div>Layers of craft foams and fabrics are used to accurately simulate the layers of the abdominal wall, both on and off midline. Sixteen general surgery junior residents were proctored by a colorectal surgeon to complete each simulation. Residents completed pretask and post-task 5-point Likert-scale regarding comfort with technical skills. Improvement in these metrics was the primary outcome of interest. Wilcoxon matched pairs signed rank test was performed, preselected alpha was set at 0.05.</div></div><div><h3>Results</h3><div>Residents reported that their confidence in all aspects of stoma creation improved following completion of the lab. On prelab <em>versus</em> postlab survey, residents significantly increased in overall technical comfort by 2 points (<em>P</em> &lt; 0.001), comfort in siting the stoma by 1 point (<em>P</em> &lt; 0.001), creating the trephine by 2 points (<em>P</em> &lt; 0.001), and securing the stoma by 1 point (<em>P</em> &lt; 0.001). On pretest <em>versus</em> post-test survey residents significantly improved their technical comfort with Veress needle by 2 points (<em>P</em> &lt; 0.001), optical trocar by 1 point (<em>P</em> &lt; 0.001), and Hasson by 1.5 points (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>This model is easy to make and effective in increasing resident-reported comfort with ostomy formation and abdominal access. This offers an opportunity for residents to practice critical procedures in general surgery at low-cost and with no associated patient risk.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 79-85"},"PeriodicalIF":1.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206712","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":"Detection of PIK3CA Mutations in Anal Dysplasia","authors":"Hillary R. Johnson MD ,&nbsp;Elise C. Dietmann BS ,&nbsp;Corinne E. Praska MD ,&nbsp;Kirsten L. Dennison MS ,&nbsp;Stephanie M. McGregor MD, PhD ,&nbsp;William Suter AS ,&nbsp;Glen Leverson PhD ,&nbsp;Muhammed Murtaza MBBS, PhD ,&nbsp;Evie H. Carchman MD","doi":"10.1016/j.jss.2025.09.003","DOIUrl":"10.1016/j.jss.2025.09.003","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of anal cancer is increasing despite screening and treatment options for anal dysplasia, the precursor to anal cancer. Once anal dysplasia is identified, predicting which patients are at the highest risk of progressing to anal cancer remains challenging, as there are no molecular biomarkers for risk stratification. The most common mutation in anal cancer affects the catalytic subunit of Phosphatidylinositol (3, 4, 5)-trisphosphate Kinase (PI3K). We sought to determine if <em>PIK3CA</em> mutations are detectable in precancerous anal lesions.</div></div><div><h3>Methods</h3><div>DNA was extracted from formalin-fixed, paraffin-embedded anal tissue slides. Digital polymerase chain reaction was performed to test each sample for the presence or absence of three of the most common <em>PIK3CA</em> mutations: E545 K (c.1633 G &gt; A), H1047 R (c.3140 A &gt; G), and H1047 L (c.3140 A &gt; T). Mutation data, histology, and demographic data were compared.</div></div><div><h3>Results</h3><div>We analyzed 124 tissue samples from 68 unique patients across the spectrum of anal disease. Forty of these samples were E545 K positive, three were H1047 R positive, and two were H1047 L positive. <em>PIK3CA</em> mutations were detected in 8/42 (19%) low-grade dysplasia samples, 14/45 (31%) high-grade dysplasia samples, and 20/37 (54%) cancer samples. The presence of a mutation was associated with higher grade of disease on per-sample analysis (<em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div><em>PIK3CA</em> mutations can be detected in anal tissue samples across the spectrum of carcinogenesis with increasing incidence with higher grade of disease. Our results warrant further evaluation of <em>PIK3CA</em> mutations as a biomarker for identifying patients with anal dysplasia at highest risk of progression to anal cancer.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 106-112"},"PeriodicalIF":1.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206658","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":"Feasibility of Low-Volume Atomized Povidone-Iodine as a Peritoneal Antiseptic in Complicated Appendicitis","authors":"Kelly R. Bates BA ,&nbsp;Alison J. Lehane MD ,&nbsp;Ashley C. Dodd MD, MS ,&nbsp;Daniel R. Liesman MD ,&nbsp;Julia E. Grabowski MD ,&nbsp;Timothy B. Lautz MD ,&nbsp;Seth D. Goldstein MD, MPhil","doi":"10.1016/j.jss.2025.09.018","DOIUrl":"10.1016/j.jss.2025.09.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric complicated appendicitis carries significant risk of abscess formation. Current surgical techniques for reduction of postoperative abscess include suction, irrigation with saline or dilute povidone-iodine, or drain placement. However, these approaches are not supported by high-quality evidence. This study aims to investigate the feasibility of administering low-volume atomized povidone-iodine (LVAP) as an antiseptic technique for complicated appendicitis.</div></div><div><h3>Materials and Methods</h3><div>A retrospective case-control study of pediatric complicated appendectomies was performed at a children's hospital from 2020 to 2024. Extent of perforation was characterized as contained infection <em>versus</em> uncontained infection with widespread peritonitis. LVAP comprised of 5-10 cc of finely misted, nondilute povidone-iodine applied to areas of peritoneal contamination using a customized hand-powered nozzle via a standard working 5 mm trocar over approximately 15 s. Treatment was recorded as LVAP <em>versus</em> standard practice (suction or saline irrigation). Clinical results were compared in a stratified matching analysis.</div></div><div><h3>Results</h3><div>A total of 25 patients underwent LVAP and 340 underwent standard practice. Following 2:1 matching, 50 standard practice controls were included. No adverse sequelae of LVAP were noted. No statistically significant difference was detected between abscess rates following LVAP <em>versus</em> standard practice (16% (4/25) <em>versus</em> 24% (12/50), <em>P</em> = 0.56), though no abscesses were seen following LVAP administration for contained infection.</div></div><div><h3>Conclusions</h3><div>LVAP is a novel, feasible operative technique for complicated pediatric appendicitis. Though we were unable to demonstrate statistical significance, our observations of LVAP in reducing abscess rates for contained infection are promising. We are now able to estimate appropriate sample sizes needed to achieve sufficient power for a future study.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 86-92"},"PeriodicalIF":1.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206715","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":"Prognostic Factors and Outcomes of Nonoperative Versus Operative Management in Adult and Pediatric Patients Following Pancreatic Trauma: A Systematic Review","authors":"Ariel Hus BS ,&nbsp;Cameron Nishida BS ,&nbsp;Yumna Indorewala BS ,&nbsp;Ruth Zagales BS ,&nbsp;Alexandra Kata BS ,&nbsp;Logan Rogers BS ,&nbsp;Deepa Elangovan BS ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2025.09.012","DOIUrl":"10.1016/j.jss.2025.09.012","url":null,"abstract":"<div><h3>Introduction</h3><div>This systematic review aims to evaluate prognostic factors of poor outcomes and compare clinical outcomes between nonoperative management (NOM) and operative management in adult or pediatric pancreatic trauma patients.</div></div><div><h3>Methods</h3><div>A systematic review of five databases was conducted through May 6, 2025. Studies assessing pancreatic trauma patients, identifying prognostic factors, or comparing operative <em>versus</em> NOM were included. Outcomes of interest included in-hospital mortality, in-hospital complications, and intensive care unit length of stay.</div></div><div><h3>Results</h3><div>Sixteen studies met the inclusion criteria and analyzed over 14,000 patients. Prognostic factors associated with increased mortality included shock (odds ratio: 3.31, 95% confidence interval: 1.16-9.42, 0.022) and sepsis (odds ratio: 43.47, 95% confidence interval: 4.15-455.75, <em>P</em> = 0.002). In addition, high-grade injuries (American Association for the Surgery of Trauma ≥ 3) resulted in increased NOM failure (<em>P</em> = 0.0169) in pediatric patients. There were no differences in mortality between management approaches, regardless of injury grade, type, or age group. NOM resulted in increased rates of pancreatic complications, including pseudocysts, in patients with blunt trauma (37.5% <em>versus</em> 5.2%, <em>P</em> &lt; 0.001) and in pediatric patients with high-grade injuries (44% <em>versus</em> 0%, <em>P</em> &lt; 0.001). No significant differences were noted between resection and nonresection procedures, although resection resulted in reduced complications for higher grade trauma in adult and pediatric patients (33% <em>versus</em> 77%, <em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Prognostic factors such as increased injury severity were associated with higher rates of mortality and nonoperative failure. NOM demonstrated increased complications in adult and pediatric patients with high-grade blunt pancreatic trauma. Patients with high-grade pancreatic injuries treated with pancreatic resection showed improved outcomes, which demonstrates the safety of pancreatic resection in these patient populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 93-105"},"PeriodicalIF":1.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Perioperative Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia","authors":"Takuya Takami MD ,&nbsp;Kayoko Mizuno MD, PhD ,&nbsp;Kazutaka Obama MD, PhD ,&nbsp;Koji Kawakami MD, PhD","doi":"10.1016/j.jss.2025.08.017","DOIUrl":"10.1016/j.jss.2025.08.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Nonocclusive mesenteric ischemia (NOMI) is a life-threatening condition characterized by mesenteric hypoperfusion without arterial occlusion and is associated with a high mortality rate. Although vasodilator therapy is recommended in clinical guidelines, its effectiveness in surgical cases of NOMI remains unclear. In this study, we aimed to evaluate the effectiveness of perioperative vasodilator therapy in patients undergoing surgery for NOMI, using a nationwide real-world database in Japan.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using data from 2014 to 2024. Patients who underwent surgery for NOMI were included and categorized into a vasodilator group (those who received prostaglandin E1 or papaverine hydrochloride within 1 d before or after surgery) and a nonvasodilator group. Inverse probability of treatment weighting with stabilized weights was applied to adjust for baseline differences. The primary outcome was 30-d mortality. Secondary outcomes included in-hospital mortality, reoperation proportion, and complication proportion.</div></div><div><h3>Results</h3><div>A total of 702 patients were analyzed (86 in the vasodilator group and 616 in the nonvasodilator group). After inverse probability of treatment weighting, baseline characteristics were well balanced. The vasodilator group showed significantly lower 30-d mortality (weighted hazard ratio, 0.44; 95% confidence interval (CI), 0.22-0.88) and in-hospital mortality (weighted risk ratio, 0.62; 95% confidence interval, 0.40-0.96). Reoperation and complication proportions did not differ significantly between the groups.</div></div><div><h3>Conclusions</h3><div>Perioperative vasodilator therapy was associated with reduced mortality in patients undergoing surgery for NOMI. These findings suggest that vasodilator therapy may serve as a beneficial adjunct in the surgical management of NOMI.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 70-78"},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149634","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":"Insights From Bone and Muscle Oxygenation Toward a More Comprehensive Model of Tissue Healing","authors":"Yuqian Tian MD ,&nbsp;Ali H. Hakim MD ,&nbsp;Cody P. Anderson BS ,&nbsp;Prateek Sharma MBBS ,&nbsp;Al-Murtadha Al-Gahmi MD ,&nbsp;Kyung-Soo Kim PhD ,&nbsp;Song-Young Park PhD ,&nbsp;Panagiotis Koutakis PhD ,&nbsp;Ulka Sachdev MD ,&nbsp;Adina E. Draghici PhD ,&nbsp;Pooneh Bagher PhD ,&nbsp;Mark A. Carlson MD ,&nbsp;Iraklis I. Pipinos MD","doi":"10.1016/j.jss.2025.08.015","DOIUrl":"10.1016/j.jss.2025.08.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Predicting healing after amputation and revascularization in diabetes and PAD patients with tissue loss is challenging. Current methods, like transcutaneous oximetry, only measure skin oxygenation, overlooking deeper tissues critical for wound healing. Near-infrared spectroscopy (NIRS) during postocclusive reactive hyperemia (PORH) measures muscle oxygenation under ischemic stress but does not account for bone, which is crucial in healing of complex wounds. This study employed NIRS during PORH to evaluate both bone and muscle perfusion in a swine model of hindlimb ischemia.</div></div><div><h3>Methods</h3><div>Eight Ossabaw swine underwent right hindlimb ischemia induction via endovascular coil occlusion of the right external iliac, femoral, and popliteal arteries. PORH was performed before (T0) and 4 wk after ischemia induction (T4) using a 5-min infrarenal aortic occlusion, with NIRS recording oximetry changes in bilateral gastrocnemius muscle and metatarsal bones. Data endpoints were derived in MATLAB.</div></div><div><h3>Results</h3><div>At T0 (normal circulation), bone showed a smaller StO₂ drop (<em>P</em> = 0.008), slower oxygen decline (<em>P</em> = 0.050), and smaller oxygen deficit (<em>P</em> = 0.027) during occlusion, along with slower recovery (<em>P</em> &lt; 0.001) during PORH reperfusion. At T4, ischemic bone and muscle had reduced oximetry drops, smaller oxygen deficits, and slower recovery relative to nonischemic tissues. Notably, ischemic bone maintained occlusion rates but had diminished hyperemia response (<em>P</em> = 0.038), differing from muscle dynamics.</div></div><div><h3>Conclusions</h3><div>Bone and muscle display distinct oxygenation dynamics under ischemia. Chronic ischemia attenuates metabolic and reperfusion responses in both tissues. These findings highlight bone's under-recognized role in ischemia/reperfusion events and the need for comprehensive tissue-specific oxygenation models to predict healing outcomes.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 59-69"},"PeriodicalIF":1.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119634","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 Factors for Surgical Site Infections Following Achilles Tendon Rupture Surgery: A Systematic Review and Meta-Analysis","authors":"Yuxiang Zhou MM ,&nbsp;Ming Zhong MM ,&nbsp;Jianfeng Long MM ,&nbsp;Gang Zhou BD ,&nbsp;Xiaobing Luo MM ,&nbsp;Qiang Zhang MM","doi":"10.1016/j.jss.2025.07.054","DOIUrl":"10.1016/j.jss.2025.07.054","url":null,"abstract":"<div><h3>Introduction</h3><div>The Achilles tendon is most susceptible to rupture in the lower extremity during exercise. For patients with high requirements for Achilles tendon function, surgery is the preferred method. However, surgical site infections (SSIs) significantly affect functional prognosis and increase the medical burden. This meta-analysis identified risk factors for SSIs in patients with Achilles tendon rupture (ATR).</div></div><div><h3>Methods</h3><div>We systematically searched Embase, PubMed, Cochrane Library, CNKI (China National Knowledge Infrastructure), Web of Science, VIP (VIP Database for Chinese Technical Periodicals), Wanfang Data, and SinoMed up to October 2024 for studies comparing SSI and non-SSI patients with ATR. Study quality was assessed using the Newcastle–Ottawa Scale. Odds ratios (OR) and 95% confidence intervals were calculated for potential risk factors, and STATA 17.1 was used for analysis.</div></div><div><h3>Results</h3><div>Nineteen studies were included. Smoking (OR = 2.39), diabetes (OR = 2.18), open wounds (OR = 11.95), and season (autumn and winter) of injury (OR = 3.00) were identified as significant risk factors for SSIs. Male (OR = 0.55), acute ATR (OR = 0.22), and antibiotic use (OR = 0.31) were identified as protective factors against SSIs.</div></div><div><h3>Conclusions</h3><div>This study highlights key risk factors for SSIs following ATR surgery, aiding clinicians in identifying high-risk patients and implementing targeted interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 48-58"},"PeriodicalIF":1.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092147","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":"Cost-Effectiveness and Cost-Only Studies for Inflammatory Bowel Disease Surgery: A Scoping Review.","authors":"Ira L Leeds, Arabella Dill-Macky, Christopher Prien, Hengjian Li, Eddy Lincango, Benjamin C Cohen, Stefan D Holubar","doi":"10.1016/j.jss.2025.08.013","DOIUrl":"10.1016/j.jss.2025.08.013","url":null,"abstract":"<p><strong>Introduction: </strong>Studies examining the cost-effectiveness of surgical procedures and surgery-related interventions in patients with inflammatory bowel disease (IBD) remain limited. This dearth of studies hampers decision-makers' assessment of surgery-related interventions for patients with IBD. This study aimed to conduct a scoping review of the available literature for cost-effectiveness analyses of IBD-related surgery.</p><p><strong>Methods: </strong>We performed a comprehensive search in common publication registries. Preplanned controlled vocabulary related to IBD and its subtypes, surgery, and cost measures were used. We defined the study selection criteria to include all IBD-related surgical interventions that also reported a measure of costs of care. Studies for medical versus surgical interventions for refractory IBD were excluded. All search findings were screened by two reviewers using titles, abstracts, and ultimately full-length manuscripts. Fully screened studies were then extracted to facilitate a qualitative synthesis of results.</p><p><strong>Results: </strong>We identified seven formal cost-effectiveness studies and 55 cost only studies. Cost-effectiveness studies assessed intraoperative (42.9%) and postoperative interventions (57.1%), mostly in patients with Crohn's disease (71.4%). Topics included surgical approaches (42.8%), venous thromboembolism prophylaxis (28.6%), and surveillance for postoperative recurrence (28.6%). Of the cost only studies, most focused on intraoperative interventions (81.8%), particularly in ulcerative colitis patients (45.5%). Predefined areas with no reported interventions included enhanced recovery interventions, robotic surgery, timing to surgery, perianal disease, pediatric disease, and genetic testing.</p><p><strong>Conclusions: </strong>This scoping review found minimal cost-effectiveness literature to inform IBD-related surgical care. There were many more cost only studies than cost-effectiveness studies related to these clinical topics. This asymmetry highlights immediately available opportunities to broaden the use of cost-effectiveness analyses for IBD-related surgical interventions.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085962","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":"A Nationwide Analysis of Outcomes, Healthcare Encounters, and Costs of Small Bowel Obstruction","authors":"Lakshika Tennakoon MD, MPhil, DrPH ,&nbsp;Jung Gi Min MD ,&nbsp;Ruoxue Wu MPH ,&nbsp;David Alan Spain MD, FACS ,&nbsp;David Hindin MD, MS","doi":"10.1016/j.jss.2025.08.011","DOIUrl":"10.1016/j.jss.2025.08.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Small bowel obstruction (SBO) is a prevalent and clinically challenging condition. Surgical interventions may be relatively high-risk for vulnerable populations, like the elderly and underinsured. We investigated the sociodemographic characteristics, clinical outcomes, and hospital characteristics of SBO encounters to better understand risk factors.</div></div><div><h3>Methods</h3><div>We utilized the 2020 National Inpatient Sample database for adults (age ≥ 18 y) with a diagnosis of SBO, identified using International Classification of Diseases, 10th Revision, Clinical Modification codes. International Classification of Diseases, 10th Revision Procedure Coding System codes were used to define the type of management. The primary outcome was mortality. The secondary outcomes were inpatient cost and length of hospital stay.</div></div><div><h3>Results</h3><div>Among 246,395 patients with SBO, 25,083 (10%) underwent operative management (OM) and 221,312 (90%) underwent nonoperative management (NOM). Among all patients, majority were female (56%), used Medicare (58%), were White (72%), with a mean age of 65. NOM patients were discharged home more often (75% <em>versus</em> 53%, <em>P</em> &lt; 0.001). OM patients experienced more mortality (4.5% <em>versus</em> 1.4%). OM patients were treated at urban teaching hospitals (71% <em>versus</em> 67%, <em>P</em> &lt; 0.001) more often and had shorter lengths of stay (4.2 <em>versus</em> 11.1 d, <em>P</em> &lt; 0.001) with lower inpatient costs ($11,124 <em>versus</em> $35,346, <em>P</em> &lt; 0.001) compared to NOM. In adjusted analyses, patients aged 75-84 had 9.0 times greater odds of mortality (adjusted odds ratio: 9.0, <em>P</em> &lt; 0.001), and OM had 3.3 greater odds of mortality (adjusted odds ratio: 3.3, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>SBO patients undergoing NOM were found to have longer hospital stays and higher inpatient cost, but overall lower odds of mortality compared to their operative counterparts. These findings may help guide decision making regarding SBO management, especially in the elderly population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 41-47"},"PeriodicalIF":1.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047348","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}