Journal of Surgical Research最新文献

Introduction: Textbook outcome (TO) is a composite measure designed to assess the overall short-term outcome of an operation. TO after esophagectomy with gastric conduit using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database has not yet been defined.

Methods: Records in the NSQIP Esophagectomy Procedure-Targeted database from 2016 to 2021 were analyzed. Patients who underwent elective esophagectomies with gastric conduit for resectable esophageal cancer were included. TO was defined as the absence of anastomotic leak, major complications, positive surgical margins, reintervention ≤30 d postsurgery, prolonged hospital stay (> 21 d), postoperative mortality ≤ 30 d after surgery, and readmission ≤ 30 d after discharge.

Results: Of the 6813 patients in the 2016-2021 NSQIP database who underwent esophagectomy, 3733 met study criteria. A total of 2520 (68%) patients achieved TO. The presence of a major complication most frequently prevented the achievement of TO (19%, 692/3733), while the presence of postoperative mortality ≤ 30 d after surgery least frequently prevented achievement of TO (2.3%). The most common complications were organ/space Surgical Site Infection (10%, 372/3733) and unplanned intubation (10%, 366/3733). Of the 493 patients who failed to achieve TO due to one parameter, positive margins (4.7%, 175/3733) and major complications (3.2%, 120/3733) most frequently prevented the achievement of TO. In a multivariable analysis, node stage of 2 or 3 in the TNM staging system, chronic obstructive pulmonary disease, American Society of Anesthesiologists classification of 4, underweight body mass index, Asian race, prolonged operation time, increased preoperative white blood cell, and older age had statistically significant association with failure to achieve TO.

Conclusions: In an analysis of the NSQIP database, 68% of cases resulted in TO. Several factors were associated with failure to achieve TO. Further investigations are needed to test if modifying variables like preoperative weight can lead to improved outcomes.

Introduction: Pelvic fractures can cause severe hemorrhage and instability in trauma patients. The association between pelvic fracture morphology, venous thromboembolism (VTE) risk, and clinical outcomes remains unclear. This study evaluates the incidence, risk factors, characteristics, and outcomes of VTE in hemodynamically unstable pelvic fractures.

Methods: This retrospective cohort study included adult trauma patients with blunt pelvic ring disruptions and hemorrhagic shock (systolic blood pressure <90 mmHg) admitted to an American College of Surgeons-verified Level I adult trauma center between January 1, 2022 and May 31, 2023. Demographic and clinical data were abstracted from the electronic medical record. The primary outcome was in-hospital VTE. Secondary outcomes included intensive care unit and hospital length of stay (LOS) and mortality.

Results: Of 133 patients, 32 (24.1%) developed VTE (4.5% deep vein thrombosis alone, 12.8% pulmonary embolism alone, 6.8% both). VTE was diagnosed a median of 7 d after admission. Nearly all patients received early chemoprophylaxis (median initiation hospital day 1), with no differences in timing by VTE status or fracture pattern (P > 0.05). Fracture morphology was not independently associated with VTE. VTE was associated with longer intensive care unit LOS (11.5 versus 5.0 d, P < 0.001) and hospital LOS (20.5 versus 17.0 d, P = 0.028), though mortality did not differ. In multivariable regression, no independent associations were found between VTE and age, sex, body mass index, or injury severity score.

Conclusions: VTE was common despite early chemoprophylaxis. Fracture morphology did not independently predict VTE. Early VTE timing underscores the need for vigilant surveillance and uninterrupted prophylaxis. Prospective studies are needed.

Introduction: Bariatric surgery is the most effective treatment modality for individuals with morbid obesity, providing significant and durable weight loss and comorbidity resolution. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide receptor agonists have shown promise as weight loss drugs, in addition to their use in the treatment of metabolic disorders. While multimodal weight management is the standard of care for individuals with morbid obesity, the benefit of antecedent GLP-1 therapy prior to bariatric surgery has not been well-studied. The objective of this study is to conduct a clinical trial testing the hypothesis that preoperative treatment with a dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonist enhances preoperative weight loss and decreases tissue inflammation, resulting in improved postoperative outcomes.

Materials and methods: We designed a randomized controlled trial (RCT) comparing preoperative treatment with tirzepatide versus standard medical care prior to minimally invasive bariatric surgery with a target enrollment of 50 patients randomized 1:1. For 3 mo preoperatively, the control arm will receive standard care in the form of dietary and lifestyle modification recommendations, whereas the treatment arm will receive weekly tirzepatide, in addition to standard care. Blood will be collected at enrollment through 12-mo postoperatively and analyzed for inflammatory and metabolic markers. Tissues (adipose, stomach, and liver) will be collected intraoperatively for transcriptome profiling and histological assessment.

Results: This is an ongoing trial with no reportable results.

Conclusion: Completion of this pilot RCT will provide data to support initiation of a multicenter RCT to determine therapeutic efficacy, and mechanisms of action, by which patients could benefit from preoperative treatment with tirzepatide.

Introduction: Best Practice Advisories (BPAs) are electronic medical record (EMR) tools that help increase uptake of recommended health care behaviors, such as cancer screenings, by identifying eligible patients and alerting providers. However, incomplete/inaccurate documentation within the EMR can be a potential barrier to BPA utility. The purpose of this work was to investigate the effectiveness of a BPA tool to identify eligible patients for lung cancer screening (LCS) using available EMR smoking histories.

Materials and methods: Retrospective observational review was conducted of a BPA programmed to identify LCS-eligible patients at a single quaternary, LCS-accredited, academic medical center. Programming targeted patients aged 50-77 y classified as "current" or "former smokers," excluding patients with recent lung computed tomography scans and/or lung cancer diagnoses. Data analyzed included frequency of BPA activation and the associated smoking history. Descriptive statistics were used to analyze outcomes.

Results: Between January 2017 and December 2021, there were 25,172 BPA activations, of which 11,701 were removed because they occurred outside a clinical/telehealth visit. This left 14,101 BPAs linked to 3150 patients. EMR information was not sufficient to calculate pack-year history for 48.9% (1541/3150), and the LCS order rate was 2.5% (78/3150). Although pulmonary disease specialists accounted for 13.7% (236/1721) of total LCS orders, the BPA did not activate for them.

Conclusions: Incomplete EMR data entry may contribute to the complexities of identifying LCS-eligible patients. This highlights the value of improving the completeness of EMR smoking history data and conducting targeted BPA audits to understand optimal activation parameters to improve clinician orders for LCS.

Introduction: With a projected shortage of over 30,000 surgeons by 2034, understanding and reducing nonretirement attrition is critical to maintaining a sustainable surgical workforce. Prior studies show higher attrition rates among women surgeons but have limited insight into the reasons behind these decisions. This study aims to identify the factors contributing to consideration of workforce attrition among women surgeons and to highlight modifiable elements that may support retention.

Methods: An anonymous online survey was distributed to the Association of Women Surgeons email list and women surgeons' WhatsApp groups between October and December 2024. Respondents were asked whether they had considered leaving the surgical workforce for reasons unrelated to retirement and about factors contributing to both their consideration of leaving and their decision to remain. Responses were analyzed using descriptive statistics and chi-square tests.

Results: The response rate was 15%. Of 371 total female respondents, 242 (65%) reported having considered or currently considering leaving surgery. The top reasons cited were poor work-life balance (71%), overly demanding work (57%), and discrimination or mistreatment (50%), among whom 96% reported gender-based discrimination. Primary factors for staying included financial necessity (61%), good patient relationships (60%), and collegial support (54%). Among those who considered but decided not to leave, improved work-life balance (43%), increased compensation (26%), and improved workplace relationships (26%) were the most common influences.

Conclusions: Attrition among women surgeons stems from systemic challenges. Interventions targeting work-life balance, compensation, and workplace inclusion may meaningfully support retention and help sustain a diverse and effective surgical workforce.