Surgery open science最新文献

{"title":"Real-world assessment of longitudinal opioid use and healthcare resource utilization in patients undergoing colorectal resection","authors":"Gary Schwartz ,&nbsp;Jennifer H. Lin ,&nbsp;Swapnabir Kakoty","doi":"10.1016/j.sopen.2024.05.022","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.022","url":null,"abstract":"<div><p>Liposomal bupivacaine (LB) has been used in multimodal pain management regimens to improve postsurgical analgesia. This retrospective cohort analysis assessed clinical and economic outcomes of LB vs non-LB analgesia in minimally invasive colorectal resection surgery using real-world patient data from the IQVIA linkage claims databases. Patients who received LB were 1:1 matched to patients who did not receive LB (non-LB) via propensity scores. Outcomes included opioid use during the perioperative (2 weeks before surgery to 2 weeks after discharge), continued (&gt;2 weeks to 3 months after discharge), and persistent (&gt;3 months to 6 months after discharge) periods and healthcare resource utilization (HRU) during the first 3 months after discharge. Mean opioid consumption was lower in the LB (<em>n</em> = 4397) versus non-LB (n = 4397) cohort perioperatively (483 vs 538 morphine milligram equivalents [MMEs]; <em>P</em> = 0.001) and after discharge within ∼3 months (222 vs 328 MMEs; <em>P</em> &lt; 0.0001) and 3–6 months (245 vs 384 MMEs; <em>P</em> &lt; 0.0001). The LB cohort had shorter mean length of stay (5.2 vs 5.7 days; <em>P</em> &lt; 0.0001) and fewer inpatient readmissions (odds ratio [OR], 0.71; <em>P</em> &lt; 0.0001), emergency department visits (OR, 0.78; <em>P</em> &lt; 0.0001), and outpatient/office visits (OR, 0.91; <em>P</em> = 0.028) than the non-LB cohort 3 months after discharge. These data suggest use of LB in minimally invasive colorectal resection surgery may reduce perioperative and postdischarge opioid use as well as HRU. Although additional studies are needed to confirm these findings, this analysis provides valuable real-world data from large claims databases to evaluate clinical and economic outcomes that complement other types of retrospective and prospective studies.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 94-97"},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000794/pdfft?md5=196ad89e9c104e6dec290b138248a975&pid=1-s2.0-S2589845024000794-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141324348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the gender gap: A nationwide comparative analysis of general surgery residency program leadership","authors":"Xinfei Miao BS,&nbsp;Reem Sarsour BS,&nbsp;Madeleine Givant BS,&nbsp;Helena Spartz MD, PhD, FCAP","doi":"10.1016/j.sopen.2024.05.020","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.020","url":null,"abstract":"<div><h3>Background</h3><p>The gender disparity in surgery leadership roles is well-reported. However, the effect of program type and region on mean number of men or women occupying a particular leadership role has yet to be explored. This study aims to investigate the gender disparity of leadership positions in different types of General Surgery Residency Programs (GSRPs).</p></div><div><h3>Methods</h3><p>Leadership roles of the general surgery departments were collected from the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) database. Each GSRP was categorized by region and program type using FRIEDA. Analysis of the mean number of men and women holding various leadership positions by program type and region was conducted using one-way ANOVA with post-hoc tests.</p></div><div><h3>Results</h3><p>A total of 345 GSRPs were analyzed. The mean number of women occupying various leadership roles was significantly higher at university-based programs when compared to community-based programs. No significant difference in mean number of women leaders was observed by region.</p></div><div><h3>Conclusions</h3><p>Women consistently occupy a lower number of GSRP leadership positions when compared to men, regardless of program type or region. University-based GSRP leadership positions have significantly greater gender inclusion compared to community-based GSRPs.</p></div><div><h3>Key messages</h3><p>University-based general surgery residency programs had a higher mean number of women in all leadership roles compared to other program types. In comparison, region did not appear to be a significant factor impacting the leadership gender disparity. Improvement is needed in community-based general surgery residency programs to bridge the gender gap in leadership roles.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 57-61"},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000824/pdfft?md5=7ff9ae63202ae5ce60fb8eb39271654c&pid=1-s2.0-S2589845024000824-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The utility of a CT grading scale in deciding on surgical intervention for patients with suspected small bowel obstruction","authors":"Marianne Becnel ,&nbsp;Ikaikaolahui Danner ,&nbsp;Maria De Los Santos ,&nbsp;Lindsay J. Escobedo ,&nbsp;Marie Mohrbacher ,&nbsp;Jacob Young ,&nbsp;Robert Patterson","doi":"10.1016/j.sopen.2024.05.016","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.016","url":null,"abstract":"<div><h3>Background</h3><p>A grading system was developed for computerized tomography (CT) scans evaluating patients with suspected small bowel obstruction (SBO). We hypothesized that patients with a higher grade of suspected SBO on CT scan would be more likely to require surgical intervention.</p></div><div><h3>Methods</h3><p>Retrospective chart review of patients who presented to the Emergency Room (ER) who had a CT of the abdomen and pelvis for suspected SBO. Patients were divided into 5 groups: Grade 1 (SBO unlikely), Grade 2 (probable partial or early SBO), Grade 3 (probable high grade SBO), Grade 4 (SBO with changes concerning for ischemia) and Not Graded.</p></div><div><h3>Results</h3><p>The CT scans of 655 patients were graded. Of the 22 patients with a grade 1 SBO, only 1 went for surgery (4.5 %). For grade 2 patients, 23 out of 299 had an operation (7.7 %), for grade 3 it was 84 out of 299 (28.1 %) and for grade 4 SBO, 25 out of 35 patients (71.4 %) had surgery. The <em>p</em> value is &lt;0.00001. The three most common intraoperative findings were SBO obstruction from adhesions alone (48 % of cases), followed by incarcerated hernias (12 %) and ischemic bowel (9 %). Only 8 cases out of 133 operations (6 % of total) had no findings at time of surgery other than dilated bowel.</p></div><div><h3>Conclusions</h3><p>The CT grading scale for SBO developed at our institution shows excellent correlation between grade and going for surgery, with few negative results, and can be a useful tool among other factors for general surgeons when deciding whether or not to operate on a patient with suspected SBO.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 70-76"},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000769/pdfft?md5=1633487f23c6f32ff097afc48332c39c&pid=1-s2.0-S2589845024000769-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141291466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced recovery after surgery in percutaneous transhepatic cholangioscopic lithotripsy for patients with hepatolithiasis and choledocholithiasis","authors":"Peng Zhang ,&nbsp;Xi Dang ,&nbsp;Xiaojie Li ,&nbsp;Bo Liu ,&nbsp;Qingliang Wang","doi":"10.1016/j.sopen.2024.05.015","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><p>Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) provides an effective alternative procedure for the management of complex hepatolithiasis and choledocholithiasis. Enhanced recovery after surgery (ERAS) program is an evidence-based approach that was developed to reduce surgical stress and accelerate postoperative recovery. However, little is known regarding PTCSL in the context of ERAS. The aim of this study was to evaluate the efficacy and safety of PTCSL within ERAS programs.</p></div><div><h3>Patient and methods</h3><p>The clinical data of patients who underwent PTCSL within ERAS programs consulted at our hospital between November 2017 and November 2022 was retrospectively reviewed. Individualized perioperative ERAS items were evaluated for all patients. The demographics, intraoperative variables, and postoperative outcomes were analyzed.</p></div><div><h3>Results</h3><p>A total of 43 patients who underwent PTCSL were included in the study. There were 13 men and 30 women aged between 39 and 89 years with an average age of 60 years (60.49 ± 12.37). The stone clearance rate was 77 % after the first operation, and the final clearance rate was 95 %. The incidence of complications in this study is 18.6 % (8/43), including 6 patients with Clavien-Dindo I-II, and 2 patients with Clavien-Dindo III. Pleural effusion, abdominal effusion, infection, bile leakage, and biliary bleeding are the most common complications, however, all patients recovered after aggressive treatment.</p></div><div><h3>Conclusion</h3><p>PTCSL is a relatively safe, feasible, and efficient method for treating complex hepatolithiasis and choledocholithiasis within ERAS programs. Individualized ERAS entries and precise disease management are required to minimize the occurrence of complications and to provide effective treatment.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 38-44"},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000782/pdfft?md5=bdbbee23c306c3602e6341cbc91c16a6&pid=1-s2.0-S2589845024000782-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure to rescue following emergency general surgery: A national analysis","authors":"Jeffrey Balian,&nbsp;Nam Yong Cho BS,&nbsp;Amulya Vadlakonda BS,&nbsp;Oh. Jin Kwon MD,&nbsp;Giselle Porter BS,&nbsp;Saad Mallick MD,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2024.05.013","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event.</p></div><div><h3>Methods</h3><p>All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016–2020 National Readmissions Database. Patients undergoing trauma-related operations or procedures ≤2 days of admission were excluded. FTR was defined as in-hospital death following acute kidney injury requiring dialysis (AKI), myocardial infarction, pneumonia, respiratory failure, sepsis, stroke, or thromboembolism. Multilevel mixed-effect models were developed to assess factors linked with FTR.</p></div><div><h3>Results</h3><p>Among 826,548 EGS operations satisfying inclusion criteria, 298,062 (36.1 %) developed at least one MAE. Of those experiencing MAE, 43,477 (14.6 %) ultimately did not survive to discharge (FTR). Following adjustment for fixed hospital level effects, only 3.5 % of the variance in FTR was attributable to center-level differences. Relative to private insurance and the highest income quartile, Medicaid insurance (AOR 1.33; 95%CI, 1.23–1.43) and the lowest income quartile (AOR 1.22; 95%CI, 1.17–1.29) were linked with increased odds of FTR.</p><p>A subset analysis stratified complication-specific rates of FTR by insurance status. Relative to private insurance, Medicaid coverage and uninsured status were linked with greater odds of FTR following perioperative sepsis, pneumonia, and AKI.</p></div><div><h3>Conclusion</h3><p>Our findings underscore the need for increased screening and vigilance following perioperative complications to mitigate disparities in patient outcomes following high-risk EGS.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 77-81"},"PeriodicalIF":1.4,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000745/pdfft?md5=2c4d4ed6f1b40fbf3f0f67ad56b22c8b&pid=1-s2.0-S2589845024000745-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141314309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are routine, daily chest radiographs (CXR) necessary following (VATS and RATS) lobectomies?","authors":"Nathan J. Alcasid MD ,&nbsp;Kian C. Banks MD ,&nbsp;Sheng-Fang Jiang MS ,&nbsp;Cynthia J. Susai MD ,&nbsp;Diana Hsu MD ,&nbsp;William Carroway MD ,&nbsp;Kenneth Williams MD ,&nbsp;Ashish Patel MD ,&nbsp;Simon Ashiku MD ,&nbsp;Jeffrey B. Velotta MD","doi":"10.1016/j.sopen.2024.05.010","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><p>Consensus guidelines regarding the amount and necessity of post-operative imaging in thoracic surgery are lacking. The efficacy of daily chest radiographs (CXR) following video-assisted (VATS) and robotic-assisted (RATS) thoracoscopic surgery in directing management has not been previously studied. We hypothesize that abnormal clinical findings, rather than abnormal imaging findings, better predict post-operative complications in patients undergoing VATS/RATS lobectomies.</p></div><div><h3>Methods</h3><p>A retrospective review of VATS and RATS lobectomy patients were performed at a tertiary referral center from 1/1/2019–12/31/2021. Demographics, hospital course, and imaging were evaluated. Descriptive statistics, Chi-Square test, Fisher's exact, Wilcoxon rank sum, and multivariable logistic regression were performed. Our outcomes were post-operative complications requiring a procedure and extended length of stay (LOS) (&gt;2 days post-operatively).</p></div><div><h3>Results</h3><p>Out of 362 VATS/RATS lobectomy patients, 15 patients had post-operative complications requiring a procedure. Almost all patients who required a procedure had abnormal clinical signs and symptoms (14/15; <em>p</em> &lt; 0.001) while 70 % had expected post-operative day (POD) one CXR findings (11/15; <em>p</em> = 0.463). Multivariable logistic regression demonstrated clinical signs and symptoms independently predicted procedural requirement (odds ratio [OR] = 48, 95 % Confidence Interval [CI]:8.5–267) while abnormal POD one imaging did not. For extended LOS, a positive smoking history (OR = 4.4, 95 % CI:1.4–14.1), number of CXRs (OR = 2.4, 95 % CI:1.8–3.2) and thoracostomy tubes (OR = 5.3, 95 % CI:1.0–27.3) were independent predictors while clinical signs and symptoms was not.</p></div><div><h3>Conclusion</h3><p>Abnormal clinical findings may guide management more predictably than abnormal CXRs after VATS/RATS. Routine CXR in the post-operative setting may be unnecessary in those without clinical signs or symptoms.</p></div><div><h3>Key message</h3><p>There are no consensus guidelines regarding the efficacy of routine, post-operative diagnostic studies after major thoracic lobar resections. The presence of abnormal signs or symptoms after minimally invasive lobectomies may better predict those who will require additional procedures better than the presence of abnormal routine, post-operative chest radiographs.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 20-26"},"PeriodicalIF":1.4,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000721/pdfft?md5=dcb502ca969faf20e7c0addbb81ea8a2&pid=1-s2.0-S2589845024000721-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General surgery educational resources for Jordanian medical students","authors":"Mohammad Nebih Nofal ,&nbsp;Mahmoud Mousa Al Awayshish ,&nbsp;Ali Jad Yousef ,&nbsp;Ammar Masoud Alamaren ,&nbsp;Zaid Issam Al-Rabadi ,&nbsp;Dina Samer Haddad ,&nbsp;Yaqeen Ahmad Al-Rbaihat ,&nbsp;Yazeed Nabeel Al-Qusous","doi":"10.1016/j.sopen.2024.05.009","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.009","url":null,"abstract":"<div><h3>Background</h3><p>To outline the resources deemed most beneficial to medical students during their general surgery clerkship, as well as to examine their link to students' general surgery scores and the usage of artificial intelligence in general surgery study.</p></div><div><h3>Methods</h3><p>A retrospective survey of Jordanian medical students from six universities was done between March and June 2023 using a 7-item questionnaire covering questions concerning general surgery study methods and scores. Descriptive statistics were used to evaluate demographic data. Chi-square is used to evaluate categorical data, with a <em>P</em> value &lt;0.05 deemed significant.</p></div><div><h3>Results</h3><p>The average age of respondents was 23.3 years, and 54.2 % of the respondents were females, 47.8 % were from Mutah University. Most students (48.2 %) relied on tutor lectures. Students who studied through instructor lectures had the highest grades (9 % excellent, 17 % very good), followed by students who studied using surgery textbooks (6.8 % and 14.6 %, respectively). The relationship between the study method and academic achievement was statistically significant (<em>P</em> &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>Traditional face-to-face learning with instructor lectures and surgery textbooks is still the most efficient approach to attain the greatest scores. Medical students are still underutilizing artificial intelligence.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 62-65"},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S258984502400071X/pdfft?md5=bd8bbe009d764663aa2b574cae0c454d&pid=1-s2.0-S258984502400071X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrahepatic cystic mass and bile duct malformation","authors":"Arianna Pontrelli ,&nbsp;Piercarmine Panzera ,&nbsp;Francesco Paolo Prete ,&nbsp;Enrico Fischetti ,&nbsp;Carlotta Testini ,&nbsp;Mario Testini","doi":"10.1016/j.sopen.2024.05.017","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.017","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 128-130"},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000800/pdfft?md5=ec5cbae6a22adc64a329105e7321cf8f&pid=1-s2.0-S2589845024000800-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of rurality on racial disparities in costs of bowel obstruction treatment","authors":"Corynn Branche ,&nbsp;Nikhil Chervu MD MS ,&nbsp;Giselle Porter BS ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Sara Sakowitz MS MPH ,&nbsp;Konmal Ali ,&nbsp;Saad Mallick MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2024.05.012","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race.</p></div><div><h3>Methods</h3><p>The 2016–2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality.</p></div><div><h3>Results</h3><p>Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β −1.66 days, CI[−1.99, −1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]).</p></div><div><h3>Conclusions</h3><p>We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 27-31"},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000733/pdfft?md5=46d4a4368bffb94fe577354cc209abd0&pid=1-s2.0-S2589845024000733-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long gun violence in California versus Texas: How legislation can reduce firearm violence","authors":"Jonathan Shipley BS ,&nbsp;Areg Grigorian MD ,&nbsp;Lourdes Swentek MD ,&nbsp;Cristobal Barrios MD ,&nbsp;Catherine Kuza MD ,&nbsp;Jeffrey Santos MD ,&nbsp;Jeffry Nahmias MD, MHPE","doi":"10.1016/j.sopen.2024.05.011","DOIUrl":"https://doi.org/10.1016/j.sopen.2024.05.011","url":null,"abstract":"<div><h3>Introduction</h3><p>Long guns (LGs) are uniquely implicated in firearm violence and mass shootings. On 1/1/2019 California (CA) raised the minimum age to purchase LGs from 18 to 21. This study aimed to evaluate the incidence of LG violence in CA vs. Texas (TX), a state with rising firearm usage and fewer LG regulations, hypothesizing decreased LG firearm incidents in CA vs increased rates in TX after CA LG legislation.</p></div><div><h3>Methods</h3><p>A retrospective analysis of the Gun Violence Archive (2015–2021) was performed. An additional analysis of all firearm incidents within TX and CA was performed. CA and TX census data were used to calculate incidents of LG violence per 10,000,000 people. The primary outcome was the number of LG-related firearm incidents. Median yearly rates of LG violence per 10,000,000 people were compared for pre (2015–2018) vs post (2019–2021) CA LG legislation (Senate Bill 1100 (SB1100).</p></div><div><h3>Results</h3><p>Median LG incidents decreased in CA post-SB1100 (4.21 vs 1.52, <em>p</em> &lt; 0.001) by nearly 64 %, whereas any gun firearm violence was similar pre vs post-SB1100 (77.0 vs 74.5 median incidents, <em>p</em> = 0.89). In contrast, median LG incidents increased after SB1100 (4.34 vs 5.17 median incidents, <em>p</em> = 0.011) by nearly 35 % in TX, with any gun incidents increasing by nearly 53 % (83.48 vs 127.46, p &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>CA LG firearm incidents decreased following SB 1100 legislation whereas the incidence in TX increased during this same time. Meanwhile, the incidence of any firearm violence remained similar in CA but increased in TX. This suggests the sharp decline in CA LG incidents may be related to SB1100. Accordingly, increasing the age to purchase a LG from 18 to 21 at a federal level may help curtail LG violence nationally.</p></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"20 ","pages":"Pages 51-54"},"PeriodicalIF":1.4,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589845024000757/pdfft?md5=420ffbc8ebf851fc5525b9a9f1ffd560&pid=1-s2.0-S2589845024000757-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141243417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}