Journal of Surgical Research最新文献

Introduction: Clostridium sordellii (C sordellii) is a gram positive, anaerobic bacterium that causes severe, often fatal infections. Classically, C sordellii infection is described as a high mortality process for women of childbearing age. We examined C sordellii infections in our hospital to determine if there have been any changes in prevalence, treatment, or outcome.

Methods: We performed a query review of all patients with positive cultures for any type of Clostridium from 2007 to 2022. Individual charts were then reviewed for culture data. Data was analyzed using descriptive statistics, while comparison between the patients that lived compared to those who died was analyzed using a student's t-test.

Results: A total of 15 patients had culture results positive for C sordellii. Interestingly, five patients had a C sordellii microbiology result without clinical evidence of soft tissue infection, suggesting colonization. Of the remaining ten patients with soft tissue infections, eight (80%) had a known history of intravenous drug use. All four patients who died presented with hypotension and markedly elevated WBCs. All four who died had a known history of intravenous drug use.

Conclusions: To date, we believe this is the largest case series of C sordellii infections at a single institution. Our findings suggest that C sordellii may be more common in the environment that previously reported. Determining what makes this bacterium deadly to some, but not to others, requires further research. We must remain vigilant in evaluation of C sordellii infections to improve patient survival.

Introduction: Trauma is a major cause of death and disability among young adults in Saudi Arabia, with a road traffic fatality rate three times higher than other high-income countries. The vast expanse of the Riyadh region comprises 21 governorates over 156,078 square miles, most of which is rural. Although delays in access to trauma care pose a significant mortality and economic burden, regions at highest risk of delays have not been previously studied. This paper aims to identify the trauma center distribution, trauma burden, and areas with delayed access to trauma care in the rural governorates of the Riyadh region.

Methods: We conducted a retrospective review of 24,268 reports from 17 rural governorates in the Riyadh region from the official data registry of the Red Crescent of Saudi Arabia from January 2021 to March 2023. Higher severity cases were classified under the red criteria (for age 15-64 ys: systolic blood pressure (SBP) < 90 mmHg or heart rate > SBP); for age ≥65 ys: SBP <110 mmHg or heart rate > SBP) based on established trauma activation criteria. We geospatially mapped all level 1-3 trauma centers in the rural governorates of the Riyadh region with an overlay of trauma burden, and identified red criteria cases and those that had delayed access to trauma centers in each of the governorates. Data were mapped using Quantum Geographic Information System, and analysis was performed using R statistics.

Results: Rural Riyadh lacks level 1 trauma centers, with level 3 facilities primarily delivering trauma care. Among the reported trauma cases, majority were classified under the red criteria (67.7%, n = 16,433). Al-Kharj emerged as a hotspot for trauma cases, reporting the highest number of cases (21.4%, n = 5202) and red criteria cases (21.4%, n = 3512), followed by Al-Quwayiyah (14.4%, n = 3490) and Al-Majma'ah (9.8%, n = 2369). Blunt trauma predominated (79.4%, n = 19,280), with a substantial portion meeting the red criteria (62.4%, n = 12,032), while penetrating injuries were less common (14.5%, n = 3524). Of the red criteria cases, 38.2% (n = 6048) were delayed, most notably in Al-Kharj (21.8%, n = 1320).

Conclusions: In conclusion, our study reveals significant gaps in trauma care access and burden across rural governorates in the Riyadh region. The absence of level 1 trauma centers, coupled with high proportions of red criteria cases and delays in accessing care, underscores the need for targeted interventions and resource optimization. Addressing these challenges requires standardized trauma systems, improved transfer protocols, and a national trauma registry for comprehensive monitoring of patient outcomes.

Introduction: Despite increasing female representation in medical fields, women remain underrepresented in high-impact authorship positions. This study examines gender disparities in authorship of randomized controlled trials in general surgery journals over the past 20 y.

Methods: Utilizing PubMed and the Journal Citation Reports (Clarivate, 2023), we identified 8810 randomized controlled trials from 117 surgery journals, filtering down to 5694 studies for final analysis. Gender identification was performed using Genderize.io.

Results: Results indicate that women accounted for 26.4% of first authorships and 18.7% of last authorships. Logistic regression revealed that a male last author significantly increases the likelihood of a male first author (odds ratio 2.68; 95% confidence interval 2.18-3.32). Over time, there is a positive trend in female authorship, with high correlation coefficients for both first (Spearman's correlation coefficient 0.916, P < 0.005) and last (Spearman's correlation coefficient 0.878, P < 0.005) authors. Interestingly, journal quartiles did not significantly influence the gender of first authors.

Conclusions: These findings suggest persistent gender inequity in surgical research authorship, influenced by mentorship dynamics. The study underscores the need for strategies to enhance female representation in academic leadership to foster a more equitable scholarly environment. Limitations include reliance on Genderize.io for gender determination and the focus on general surgery journals, which may omit relevant studies from other domains. Overall, this research highlights incremental progress toward gender equality in surgical academia, advocating for continued efforts to close the gender gap.

Introduction: Trauma bay and emergency department (ED) length of stay (LOS) are important time measures in patient care. The data on this subject are inconclusive or specific to one condition. Our goal was to determine the relationship between ED LOS and outcomes or mortality of trauma patients. We sought to investigate certain cofactors which influence this relationship. We hypothesized that ED LOS will be correlated with negative patient outcomes and mortality for moderately and severely injured trauma patients.

Methods: A retrospective study was conducted from June 2018 to June 2022 at our level 1 Trauma center. Patients ≥18 y that arrived as a trauma activation were included. Patients were excluded if they were transfers in or out, expired before arrival, or were discharged from the ED. Univariate and multivariable statistical analysis based on disposition time were performed. The primary outcome was mortality.

Results: Six thousand seven hundred eighty-one patients met the inclusion criteria. Patients were stratified based on time to disposition ≤60 (n = 521) and >60 min (n = 6260). The ≤60-min group was younger than the >60-min group (53 (interquartile range (IQR) 30-73) versus 68 (IQR 48-82), P < 0.001), and was more often male (69.48% (n = 362) versus 50.32% (n = 3150), P < 0.001). The ≤60-min group had a lower Glasgow Coma Scale (14 (IQR 8-15) versus 15 (IQR 15-15), P < 0.001), a longer intensive care unit LOS (2 (IQR 1-5) versus 1 (IQR 1-3), P < 0.001), a longer hospital LOS (4 (IQR 1-10) versus 3 (IQR 2-6), P < 0.001), and a greater Injury Severity Score (13 (IQR 5-22) versus 5 (IQR 4-10), P < 0.001) compared to the >60-min group. The ≤60-min group was also more likely to receive blood products (39.92% (n = 208) versus 13.15% (n = 823), P < 0.001) compared to the >60-min group. A greater risk of mortality was found in the ≤60-min versus >60-min group (17.47% (n = 91) versus 2.75% (172), P < 0.001). The ≤60-min group had a shorter transport time (14 (IQR 8-21) versus 17 (IQR 11-24), P < 0.001). On multivariable analysis, there was an association between a disposition time of 60 min or less and a decreased risk of mortality. However, men had a greater risk of mortality compared to women. Patients that received blood products and patients with more severe injuries had a higher likelihood of mortality.

Conclusions: Trauma patients with a decreased ED LOS had a higher rate of mortality, contrary to our hypothesis. The patients with a decreased ED LOS were also more severely injured. It may be reasonable that trauma patients can receive the same level of care regardless of location in the hospital.

Introduction: The long-term cardiovascular benefits of bariatric surgery remain unclear. We aimed to analyze the association between bariatric surgery and cardiovascular disease outcomes.

Methods: The Maryland Health Services Cost Review Commission database (2015-2022) was queried for patients aged 15 to 84 y with obesity. Bariatric surgery patients were matched with nonsurgical patients using propensity score matching. Primary outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. A subgroup analysis of outcomes based on age, sex, diabetes, and smoking status was performed.

Results: A total of 222,700 patients met the inclusion criteria. 104,855 (47.09%) bariatric and 117,845 (52.90%) nonsurgical patients were analyzed. Bariatric surgery was associated with reduced risk of all-cause mortality 12.1 versus 15.7 per 1000 person-years (hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.73-0.79, P < 0.001), HF (HR = 0.63, 95% CI = 0.69-0.67, P < 0.001), MI (HR = 0.69, 95% CI = 0.63-0.74, P < 0.001), and stroke (HR = 0.75, 95% CI = 0.69-0.80, P < 0.001). The association between bariatric surgery in the obese population and the improvement in cardiovascular outcomes was significantly pronounced in the pre-existing diabetes mellitus (DM) group compared to the non-DM group in terms of all-cause mortality, HF, and MI (adjusted HR = 0.59, 0.62, 0.59 respectively, P < 0.05). Bariatric surgery was also associated with a statistically significant reduction in all-cause mortality, MI, and stroke in smokers compared to nonsmokers (adjusted HR = 0.61, 0.59, 0.59 respectively, P < 0.05).

Conclusions: Our study demonstrates a statistically significant association between bariatric surgery and improvement in long-term cardiovascular outcomes and reduction in all-cause mortality in the obese population following bariatric surgery.

Introduction: Medical providers utilize professional medical interpreters (PMIs) daily. Despite this, the challenges PMIs may experience when translating surgical care has not been well explored. Limited English-language proficiency (LEP) patients depend on PMIs for accurate understanding of their care and the lack of quality control can further disenfranchise an already vulnerable population. To address this, we interviewed interpreters to investigate their perspective on language access and current policies. Our study aims to better understand the challenges interpreters face and explore possible interventions.

Methods: Snowball sampling was used to recruit medical interpreters across various hospitals throughout the US through an electronically distributed survey. Twenty individuals participated in 30-60 min Zoom interviews which were transcribed. All identifiable information was redacted. Coding and analysis were done using MAXQDA software. Our codebook was adjusted according to the iterative process intrinsic to qualitative research.

Results: Three major themes regarding challenges to interpretation were identified. The table summarizes themes with representative quotes. First, improved access to patient information prior to appointments resulted in better quality interpretation. Presessions with clinicians were noted to serve as a way for the interpreter to establish their role and limitations. Second, clinician knowledge on how to work with an interpreter was variable. Interpreters associated poor communication with clinicians with negative patient care outcomes due to poor interpretation. Finally, verifying patient understanding was also noted to be difficult. Better organized and funded departments were better able to identify and mitigate challenges, providing more consistent quality interpretation.

Conclusions: Suboptimal use of medical interpreters negatively impacts the health of LEP patients. Our study suggests that there are gaps in clinician knowledge regarding how to work with interpreters. Currently, no guidelines exist illustrating how to work with PMIs. Similarly, no formal curriculum exists to prepare future providers for working with LEP patients. A better workflow and quality control of language services is needed to ensure patients are receiving equitable care.