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Outcomes of Gastroschisis and Omphalocele Treated at Children’s Surgery Verified Centers in Texas 得克萨斯州儿童手术验证中心治疗胃畸形和脐膨出的效果。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1016/j.jss.2024.10.001

Introduction

Anterior abdominal wall defects (AWDs), such as gastroschisis or omphalocele, are often diagnosed prenatally and counseled to deliver at facilities with resources capable of managing their AWD and complex-associated anomalies. The American College of Surgeons instituted their Children’s Surgery Verification (CSV) program to identify facilities with the optimal resources for pediatric surgical care. We aimed to evaluate the impact of CSV status on the outcomes of AWD and potential health disparities in the care of AWD in the first year of life in Texas.

Materials and Methods

We performed a multicenter epidemiological cohort study of infants <1 y of age at discharge with AWD from 2013 to 2021. Data were extracted from the Texas Health Care Information Council Public Use Data File. Patients who were transferred were excluded to avoid systematic double counting.

Results

We identified 2282 AWD patients with 26% treated at CSV centers and 68% undergoing surgical abdominal wall repair. The majority (70%) had gastroschisis. CSV center care recipients were more likely to be non-Hispanic (64% versus 58%, P = 0.018), reside in urban counties (92% versus 82%, P < 0.001), or counties not along the Mexican border (98% versus 81%, P < 0.001) when compared with non-CSV patients. While non-CSV admissions had lower costs per day ($9316 versus $10,109, P = 0.003), CSV centers had slightly lower mortality although this was not statistically significant (8% versus 10%, P = 0.153) despite higher illness severity scores (extreme illness severity: 51% versus 44%, P = 0.019). However, it is notable that non-CSV centers had higher rates of prematurity (62% versus 55%, P = 0.003). Multivariable logistic regression analysis for mortality revealed that treatment at CSV centers (adjusted odds ratio 0.562, P = 0.005) was protective. Predictive modeling revealed that CSV centers have lower predicted mortality across all illness severity levels as compared with non-CSV centers.

Conclusions

AWD treated at CSV centers have superior outcomes with improved mortality despite increased patient complexity and illness severity. Disparities in care at CSV centers exist based on race and geographic residency. Ongoing quality efforts are needed to improve quality universally and recognize facilities providing high-quality care while also ensuring equitable access to high-quality pediatric surgical care.
导言:腹壁前部缺损(AWD),例如胃裂或脐膨出,通常在产前就被诊断出来,并被建议到有能力处理腹壁前部缺损和复杂相关畸形的医疗机构分娩。美国外科医生学会(American College of Surgeons)制定了儿童手术验证(CSV)计划,以确定拥有最佳儿科手术护理资源的机构。我们的目的是评估 CSV 状态对得克萨斯州出生后第一年的 AWD 治疗结果和潜在健康差异的影响:我们对婴儿进行了一项多中心流行病学队列研究:我们确定了 2282 名 AWD 患者,其中 26% 在 CSV 中心接受治疗,68% 接受腹壁手术修复。大多数(70%)患有胃裂。在 CSV 中心接受治疗的患者更有可能是非西班牙裔(64% 对 58%,P = 0.018),居住在城市县(92% 对 82%,P 结论:在 CSV 中心接受治疗的 AWD 患者更有可能是非西班牙裔(64% 对 58%,P = 0.018),居住在城市县(92% 对 82%,P = 0.018):在CSV中心接受治疗的AWD患者尽管病情复杂程度和严重程度有所增加,但其治疗效果更佳,死亡率也有所提高。CSV 中心的医疗服务因种族和居住地不同而存在差异。需要持续开展质量工作,以普遍提高质量,并表彰提供高质量护理的机构,同时确保公平获得高质量的儿科外科护理。
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引用次数: 0
Sequential Fasciotomies for Managing Abdominal Compartment Syndrome: Porcine Experimental Study 治疗腹腔隔室综合征的连续筋膜切开术:猪实验研究
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1016/j.jss.2024.09.072

Introduction

Abdominal compartment syndrome (ACS) poses a significant clinical challenge, with high morbidity and mortality rates. Conventional treatment via decompressive laparotomy with open abdomen and temporary closure presents significant drawbacks. This experimental study evaluates the efficacy of open minimally invasive sequential fasciotomy in managing simulated ACS in a porcine model.

Methods

Ten adult pigs were included in this prospective experimental investigation, wherein a mechanical model of abdominal hypertension was induced by pneumoperitoneum via a Veres needle. Open minimally invasive sequential fasciotomy, involving bilateral external oblique muscles (EOMs) and linea alba (LA), was performed. Physiological parameters were recorded preprocedure and postprocedure.

Results

In our study, 70% of pigs completed the fasciotomy sequence. Unilateral EOM fasciotomy significantly reduced intravesical pressure and femoral venous pressure by 18% and 16%, respectively. Bilateral EOM fasciotomies led to a 35.7% decrease in both parameters. Following re-establishment of intra-abdominal pressure to 20 mmHg, LA fasciotomy resulted in a 47% drop in intravesical pressure and femoral venous pressure. Significant increases in tidal volume and abdominal perimeter were observed after each fasciotomy.

Conclusions

This study establishes that open minimally invasive sequential fasciotomy of bilateral EOM and LA is an effective strategy for managing simulated ACS in a porcine model. Each fasciotomy resulted in a significant reduction in intra-abdominal pressure. These findings suggest that sequential fasciotomy techniques offer a promising alternative to decompressive laparotomy in ACS management. Further research is essential to validate these outcomes in human subjects.
简介:腹腔隔室综合征(ACS)是一项重大的临床挑战,发病率和死亡率都很高。传统的开腹减压术和临时闭合术存在很大缺陷。本实验研究评估了开放式微创连续筋膜切开术在猪模型中处理模拟 ACS 的疗效:方法:10 头成年猪参与了这项前瞻性实验研究,通过维雷斯针腹腔积气诱发机械性腹腔高压模型。进行开放式微创连续筋膜切开术,涉及双侧腹外斜肌(EOMs)和白线(LA)。记录术前和术后的生理参数:结果:在我们的研究中,70%的猪完成了筋膜切开术。单侧EOM筋膜切开术显著降低了膀胱内压和股静脉压,降幅分别为18%和16%。双侧EOM筋膜切开术使这两个参数降低了35.7%。腹腔内压力恢复到20 mmHg后,LA筋膜切开术使膀胱内压和股静脉压下降了47%。每次筋膜切开术后,潮气量和腹围都有显著增加:本研究证实,开放式微创双侧 EOM 和 LA 顺序筋膜切开术是在猪模型中处理模拟 ACS 的有效策略。每次筋膜切开术都能显著降低腹内压。这些研究结果表明,连续筋膜切开术是一种替代减压开腹手术治疗 ACS 的有效方法。进一步的研究对于在人体中验证这些结果至关重要。
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引用次数: 0
Vascular Graft Infections Treated With Bioabsorbable Antibiotic Beads 用生物可吸收抗生素珠治疗血管移植感染。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1016/j.jss.2024.09.079

Introduction

Inguinal vascular surgical site infections (VSSI) and infected prosthetic grafts remain a critical problem in vascular surgery. Prior clinical reports suggest antibiotic-impregnated beads may be used to attempt salvage of the graft and improve outcomes, especially if explant would result in major amputation or mortality. Described is our institutional experience managing inguinal VSSI using bioabsorbable, antibiotic-impregnated beads compared to inguinal VSSI managed with debridement alone.

Methods

Patients with VSSIs after lower-extremity procedures were identified through the institutional database and departmental registries from 2014 to 2023. Cases were excluded if they did not involve an inguinal wound infection or an operation for VSSI management. Outcomes, including amputation-free survival, reinfection, and re-operation for infection were recorded, along with microbial isolates. Basic descriptive statistics, Kaplan–Meier, and Multiple variable Cox proportional hazards analyses were performed.

Results

There were 43 patients identified (23 with intravenous antibiotics and debridement alone, and 20 treated with intravenous antibiotics, debridement, and antibiotic beads). The two groups differed significantly in their Szilagyi classification, with thirteen patients (65%) with class III infections in the antibiotic bead group compared with one (7%) in the debridement alone group. There was no significant difference in amputation-free survival for those cases that received debridement and antibiotic beads versus debridement alone (P = 0.20) or amputation-free survival between Szilagyi classifications (P = 0.47) despite a higher representation of Szilagyi III cases in the antibiotic bead group (P = 0.0001). Patients with graft infections treated with beads experienced similar survival outcomes to patients with subcutaneous infections treated with debridement alone (P = 0.21).

Conclusions

The efficacy of bioabsorbable antibiotic beads in VSSIs remains controversial. While this cohort study demonstrated an increased risk of re-infection, this is confounded by the antibiotic bead group having a higher frequency of graft infections. Antibiotic beads appear to be safe for use in patients with vascular graft infections and may help achieve outcomes comparable to patients without graft involvement. Further studies with larger patient populations and similar infection severity between groups are needed.
导言:腹股沟血管手术部位感染(VSSI)和假体移植物感染仍是血管外科的一个严重问题。之前的临床报告显示,抗生素浸泡珠可用于挽救移植物并改善预后,尤其是在切除移植物会导致重大截肢或死亡的情况下。本院使用生物可吸收抗生素浸渍珠处理腹股沟 VSSI 的经验与单纯清创处理腹股沟 VSSI 的经验进行了比较:2014年至2023年期间,通过机构数据库和部门登记册确定了下肢手术后发生VSSI的患者。如果病例未涉及腹股沟伤口感染或未进行VSSI处理手术,则将其排除在外。结果包括无截肢存活率、再感染和因感染而再次手术,微生物分离物也一并记录在案。对结果进行了基本描述性统计、Kaplan-Meier 和多变量 Cox 比例危险度分析:共发现 43 例患者(23 例仅接受静脉注射抗生素和清创术,20 例接受静脉注射抗生素、清创术和抗生素珠治疗)。两组患者的 Szilagyi 分类差异很大,抗生素珠组有 13 名患者(65%)属于 III 级感染,而单纯清创组只有 1 名患者(7%)属于 III 级感染。接受清创和抗生素微珠治疗的病例与仅接受清创治疗的病例在无截肢存活率(P = 0.20)或无截肢存活率(P = 0.47)方面没有明显差异,尽管抗生素微珠组中 Szilagyi III 级病例的比例更高(P = 0.0001)。使用微珠治疗移植物感染的患者与仅使用清创术治疗皮下感染的患者存活率相似(P = 0.21):结论:生物可吸收抗生素珠对 VSSI 的疗效仍存在争议。虽然这项队列研究显示再感染风险增加,但抗生素珠组发生移植物感染的频率较高,这就混淆了再感染风险。在血管移植物感染患者中使用抗生素珠似乎是安全的,而且可能有助于获得与未受移植物影响的患者相当的治疗效果。还需要对更大的患者群体和不同组别之间相似的感染严重程度进行进一步研究。
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引用次数: 0
Rodent Model of Cardiopulmonary Bypass Demonstrates Systemic Inflammation and NeuroMarker Changes 啮齿动物心肺旁路模型显示全身炎症和神经标记物变化
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1016/j.jss.2024.09.041

Introduction

The physiologic derangements imposed by cardiopulmonary bypass (CPB) can result in complications such as postoperative delirium. We aim to validate a rodent survival model of CPB demonstrating a systemic inflammatory response and hypothesize that this contributes to post-CPB delirium.

Methods

Adult Sprague–Dawley rats were randomized to three groups: 1) Sham peripheral surgical cannulation, 2) CPB followed by acute phase harvest, or 3) CPB followed by 24-h survival. CPB was carried out for 60 min before decannulation and weaning from mechanical ventilation. Physiological and biochemical endpoints were compared between groups. Gene expression analysis of hippocampal tissue was performed using quantitative RT-PCR panels and protein expression levels were confirmed with Western blot.

Results

Sixteen animals underwent cannulation and were successfully decannulated without transfusion requirement or inotrope use with one procedure-related mortality. Serum acute phase proinflammatory chemokines cytokine-induced neutrophil chemoattractant 1, cytokine-induced neutrophil chemoattractant 3, fractalkine, and lipopolysaccharide-induced CXC chemokine as well as interleukin (IL)-10 were increased 1 h following CPB compared to sham (P < 0.05). Significant changes in hippocampal expression of biomarkers apolipoprotein 1, vascular epithelial growth factor A, and synapsin 1 were demonstrated following CPB.

Conclusions

This study validated a model of CPB that captures the resultant systemic inflammatory response, and identified differentially expressed proteins that may be associated with brain injury. Modulation of the CPB-induced inflammatory response may be a promising therapeutic target to attenuate post-CPB delirium, and this survival rat model of CPB with low surgical attrition will allow for more comprehensive evaluations of the short- and long-term effects of both CPB and potential therapeutic interventions.
导言:心肺旁路术(CPB)引起的生理失调可导致术后谵妄等并发症。我们的目的是验证一种显示全身炎症反应的 CPB 啮齿类存活模型,并推测这将导致 CPB 术后谵妄:方法:成年 Sprague-Dawley 大鼠被随机分为三组:1)假外周手术插管组;2)CPB 后急性期收获组;或 3)CPB 后 24 小时存活组。CPB持续60分钟,然后拔管并从机械通气中断气。对各组的生理和生化终点进行比较。使用定量 RT-PCR 面板对海马组织进行基因表达分析,并通过 Western 印迹确认蛋白质表达水平:结果:16 只动物接受了插管手术,并在不需要输血或使用肌注的情况下成功拔管,其中有一只动物因手术相关死亡。与假手术相比,CPB 1 小时后血清急性期促炎趋化因子细胞因子诱导的中性粒细胞趋化吸引子 1、细胞因子诱导的中性粒细胞趋化吸引子 3、分叉碱和脂多糖诱导的 CXC 趋化因子以及白细胞介素 (IL)-10 均有所增加(P 结论:该研究验证了 CPB 模型的有效性:这项研究验证了一种能捕捉到由此引起的全身炎症反应的 CPB 模型,并确定了可能与脑损伤有关的不同表达蛋白。调节 CPB 引起的炎症反应可能是减轻 CPB 后谵妄的一个很有前景的治疗靶点,而且这种存活的 CPB 大鼠模型手术损耗低,因此可以对 CPB 和潜在治疗干预的短期和长期影响进行更全面的评估。
{"title":"Rodent Model of Cardiopulmonary Bypass Demonstrates Systemic Inflammation and NeuroMarker Changes","authors":"","doi":"10.1016/j.jss.2024.09.041","DOIUrl":"10.1016/j.jss.2024.09.041","url":null,"abstract":"<div><h3>Introduction</h3><div>The physiologic derangements imposed by cardiopulmonary bypass (CPB) can result in complications such as postoperative delirium. We aim to validate a rodent survival model of CPB demonstrating a systemic inflammatory response and hypothesize that this contributes to post-CPB delirium.</div></div><div><h3>Methods</h3><div>Adult Sprague–Dawley rats were randomized to three groups: 1) Sham peripheral surgical cannulation, 2) CPB followed by acute phase harvest, or 3) CPB followed by 24-h survival. CPB was carried out for 60 min before decannulation and weaning from mechanical ventilation. Physiological and biochemical endpoints were compared between groups. Gene expression analysis of hippocampal tissue was performed using quantitative RT-PCR panels and protein expression levels were confirmed with Western blot.</div></div><div><h3>Results</h3><div>Sixteen animals underwent cannulation and were successfully decannulated without transfusion requirement or inotrope use with one procedure-related mortality. Serum acute phase proinflammatory chemokines cytokine-induced neutrophil chemoattractant 1, cytokine-induced neutrophil chemoattractant 3, fractalkine, and lipopolysaccharide-induced CXC chemokine as well as interleukin (IL)-10 were increased 1 h following CPB compared to sham (<em>P</em> &lt; 0.05). Significant changes in hippocampal expression of biomarkers apolipoprotein 1, vascular epithelial growth factor A, and synapsin 1 were demonstrated following CPB.</div></div><div><h3>Conclusions</h3><div>This study validated a model of CPB that captures the resultant systemic inflammatory response, and identified differentially expressed proteins that may be associated with brain injury. Modulation of the CPB-induced inflammatory response may be a promising therapeutic target to attenuate post-CPB delirium, and this survival rat model of CPB with low surgical attrition will allow for more comprehensive evaluations of the short- and long-term effects of both CPB and potential therapeutic interventions.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546105","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}
引用次数: 0
Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery 减肥手术中实施强化恢复计划的效果。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-11-01 DOI: 10.1016/j.jss.2024.09.082

Introduction

While the adoption of ERAS protocols in bariatric surgery has increased, variability exists across centers, reflecting a spectrum of implementation stages. The objective of this study is to understand and increase awareness of the effectiveness of enhanced recovery after surgery (ERAS) protocols in bariatric surgery, given the specific perioperative difficulties and risks for this population. We aimed to study the association between implementation of the ERAS program in bariatric surgery and specific outcomes.

Methods

Primary bariatric patients (≥18 y old) at a single academic institution were divided into pre-ERAS and post-ERAS groups. Poisson and quantile regressions were used to examine the association between the ERAS protocol and length of stay and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-d readmissions.

Results

A total of 680 procedures were performed in the pre-ERAS cohort, compared to 1124 procedures post-ERAS. The median length of hospital stay was shorter, and median cost of surgery was lower for post-ERAS patients compared to pre-ERAS patients by 1 d (P = 0.001) and $2000, respectively. A higher proportion of patients in the pre-ERAS period had one or more unplanned readmissions compared to the post-ERAS period (P < 0.001). The ERAS protocol was associated with decreased length of stay (incidence rate ratio = 0.72, P < 0.001), decreased median cost (−$2230, P < 0.001), and lower risk of 30-d unplanned readmissions (odds ratio = 0.48, P < 0.001).

Conclusions

This study highlights the value of an enhanced recovery program in bariatric surgery, benefiting both patients and health systems.
导言:虽然在减肥手术中采用 ERAS 方案的人数有所增加,但各中心之间存在差异,反映出不同的实施阶段。本研究的目的是了解减肥手术中术后恢复强化方案(ERAS)的有效性,并提高对其有效性的认识,因为该人群在围手术期存在特殊的困难和风险。我们旨在研究在减肥手术中实施ERAS计划与具体结果之间的关联:将一家学术机构的初诊减肥患者(≥18 岁)分为 ERAS 前和 ERAS 后两组。采用泊松回归和量子回归分别检验ERAS方案与住院时间和费用之间的关系。逻辑回归用于评估ERAS对30天再入院的影响:结果:ERAS实施前共进行了680例手术,而ERAS实施后进行了1124例手术。与ERAS实施前的患者相比,ERAS实施后的患者住院时间中位数缩短了1天(P = 0.001),手术费用中位数降低了2000美元。与ERAS实施前的患者相比,ERAS实施后的患者有一次或多次计划外再入院的比例更高(P 结论:ERAS实施前的患者住院时间更短,手术费用中位数更低,而ERAS实施后的患者住院时间更长:这项研究强调了加强康复计划在减肥手术中的价值,对患者和医疗系统都有好处。
{"title":"Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery","authors":"","doi":"10.1016/j.jss.2024.09.082","DOIUrl":"10.1016/j.jss.2024.09.082","url":null,"abstract":"<div><h3>Introduction</h3><div>While the adoption of ERAS protocols in bariatric surgery has increased, variability exists across centers, reflecting a spectrum of implementation stages. The objective of this study is to understand and increase awareness of the effectiveness of enhanced recovery after surgery (ERAS) protocols in bariatric surgery, given the specific perioperative difficulties and risks for this population. We aimed to study the association between implementation of the ERAS program in bariatric surgery and specific outcomes.</div></div><div><h3>Methods</h3><div>Primary bariatric patients (≥18 y old) at a single academic institution were divided into pre-ERAS and post-ERAS groups. Poisson and quantile regressions were used to examine the association between the ERAS protocol and length of stay and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-d readmissions.</div></div><div><h3>Results</h3><div>A total of 680 procedures were performed in the pre-ERAS cohort, compared to 1124 procedures post-ERAS. The median length of hospital stay was shorter, and median cost of surgery was lower for post-ERAS patients compared to pre-ERAS patients by 1 d (<em>P</em> = 0.001) and $2000, respectively. A higher proportion of patients in the pre-ERAS period had one or more unplanned readmissions compared to the post-ERAS period (<em>P</em> &lt; 0.001). The ERAS protocol was associated with decreased length of stay (incidence rate ratio = 0.72, <em>P</em> &lt; 0.001), decreased median cost (−$2230, <em>P</em> &lt; 0.001), and lower risk of 30-d unplanned readmissions (odds ratio = 0.48, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>This study highlights the value of an enhanced recovery program in bariatric surgery, benefiting both patients and health systems.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564250","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}
引用次数: 0
Factors Associated With Surgical Management in Gallbladder Cancer—A Surveillance, Epidemiology, and End Results Medicare–Based Study 胆囊癌手术治疗的相关因素--基于医疗保险的监测、流行病学和最终结果研究
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-31 DOI: 10.1016/j.jss.2024.09.084

Introduction

Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.

Materials and methods

SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.

Results

We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% versus 65.6%; P = 0.0104), ≥80 y old (48.2% versus 22.4%; P < 0.0001), frail (44.5% versus 27.1%; P < 0.0001), treated by general surgeons (98.1% versus 84.9%; P < 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% versus 54.5%; P < 0.0001), managed at nonacademic hospitals (51.2% versus 28.4%; P < 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% versus 47.2%; P < 0.0001), 3-y (42.8% versus 21.1%; P < 0.0001), and 5-y (37.5% versus 17.4%; P < 0.0001).

Conclusions

Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.
导言胆囊癌(GBC)的发病率不断上升,但预后仍然很差。T1b期或以上的肿瘤切除术可提高生存率,但许多患者并未接受适当的切除术。本研究旨在利用监测、流行病学和最终结果--医疗保险(SEER-Medicare)数据库评估可能导致这一差异的因素。材料和方法SEER医疗保险(2008-2015年)中T1b期或以上GBC患者被分为接受单纯胆囊切除术(CCY)或胆囊切除术和肝/胆切除术(肿瘤切除术)。对分类变量和连续变量分别采用Chi-square检验和Wilcoxon秩和检验,比较了基线特征倾向得分匹配前后的结果和总生存率。CCY 患者多为女性(73.4% 对 65.6%;P = 0.0104)、≥80 岁(48.2% 对 22.4%;P <;0.0001)、体弱(44.5% 对 27.1%;P <;0.0001)、由普通外科医生治疗(98.1%对84.9%;P <;0.0001)与肿瘤外科医生相比,未接受化疗(72.3%对54.5%;P <;0.0001),在非学术医院管理(51.2%对28.4%;P <;0.0001)。匹配后,与 CCY 相比,肿瘤切除术的总生存率在 1y (69.2% 对 47.2%; P < 0.0001)、3y (42.8% 对 21.1%; P < 0.0001) 和 5y (37.5% 对 17.4%; P < 0.0001) 均有所提高。结论大多数GBC患者可能没有接受适当的肿瘤切除术,尤其是女性、老年、体弱、由普通外科医生手术、未接受化疗或在非学术医院接受治疗的患者。即使对患者因素进行调整,完全切除仍与多个终点的总体生存结果相关。限制性别、年龄和体弱状况等因素,并让肿瘤外科医生参与或在学术中心接受治疗,可能会提高肿瘤切除率,从而改善 GBC 患者的生存率。
{"title":"Factors Associated With Surgical Management in Gallbladder Cancer—A Surveillance, Epidemiology, and End Results Medicare–Based Study","authors":"","doi":"10.1016/j.jss.2024.09.084","DOIUrl":"10.1016/j.jss.2024.09.084","url":null,"abstract":"<div><h3>Introduction</h3><div>Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results–Medicare (SEER-Medicare) database.</div></div><div><h3>Materials and methods</h3><div>SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% <em>versus</em> 65.6%; <em>P</em> = 0.0104), ≥80 y old (48.2% <em>versus</em> 22.4%; <em>P</em> &lt; 0.0001), frail (44.5% <em>versus</em> 27.1%; <em>P</em> &lt; 0.0001), treated by general surgeons (98.1% <em>versus</em> 84.9%; <em>P</em> &lt; 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% <em>versus</em> 54.5%; <em>P</em> &lt; 0.0001), managed at nonacademic hospitals (51.2% <em>versus</em> 28.4%; <em>P</em> &lt; 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% <em>versus</em> 47.2%; <em>P</em> &lt; 0.0001), 3-y (42.8% <em>versus</em> 21.1%; <em>P</em> &lt; 0.0001), and 5-y (37.5% <em>versus</em> 17.4%; <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554640","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}
引用次数: 0
Antibiotic Prophylaxis and Spinal Infection After Gunshot Wounds to the Spine: A Retrospective Study 脊柱枪伤后的抗生素预防和脊柱感染:回顾性研究。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-30 DOI: 10.1016/j.jss.2024.09.083

Introduction

Spinal and paraspinal infections (SPIs) are a potential complication following traumatic spinal column injury, and we sought to determine the association of antibiotic prophylaxis on SPI development following a spinal gunshot wound (GSW).

Methods

A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed.

Results

A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% versus 23.1%, P < 0.001), primarily colon injuries (55.6% versus 12.5%, P < 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% versus 2%; P = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (P = 0.49).

Conclusions

Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW.
简介:脊柱和脊柱旁感染(SPI)是脊柱外伤后的一种潜在并发症,我们试图确定脊柱枪伤(GSW)后抗生素预防与SPI发生的关系:单中心回顾性队列研究的对象是脊柱枪伤超过 11 年的成年人。研究对抗生素的使用和损伤模式进行了分析:共有330名患者纳入分析。大多数患者为男性(88%)、黑人(79%),平均年龄为 27 岁。死亡率为 4%。65%的患者使用了预防性抗生素,中位持续时间为5天。中空内脏损伤(HVIs)(66.7% 对 23.1%,P < 0.001),主要是结肠损伤(55.6% 对 12.5%,P < 0.001),与 SPI 独立相关。抗生素的使用与 SPI 的降低无关(3% 对 2%;P = 0.41)。在出现 SPI 的患者中,有 7 名患者接受了 3 天或更短时间的抗生素治疗,但这并无统计学意义(P = 0.49):结论:脊柱GSW术后,HVI患者的SPI发生率较高。尽管抗生素的使用和持续时间与SPI没有统计学意义,但即使是HVI患者,使用4天或4天以上抗生素的患者也没有发生感染。由于 SPI 发生率较低,多中心试验可能有助于确定预防性抗生素的最佳持续时间。不过,我们建议在 GSW 后最多使用 4 天抗生素预防 SPI。
{"title":"Antibiotic Prophylaxis and Spinal Infection After Gunshot Wounds to the Spine: A Retrospective Study","authors":"","doi":"10.1016/j.jss.2024.09.083","DOIUrl":"10.1016/j.jss.2024.09.083","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal and paraspinal infections (SPIs) are a potential complication following traumatic spinal column injury, and we sought to determine the association of antibiotic prophylaxis on SPI development following a spinal gunshot wound (GSW).</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed.</div></div><div><h3>Results</h3><div>A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% <em>versus</em> 23.1%, <em>P</em> &lt; 0.001), primarily colon injuries (55.6% <em>versus</em> 12.5%, <em>P</em> &lt; 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% <em>versus</em> 2%; <em>P</em> = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (<em>P</em> = 0.49).</div></div><div><h3>Conclusions</h3><div>Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546108","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}
引用次数: 0
Resident Race and Operative Experience in General Surgery Residency: A Mixed-Methods Study 普通外科住院医生的种族和手术经验:混合方法研究
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-28 DOI: 10.1016/j.jss.2024.09.049

Introduction

Recent multi-institutional quantitative work has found that Black general surgery residents perform fewer operations during training. Further mixed-methods research exploring the reasons for this phenomenon is needed to address this inequity for residents who are underrepresented in medicine (URiM).

Material and methods

Data were collected through open response and Likert scale questions that were distributed electronically to residents at 21 accredited US general surgery programs within the US Resident Operative Experience Consortium. Questions focused on what barriers prevent residents from going to the operating room and potential solutions. Free text was analyzed by three qualitative reviewers.

Results

The online survey was completed by 96 general surgery residents representing a 12% overall response rate from the 21 US Resident Operative Experience Consortium programs. Eight (n = 8/13, 62%) of the URiM residents endorsed that they experienced barriers in obtaining case numbers compared to 13% of non-URiM residents (P < 0.05). A similar proportion of both groups agreed that their quality of training was affected by their race or ethnicity (n = 6/13, 46% versus n = 34/49, 41%; P = 0.77). Floor work and clinical tasks were the most common qualitative themes regarding operative barriers (75 responses). Racial bias (n = 22) was frequently referenced as a barrier specifically experienced by URiM residents. Suggestions to improve the operative experience of URiM residents included increasing mentorship at the attending level (n = 25) and setting objective standards for resident operating room participation (n = 30).

Conclusions

Nearly five times as many URiM residents reported experiencing barriers in obtaining case numbers compared to non-URiM residents. Qualitative analysis suggests that clear expectations for resident participation in cases and increasing mentorship at the attending level may be ways to achieve parity.
导言最近的多机构定量研究发现,黑人普外科住院医师在培训期间进行的手术较少。材料与方法通过开放式回答和李克特量表问题收集数据,这些问题以电子方式分发给美国住院医师手术经验联盟(US Resident Operative Experience Consortium)中 21 个经认证的美国普外科项目的住院医师。问题主要涉及哪些障碍阻碍住院医师进入手术室以及潜在的解决方案。三位定性评审员对自由文本进行了分析。结果在线调查由96名普外科住院医师完成,占美国住院医师手术经验联盟21个项目总回复率的12%。8名(n = 8/13,62%)URiM住院医师表示他们在获取病例号时遇到了障碍,而非URiM住院医师的这一比例为13%(P <0.05)。两组住院医师中同意其培训质量受种族或民族影响的比例相近(n = 6/13,46%;n = 34/49,41%;P = 0.77)。地面工作和临床任务是有关手术障碍最常见的定性主题(75 个回答)。种族偏见(n = 22)是URiM住院医师经常遇到的障碍。改善URiM住院医师手术体验的建议包括增加主治医师层面的指导(n = 25)以及为住院医师参与手术室工作设定客观标准(n = 30)。定性分析表明,明确住院医师参与病例的期望值和加强主治医师层面的指导可能是实现均等的途径。
{"title":"Resident Race and Operative Experience in General Surgery Residency: A Mixed-Methods Study","authors":"","doi":"10.1016/j.jss.2024.09.049","DOIUrl":"10.1016/j.jss.2024.09.049","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent multi-institutional quantitative work has found that Black general surgery residents perform fewer operations during training. Further mixed-methods research exploring the reasons for this phenomenon is needed to address this inequity for residents who are underrepresented in medicine (URiM).</div></div><div><h3>Material and methods</h3><div>Data were collected through open response and Likert scale questions that were distributed electronically to residents at 21 accredited US general surgery programs within the US Resident Operative Experience Consortium. Questions focused on what barriers prevent residents from going to the operating room and potential solutions. Free text was analyzed by three qualitative reviewers.</div></div><div><h3>Results</h3><div>The online survey was completed by 96 general surgery residents representing a 12% overall response rate from the 21 US Resident Operative Experience Consortium programs. Eight (<em>n</em> = 8/13, 62%) of the URiM residents endorsed that they experienced barriers in obtaining case numbers compared to 13% of non-URiM residents (<em>P</em> &lt; 0.05). A similar proportion of both groups agreed that their quality of training was affected by their race or ethnicity (<em>n</em> = 6/13, 46% <em>versus n</em> = 34/49, 41%; <em>P</em> = 0.77). Floor work and clinical tasks were the most common qualitative themes regarding operative barriers (75 responses). Racial bias (<em>n</em> = 22) was frequently referenced as a barrier specifically experienced by URiM residents. Suggestions to improve the operative experience of URiM residents included increasing mentorship at the attending level (<em>n</em> = 25) and setting objective standards for resident operating room participation (<em>n</em> = 30).</div></div><div><h3>Conclusions</h3><div>Nearly five times as many URiM residents reported experiencing barriers in obtaining case numbers compared to non-URiM residents. Qualitative analysis suggests that clear expectations for resident participation in cases and increasing mentorship at the attending level may be ways to achieve parity.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539642","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}
引用次数: 0
A Qualitative Study of Electronic Patient-Reported Outcome Symptom Monitoring After Thoracic Surgery 胸外科手术后电子患者报告结果症状监测的定性研究。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-25 DOI: 10.1016/j.jss.2024.09.051

Introduction

Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital health systems can facilitate remote postoperative symptom management yet obstacles persist in their routine clinical adoption. This study aimed to identify patient-perceived barriers and facilitators to using an electronic patient-reported outcome (ePRO) monitoring platform specially designed to detect complications from thoracic surgery postdischarge.

Methods

Patients (n = 16) who underwent thoracic surgery and participated in an ePRO parent study completed semistructured interviews, which were analyzed using thematic content analysis and iterative team-based coding. Themes were mapped onto the three domains of the Capability, Opportunity, and Motivation Model of behavior framework to inform ePRO design and implementation improvements.

Results

Analysis demonstrated seven dominant themes, including barriers (1. postoperative patient physical and mental health, 2. lack of access to email and poor internet connectivity, 3. lack of clarity on ePRO use in routine clinical care, and 4. symptom item redundancy) as well as facilitators (5. ease of the ePRO assessment completion, 6. engagement with the surgical care team on ePRO use, and 7. increased awareness of symptom experience through ePRO use). Suggested ePRO improvements included offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient education on ePROs for perioperative care.

Conclusions

Addressable barriers and facilitators to implementation of ePRO symptom monitoring in the thoracic surgical patient population postdischarge have been identified. Future work will test the impact of design improvements on implementation outcomes of feasibility and acceptability.
简介胸外科手术是治疗肺癌和其他慢性肺部疾病的主要手段,但术后恢复往往比较复杂。数字医疗系统可促进远程术后症状管理,但其常规临床应用仍存在障碍。本研究旨在确定患者在使用专为检测胸外科手术出院后并发症而设计的电子患者报告结果(ePRO)监测平台时所遇到的障碍和促进因素:接受胸外科手术并参与 ePRO 父母研究的患者(n = 16)完成了半结构式访谈,访谈采用主题内容分析和基于团队的迭代编码法进行分析。主题被映射到能力、机会和动机行为模型框架的三个领域,为 ePRO 的设计和实施改进提供信息:结果:分析显示了七个主要的主题,包括障碍(1.术后患者的身心健康;2.无法使用电子邮件和网络连接不畅;3.常规临床护理中使用 ePRO 的情况不明确;4.症状项目冗余)和促进因素(5.完成 ePRO 评估的难易程度;6.手术护理团队参与 ePRO 的使用;7.通过使用 ePRO 提高对症状体验的认识)。建议的 ePRO 改进措施包括:提供网络完成评估的替代方法、根据患者个体情况定制症状评估,以及在围手术期护理中对患者进行有关 ePRO 的教育:结论:在胸外科患者出院后实施 ePRO 症状监测的障碍和促进因素已经确定。未来的工作将检验设计改进对可行性和可接受性实施结果的影响。
{"title":"A Qualitative Study of Electronic Patient-Reported Outcome Symptom Monitoring After Thoracic Surgery","authors":"","doi":"10.1016/j.jss.2024.09.051","DOIUrl":"10.1016/j.jss.2024.09.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital health systems can facilitate remote postoperative symptom management yet obstacles persist in their routine clinical adoption. This study aimed to identify patient-perceived barriers and facilitators to using an electronic patient-reported outcome (ePRO) monitoring platform specially designed to detect complications from thoracic surgery postdischarge.</div></div><div><h3>Methods</h3><div>Patients (<em>n</em> = 16) who underwent thoracic surgery and participated in an ePRO parent study completed semistructured interviews, which were analyzed using thematic content analysis and iterative team-based coding. Themes were mapped onto the three domains of the Capability, Opportunity, and Motivation Model of behavior framework to inform ePRO design and implementation improvements.</div></div><div><h3>Results</h3><div>Analysis demonstrated seven dominant themes, including barriers (1. postoperative patient physical and mental health, 2. lack of access to email and poor internet connectivity, 3. lack of clarity on ePRO use in routine clinical care, and 4. symptom item redundancy) as well as facilitators (5. ease of the ePRO assessment completion, 6. engagement with the surgical care team on ePRO use, and 7. increased awareness of symptom experience through ePRO use). Suggested ePRO improvements included offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient education on ePROs for perioperative care.</div></div><div><h3>Conclusions</h3><div>Addressable barriers and facilitators to implementation of ePRO symptom monitoring in the thoracic surgical patient population postdischarge have been identified. Future work will test the impact of design improvements on implementation outcomes of feasibility and acceptability.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502689","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}
引用次数: 0
Human Capital and Productivity in Surgery Research Across the Globe: A Big Data Analysis Using Artificial Intelligence 全球外科研究中的人力资本和生产力:利用人工智能的大数据分析。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-25 DOI: 10.1016/j.jss.2024.09.047

Introduction

No investigation of each nation's contribution to knowledge production and human capital in surgery currently exists. Previous studies explored country-level research productivity only in few surgical subspecialties. To identify current and future leaders in surgery research, we conduct a retrospective observational study of each country's human capital and research productivity.

Methods

A web-scraping algorithm was deployed on PubMed to retrieve information on the first and senior author of every publication in all PubMed-indexed surgery outlets—a total of 388 journals—between 2010 and 2022, according to the SCImago classification. Each country's human capital is proxied by the number of first and senior authors.

Results

A total of 665,668 publications from 110 countries were reviewed. The number of publications rises over time. The United States represents 30.78% and 31.32% of global publications based on first and senior authors, respectively. Other leading contributors include the United Kingdom (5.57% and 5.69% of global first and senior author publications, respectively), China (8.84% and 8.74%), Japan (7.14% and 7.10%), and Italy (4.54% and 4.46%). The number of publications per 100K people ranges between 0.04 and 86.01, suggesting widely varying levels of research productivity relative to the population.

Conclusions

Our findings underscore the US dominance in surgery research. Countries with a higher share of first or senior authors may have greater capacity to expand their future research output. As big data research expands, we expect studies deploying artificial intelligence methodologies, such as web scraping, on data repositories to guide healthcare provision and health policy decisions to become mainstream.
导言:目前还没有关于各国对外科知识生产和人力资本贡献的调查。以往的研究仅探讨了少数外科亚专科的国家级研究生产力。为了确定当前和未来外科研究领域的领军人物,我们对各国的人力资本和研究生产力进行了一项回顾性观察研究:方法:我们在 PubMed 上部署了一种网络抓取算法,根据 SCImago 分类检索 2010 年至 2022 年间所有 PubMed 收录的外科刊物(共 388 种期刊)中每篇论文的第一作者和资深作者的信息。每个国家的人力资本以第一作者和资深作者的数量来表示:结果:共审查了 110 个国家的 665 668 篇论文。出版物数量随着时间的推移而增加。按第一作者和资深作者计算,美国分别占全球出版物的 30.78% 和 31.32%。其他主要贡献者包括英国(分别占全球第一作者和资深作者出版物的 5.57% 和 5.69%)、中国(8.84% 和 8.74%)、日本(7.14% 和 7.10%)和意大利(4.54% 和 4.46%)。每 10 万人发表论文的数量介于 0.04 和 86.01 之间,这表明相对于人口而言,研究生产力水平差异很大:我们的研究结果凸显了美国在外科研究领域的主导地位。第一作者或资深作者比例较高的国家可能更有能力扩大其未来的研究成果。随着大数据研究的扩展,我们预计在数据存储库中部署人工智能方法(如网络搜索)以指导医疗服务和卫生政策决策的研究将成为主流。
{"title":"Human Capital and Productivity in Surgery Research Across the Globe: A Big Data Analysis Using Artificial Intelligence","authors":"","doi":"10.1016/j.jss.2024.09.047","DOIUrl":"10.1016/j.jss.2024.09.047","url":null,"abstract":"<div><h3>Introduction</h3><div>No investigation of each nation's contribution to knowledge production and human capital in surgery currently exists. Previous studies explored country-level research productivity only in few surgical subspecialties. To identify current and future leaders in surgery research, we conduct a retrospective observational study of each country's human capital and research productivity.</div></div><div><h3>Methods</h3><div>A web-scraping algorithm was deployed on PubMed to retrieve information on the first and senior author of every publication in all PubMed-indexed surgery outlets—a total of 388 journals—between 2010 and 2022, according to the SCImago classification. Each country's human capital is proxied by the number of first and senior authors.</div></div><div><h3>Results</h3><div>A total of 665,668 publications from 110 countries were reviewed. The number of publications rises over time. The United States represents 30.78% and 31.32% of global publications based on first and senior authors, respectively. Other leading contributors include the United Kingdom (5.57% and 5.69% of global first and senior author publications, respectively), China (8.84% and 8.74%), Japan (7.14% and 7.10%), and Italy (4.54% and 4.46%). The number of publications per 100K people ranges between 0.04 and 86.01, suggesting widely varying levels of research productivity relative to the population.</div></div><div><h3>Conclusions</h3><div>Our findings underscore the US dominance in surgery research. Countries with a higher share of first or senior authors may have greater capacity to expand their future research output. As big data research expands, we expect studies deploying artificial intelligence methodologies, such as web scraping, on data repositories to guide healthcare provision and health policy decisions to become mainstream.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502709","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}
引用次数: 0
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Journal of Surgical Research
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