Journal of Surgical Research最新文献_第10页

Reoperative Parathyroidectomy: Recognizing Unique Risk Profiles 再次手术甲状旁腺切除术：认识独特的风险概况

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-27 DOI: 10.1016/j.jss.2025.11.066

Tessa Gruen BS , Tim Kravchenko MD , Theodore Hu MD, MPhil , Aayushi Sinha MS , Steven Xie MD , Catherine B. Jensen MD, MS , Susan C. Pitt MD, MPHS , David T. Hughes MD , Paul G. Gauger MD , Hunter J. Underwood MD

Introduction

Reoperative parathyroidectomy following prior parathyroidectomy, thyroidectomy, or nonendocrine anterior cervical procedures is more complex than initial parathyroidectomy. Limited data exist on how the index cervical operation affects reoperative outcomes. This study aimed to characterize reoperative parathyroidectomy outcomes by index procedure.

Methods

We retrospectively reviewed adult patients who underwent reoperative parathyroidectomy for primary hyperparathyroidism at a tertiary center from 2016 to 2024. Patients were stratified by index procedure: subtotal (≥3 gland removal) parathyroidectomy, focused (single gland removal) parathyroidectomy, total thyroidectomy, hemithyroidectomy, and nonendocrine anterior cervical procedures. Immediate biochemical cure was defined as postexcision intraoperative parathyroid hormone (PTH) <65 pg/mL and surgical failure as final intraoperative PTH >65 pg/mL. Permanent postoperative hypoparathyroidism (POHP) was defined as PTH <6 pg/mL beyond 6 mo. Operative and clinical notes were reviewed for recurrent laryngeal nerve injury, postoperative neck hematoma, and parathyroid autotransplantation.

Results

Among 242 reoperative parathyroidectomy patients, 128 (60%) had prior focused parathyroidectomy, 16 (7.5%) subtotal parathyroidectomy, 33 (16%) total thyroidectomy, 26 (12%) hemithyroidectomy, and 10 (4.1%) nonendocrine anterior cervical procedures. Prior subtotal parathyroidectomy was associated with higher rates of autotransplantation (P < 0.001) and surgical failure (P = 0.03). Time to reoperation was shortest in focused parathyroidectomy patients (P < 0.001). The rate of recurrent laryngeal nerve injury in the overall cohort was 1.9%, and the rate of permanent POHP was 14%.

Conclusions

Reoperative parathyroidectomy has an increased risk profile for POHP regardless of the index procedure. Those with prior subtotal parathyroidectomy are at higher risk of surgical failure and require autotransplantation more often. Reoperative parathyroidectomy should be performed at high-volume centers with thorough preoperative risk discussion and a low threshold for autotransplantation.

在既往甲状旁腺切除术、甲状腺切除术或非内分泌前宫颈手术后再行甲状旁腺切除术比初次甲状旁腺切除术更复杂。关于颈椎指数手术如何影响再手术结果的资料有限。本研究旨在通过指数程序描述甲状旁腺再手术的结果。方法回顾性分析2016年至2024年在某三级中心接受原发性甲状旁腺功能亢进再手术治疗的成年患者。患者按指数手术分层：次全（≥3个腺体切除）甲状旁腺切除术、集中（单个腺体切除）甲状旁腺切除术、甲状腺全切除术、甲状旁腺切除术和非内分泌前宫颈手术。即刻生化治愈定义为手术后术中甲状旁腺激素(PTH)≥65 pg/mL，手术失败定义为术中最终PTH≥65 pg/mL。术后永久性甲状旁腺功能低下（POHP）定义为PTH≥6 pg/mL超过6个月。回顾了喉返神经损伤、术后颈部血肿和甲状旁腺自体移植的手术和临床记录。结果242例再手术甲状旁腺切除术患者中，既往行集中甲状旁腺切除术128例（60%），甲状旁腺次全切除术16例（7.5%），甲状腺全切除术33例（16%），甲状旁腺切除术26例（12%），非内分泌前宫颈手术10例（4.1%）。既往甲状旁腺次全切除术与较高的自体移植率（P < 0.001）和手术失败率（P = 0.03）相关。集中甲状旁腺切除术患者再手术时间最短（P < 0.001）。整个队列中喉返神经损伤的发生率为1.9%，永久性POHP的发生率为14%。结论再手术甲状旁腺切除术增加了POHP的风险，与指数手术无关。先前有甲状旁腺次全切除术的患者手术失败的风险更高，需要自体移植的可能性更大。再次手术甲状旁腺切除术应在大容量中心进行，术前应充分讨论风险，并降低自体移植的阈值。

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引用次数: 0

The Utility of Ubiquitin Carboxyl-Terminal Hydrolase L1 as a Marker of Hemorrhagic Shock 泛素羧基末端水解酶L1作为失血性休克标志物的应用

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-27 DOI: 10.1016/j.jss.2025.12.003

Gregory C. Wetmore MD, Ellen R. Becker MD, Matthew R. Baucom MD, Adam D. Price MD, Robert C. Shondel BS, Maia P. Smith PhD, Rebecca M. Schuster MS, Timothy A. Pritts MD, PhD, FACS, Michael D. Goodman MD, FACS

Introduction

Ubiquitin carboxyl-terminal hydrolase L1 (UCHL1) is used as a biomarker of traumatic brain injury (TBI). However, there is limited data on the use in critically injured or polytrauma patients. In this study, we hypothesized that UCHL1 may also serve as a marker of shock and global hypoperfusion after critical injury.

Methods

Serum samples were collected from 425 intensive care unit-admitted trauma patients. Samples were retrospectively analyzed for UCHL1 by enzyme-linked immunosorbent assay. Supplementary data were collected from medical record review, including TBI and blood transfusion requirement used as a surrogate for hemorrhagic shock.

Results

UCHL1 level was associated with TBI diagnosis at arrival (P = 0.02) but not at 24 or 72 h. UCLH1 was also significantly elevated at higher level transfusion at 24 (rho = 0.21) and 72 (rho = 0.19) h (P < 0.001). In addition, UCHL1 was significantly elevated in the 30-d mortality group at 0, 24, and 72 h (P < 0.04). When compared to lactic acid, a current standard marker of shock and resuscitation, mean lactic acid demonstrated similar associations with elevations at higher level transfusion at 0 (rho = 0.38), 6 (rho = 0.19), and 24 (rho = 0.25) h (P < 0.002). In addition, lactic acid was also elevated in the 30-d mortality group at all time points (P < 0.04).

Conclusions

In critical injury, UCHL1 levels are elevated in both TBI and hemorrhagic shock. Therefore, after severe injury, UCHL1 may also serve as an indicator of global hypoperfusion. The associations of UCHL1 with shock and 30-d mortality could be applied to rapid bedside detection of shock and assessment of resuscitation progression.

泛素羧基末端水解酶L1 （UCHL1）被用作创伤性脑损伤（TBI）的生物标志物。然而，关于在严重损伤或多发创伤患者中的应用的数据有限。在这项研究中，我们假设UCHL1也可能作为严重损伤后休克和全脑灌注不足的标志。方法对425例重症监护病房收治的创伤患者进行血清采集。采用酶联免疫吸附法回顾性分析样品中的UCHL1。补充数据收集自医疗记录回顾，包括创伤性脑损伤和作为失血性休克替代指标的输血需求。结果chl1水平与到达时的TBI诊断相关（P = 0.02），但与24和72 h无关。高水平输血时24 （rho = 0.21）和72 (rho = 0.19) h的UCLH1水平也显著升高（P < 0.001）。此外，30 d死亡组在0、24和72 h时UCHL1显著升高（P < 0.04）。与乳酸（目前休克和复苏的标准指标）相比，平均乳酸与高水平输血时0 （rho = 0.38）、6 （rho = 0.19）和24 (rho = 0.25) h （P < 0.002）时的升高有相似的关联。此外，30 d死亡率组各时间点乳酸水平均升高（P < 0.04）。结论重型颅脑损伤和失血性休克患者UCHL1水平均升高。因此，在严重损伤后，UCHL1也可以作为全脑灌注不足的指标。UCHL1与休克和30天死亡率的关联可用于快速床边检测休克和评估复苏进展。

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引用次数: 0

Abdominal Aortic Trauma Outcomes in a National Trauma Database 国家创伤数据库中的腹主动脉创伤结局

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-27 DOI: 10.1016/j.jss.2025.11.067

Vahe S. Panossian MD , Tiemen E.T. Holtrop MD , Yasmin Arda MD, Ikemsinachi C. Nzenwa MBChB, MSc, Charley Sun BS, Matthew Bartek MD, MPH, Joshua S. Ng-Kamstra MD, Casey M. Luckhurst MD, Michael P. DeWane MD, Haytham MA. Kaafarani MD, MPH, George C. Velmahos MD, PhD, John O. Hwabejire MD, MPH

Introduction

Abdominal aortic trauma (AAT), although rare, is associated with high mortality. This descriptive study aims to assess the outcomes of patients with AAT who received either open repair or endovascular aortic repair (EVAR). We hypothesize that EVAR is associated with lower injury severity and better patient outcomes.

Methods

In this retrospective study, the American College of Surgeons Trauma Quality Improvement Program database (2017-2020) was utilized to identify patients ≥18 y who had AAT and received either open repair or EVAR. The overall mortality until discharge was analyzed based on the mechanism of injury, injury severity, and types of procedures received. Multivariable logistic regression was used to assess the independent association between each variable and in-hospital mortality. Patients who died before arriving at the operating room were excluded.

Results

A total of 369 patients were included, with a median age of 32 y. The mechanisms of injury included gunshot wounds (46.3%), blunt trauma (39.6%), and stab wounds (14.1%). EVAR was performed in 14.9% and open repair in 81.0%. Overall mortality was 47.5%. On multivariable analysis, age ≥65 y (adjusted odds ratio [aOR]; 2.60; 95% confidence interval [CI], 1.09-6.21; P = 0.032), Glasgow Coma Scale ≤8 (aOR, 8.23; 95% CI, 4.50-15.05; P < 0.001), systolic blood pressure <90 mmHg (aOR, 3.76; 95% CI, 2.15-6.59; P < 0.001), blunt trauma (aOR, 3.48; 95% CI, 1.32-9.20; P = 0.012), and gunshot wounds (aOR, 3.87; 95% CI, 1.57-9.50; P = 0.003) were independently associated with increased mortality. EVAR was associated with lower mortality (aOR, 0.33; 95% CI, 0.13-0.83; P = 0.019) compared to open repair.

Conclusions

Among patients who survive the initial injury and make it to the operating room, AAT is still associated with significant mortality. EVAR was independently associated with a lower rate of mortality compared to open repair.

腹主动脉创伤（AAT）虽然罕见，但死亡率高。本描述性研究旨在评估AAT患者接受开放式修复或血管内主动脉修复（EVAR）的结果。我们假设EVAR与较低的损伤严重程度和较好的患者预后有关。方法在这项回顾性研究中，使用美国外科医师学会创伤质量改善计划数据库（2017-2020）来识别≥18岁的AAT患者，并接受开放式修复或EVAR。出院前的总死亡率根据损伤机制、损伤严重程度和所接受的手术类型进行分析。采用多变量logistic回归评估各变量与住院死亡率之间的独立相关性。在到达手术室之前死亡的患者被排除在外。结果共纳入369例患者，中位年龄32岁，伤机制包括枪伤（46.3%）、钝器伤（39.6%）和刀伤（14.1%）。EVAR占14.9%，开放式修复占81.0%。总死亡率为47.5%。在多变量分析中，年龄≥65岁（校正优势比[aOR]； 2.60； 95%可信区间[CI]， 1.09-6.21; P = 0.032）、格拉斯哥昏迷量表≤8 （aOR, 8.23; 95% CI, 4.50-15.05; P < 0.001）、收缩压和90mmhg （aOR, 3.76; 95% CI, 2.15-6.59; P < 0.001）、钝性创伤（aOR, 3.48; 95% CI, 1.32-9.20; P = 0.012）和枪伤（aOR, 3.87; 95% CI, 1.57-9.50; P = 0.003）与死亡率增加独立相关。与开放式修复相比，EVAR与较低的死亡率相关（aOR, 0.33; 95% CI, 0.13-0.83; P = 0.019）。结论在初次损伤存活并进入手术室的患者中，AAT仍与显著的死亡率相关。与开放式修复相比，EVAR与较低的死亡率独立相关。

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引用次数: 0

Racial Disparities in Chemotherapy Response in Pancreatic Cancer: A Landmark Survival Analysis 胰腺癌化疗反应的种族差异：具有里程碑意义的生存分析。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-24 DOI: 10.1016/j.jss.2025.11.051

K. Kerrick Akinola MD , Varun Pathak MBBS , Christopher Wu MD , Chandler McLeod PhD , Herbert Chen MD , Smita Bhatia MD , J. Bart Rose MD , Andrea Gillis MD, MSPH

Introduction

Racial disparities in pancreatic adenocarcinoma mortality may stem from differences in chemotherapy response. This study examines potential disparities between Black and White patients’ responses to adjuvant chemotherapy.

Methods

Using the National Cancer Database (2010-2019), we analyzed Black and White patients with pancreatic adenocarcinoma who underwent surgery with or without adjuvant therapy. Patients receiving neoadjuvant therapy, radiation, with American Joint Committee on Cancer stage >4, or missing data were excluded. A race-stratified landmark survival analysis was performed at 6 mo post surgery using Kaplan–Meier and Cox proportional hazards models.

Results

Among 22,898 surgical patients, 20,434 were White (89%) and 2464 were Black (11%) and the median follow-up was 19.9 mo. Black patients were younger (65.6 versus 69.0 y), more often female (58% versus 48%), and had higher Charlson-Deyo Comorbidity Index (CCI) scores (≥3: 6.0% versus 4.6%) than White patients. Black patients were less likely to receive adjuvant therapy (58% versus 61%). At 6 mo post surgery, 18,977 patients were alive, with 65% receiving chemotherapy. Cox analysis revealed a significant survival benefit from adjuvant therapy in White patients (hazard ratio = 0.90, 95% confidence interval = 0.87-0.95, P < 0.01); a similar effect was not seen in Black patients (hazard ratio = 0.96, 95% confidence interval = 0.84-1.09, P = 0.52).

Conclusions

Although overall survival is similar, adjuvant chemotherapy was associated with improved survival only in White patients. The lack of observed benefit in Black patients may indicate underlying biological differences warranting further study.

胰腺腺癌死亡率的种族差异可能源于化疗反应的差异。本研究探讨了黑人和白人患者对辅助化疗反应的潜在差异。方法：使用国家癌症数据库（2010-2019），我们分析了接受手术或不接受辅助治疗的黑人和白人胰腺腺癌患者。排除了接受新辅助治疗、放疗、美国癌症联合委员会分期bbbb4或缺少数据的患者。采用Kaplan-Meier和Cox比例风险模型，在术后6个月进行种族分层的里程碑生存分析。结果：在22,898例手术患者中，白人患者20,434例（89%），黑人患者2464例（11%），中位随访时间为19.9个月。黑人患者较年轻（65.6岁对69.0岁），女性患者较多（58%对48%），Charlson-Deyo合并症指数（CCI）评分高于白人患者（≥3:6.0%对4.6%）。黑人患者接受辅助治疗的可能性较小（58%对61%）。术后6个月，18,977例患者存活，65%接受化疗。Cox分析显示，白人患者辅助治疗的生存获益显著（风险比= 0.90,95%可信区间= 0.87-0.95,P < 0.01）；黑人患者未见类似效果（风险比= 0.96,95%可信区间= 0.84-1.09,P = 0.52）。结论：虽然总生存率相似，但辅助化疗仅在白人患者中与生存率改善相关。在黑人患者中缺乏观察到的益处可能表明潜在的生物学差异值得进一步研究。

{"title":"Racial Disparities in Chemotherapy Response in Pancreatic Cancer: A Landmark Survival Analysis","authors":"K. Kerrick Akinola MD , Varun Pathak MBBS , Christopher Wu MD , Chandler McLeod PhD , Herbert Chen MD , Smita Bhatia MD , J. Bart Rose MD , Andrea Gillis MD, MSPH","doi":"10.1016/j.jss.2025.11.051","DOIUrl":"10.1016/j.jss.2025.11.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial disparities in pancreatic adenocarcinoma mortality may stem from differences in chemotherapy response. This study examines potential disparities between Black and White patients’ responses to adjuvant chemotherapy.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database (2010-2019), we analyzed Black and White patients with pancreatic adenocarcinoma who underwent surgery with or without adjuvant therapy. Patients receiving neoadjuvant therapy, radiation, with American Joint Committee on Cancer stage >4, or missing data were excluded. A race-stratified landmark survival analysis was performed at 6 mo post surgery using Kaplan–Meier and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Among 22,898 surgical patients, 20,434 were White (89%) and 2464 were Black (11%) and the median follow-up was 19.9 mo. Black patients were younger (65.6 <em>versus</em> 69.0 y), more often female (58% <em>versus</em> 48%), and had higher Charlson-Deyo Comorbidity Index (CCI) scores (≥3: 6.0% <em>versus</em> 4.6%) than White patients. Black patients were less likely to receive adjuvant therapy (58% <em>versus</em> 61%). At 6 mo post surgery, 18,977 patients were alive, with 65% receiving chemotherapy. Cox analysis revealed a significant survival benefit from adjuvant therapy in White patients (hazard ratio = 0.90, 95% confidence interval = 0.87-0.95, <em>P</em> < 0.01); a similar effect was not seen in Black patients (hazard ratio = 0.96, 95% confidence interval = 0.84-1.09, <em>P</em> = 0.52).</div></div><div><h3>Conclusions</h3><div>Although overall survival is similar, adjuvant chemotherapy was associated with improved survival only in White patients. The lack of observed benefit in Black patients may indicate underlying biological differences warranting further study.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 500-507"},"PeriodicalIF":1.7,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834280","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

Re-evaluation of Blood Product Wastage From Massive Transfusion Protocol at a Level 1 Trauma Center: A Retrospective Cohort Study 1级创伤中心大规模输血方案中血液制品浪费的再评估：一项回顾性队列研究。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-23 DOI: 10.1016/j.jss.2025.11.053

Sandra M. Farach MD, MSPH , Nathan Santiago , Milad Behbahaninia MD , Joby J. Chandy MD , Emma Joiner MSc , Jose J. Diaz MD , Enrico Camporesi MD

Introduction

Massive transfusion protocols (MTPs) are essential in the management of traumatic hemorrhage, enabling timely and standardized blood product delivery. This study evaluated whether blood component wastage after MTP activation has decreased compared with previously published institutional data.

Materials and Methods

We retrospectively reviewed 5072 trauma patients ≥18 y between January 2022 and September 2023, identifying 89 (1.8%) with MTP activation. Demographic and clinical data were analyzed. Wastage rates for packed red blood cells, fresh frozen plasma, and platelets were compared to 2015-2018 institutional data. Transfusion documentation discrepancies between the blood bank and the electronic medical record were also assessed. Continuous variables were analyzed with the Mann–Whitney U test and categorical variables with the chi-square or Fisher's exact test, with significance set at P < 0.05.

Results

Of the 89 patients, 31 (34.8%) had wastage of at least one blood component. There were no significant demographic or clinical differences between patients with and those without wastage, including age, gender, injury type, Glasgow Comma Scale, injury severity score, MTP time, complications, discharge disposition, or mortality. Compared to previously published data, wastage significantly decreased for packed red blood cells (2.2% versus 1.2%), fresh frozen plasma (5.7% versus 2.3%), and platelets (13.7% versus 2.9%), all P < 0.001. Documentation discrepancies occurred in 88.7% of activations, with 25.8% involving >10-unit mismatches.

Conclusions

MTP blood product wastage has significantly decreased, reflecting sustained quality improvement. However, high documentation discrepancies highlight a critical target for process improvement.

大量输血方案（mtp）在创伤性出血的管理中至关重要，可实现及时和标准化的血液制品输送。本研究评估了MTP激活后的血液成分损耗与先前发表的机构数据相比是否有所减少。材料和方法：我们回顾性分析了2022年1月至2023年9月期间5072例≥18岁的创伤患者，发现89例（1.8%）MTP激活。对人口学和临床资料进行分析。将包装红细胞、新鲜冷冻血浆和血小板的流失率与2015-2018年的机构数据进行比较。还对血库和电子病历之间的输血记录差异进行了评估。连续变量分析采用Mann-Whitney U检验，分类变量分析采用卡方检验或Fisher精确检验，P < 0.05为显著性。结果：89例患者中，31例（34.8%）出现至少一种血液成分的浪费。在年龄、性别、损伤类型、格拉斯哥逗号量表、损伤严重程度评分、MTP时间、并发症、出院处置或死亡率等方面，有浪费的患者和没有浪费的患者之间没有显著的人口统计学或临床差异。与先前发表的数据相比，包装红细胞（2.2%对1.2%）、新鲜冷冻血浆（5.7%对2.3%）和血小板（13.7%对2.9%）的浪费显著降低，均P < 0.001。88.7%的激活发生了文档差异，其中25.8%涉及10个单元的不匹配。结论：MTP血液制品浪费明显减少，反映了持续的质量改善。然而，高文档差异突出了过程改进的关键目标。

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引用次数: 0

The First Step Is Knowing: Quantifying Social Need Through Screening in a Pediatric Surgery Clinic 第一步是了解：通过儿科外科诊所的筛查量化社会需求。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-23 DOI: 10.1016/j.jss.2025.11.055

Paris D. Rollins MD , Sarah King DO , Alicia Majcher MHSA , Byron D. Hughes MD, MPH , Erika A. Newman MD , Erin E. Perone MD

Introduction

Patient characteristics such as race, ethnicity, household income, and insurance status predict morbidity and mortality disparities for numerous pediatric surgical disease processes. Health-related social need (HRSN) screening is increasingly utilized in primary care to connect patients with support services and mitigate health disparities. The purpose of this study was to assess the impact of a novel HRSN screening program in a pediatric surgery clinic.

Materials and Methods

We implemented screening for all new patient encounters in our pediatric surgery ambulatory practice, excluding patients screened elsewhere in our health system within the preceding 12 mo. Patients or caregivers completed a comprehensive screening questionnaire up to 1 mo before their clinic visit and could elect to receive need-specific referrals and institutional resources. Using institutional clinic-level data, we evaluated the screening program's results using descriptive statistics.

Results

We screened 1410 patients in the program's first 24 mo. Patients were predominantly male (788 of 1410, 55.9%), Caucasian (1098 of 1410, 77.9%), and under age 10 (773 of 1410, 54.8%). One in five patients (241 of 1410, 17.1%) screened positive for at least one unmet social need. Virtual care access issues and food insecurity were most frequently reported within the cohort (24.9% and 22.3%, respectively). Respondents who screened positive for unmet need rarely requested assistance (82 of 241, 34.0%). Only 5.8% (82 of 1410) of screenings generated a referral.

Conclusions

Pediatric surgery patients in our catchment area experience high rates of unmet social need. Standardized screening is feasible in an ambulatory surgical care setting and may facilitate early identification of intervenable social risk factors. Further investigation is needed to understand why families frequently declined assistance.

患者的特点，如种族，民族，家庭收入，保险状况预测发病率和死亡率的差异，许多儿科外科疾病的过程。与健康相关的社会需求（HRSN）筛查越来越多地用于初级保健，以将患者与支持服务联系起来，并减轻健康差距。本研究的目的是评估一种新的HRSN筛查方案在儿科外科诊所的影响。材料和方法：我们对所有儿科外科门诊就诊的新患者进行筛查，不包括在过去12个月内在我们卫生系统其他地方进行筛查的患者。患者或护理人员在门诊就诊前1个月完成一份全面的筛查问卷，并可以选择接受特定需求的转诊和机构资源。使用机构临床水平的数据，我们使用描述性统计来评估筛查项目的结果。结果：我们在项目的前24个月筛选了1410例患者。患者主要是男性（1410例中788例，55.9%），高加索（1410例中1098例，77.9%）和10岁以下（1410例中773例，54.8%）。五分之一的患者（1410人中有241人，17.1%）在至少一项未满足的社会需求筛查中呈阳性。在队列中最常报告的是虚拟医疗获取问题和食品不安全（分别为24.9%和22.3%）。对未满足需求筛查呈阳性的应答者很少要求援助（241人中有82人，占34.0%）。只有5.8%（1410人中有82人）的筛查产生了转诊。结论：本区儿科外科患者未满足社会需求的比例较高。标准化筛查在门诊外科护理环境中是可行的，可能有助于早期识别可干预的社会风险因素。需要进一步调查，以了解为什么家庭经常拒绝援助。

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引用次数: 0

Cost-Effectiveness of Music for Preventing Postoperative Delirium in Elderly Hip Fracture Patients 音乐预防老年髋部骨折术后谵妄的成本-效果

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-20 DOI: 10.1016/j.jss.2025.11.062

Thomas L.A. Dirven MD , Antonia S. Becker MD , Heleen A. van den Brandeler BSc , Victor X. Fu MD PhD , Johannes Jeekel MD PhD , Markus Klimek MD PhD , Michael H.J. Verhofstad MD PhD , Marten J. Poley PhD

Introduction

Postoperative delirium (POD) is a major health issue associated with considerable health-care costs. Perioperative music is a promising intervention that decreases the risk of delirium. This study investigates whether perioperative music is a cost-effective intervention for preventing POD in elderly hip fracture patients.

Methods

The analysis is based on a multicenter randomized controlled trial (Dutch Trial Register ID: NTR7036). A total of 399 patients aged 65 y or older who underwent acute hip fracture surgery were included. The music group received prerecorded music, whereas the control group received standard-of-care. The primary outcomes were delirium incidence and health-care costs during primary admission and follow-up until 90 d after admission. The secondary outcomes included the Delirium Observational Screening Scale, nursing home admissions, and functional independence.

Results

POD occurred significantly less often in the music group compared to the control group (14 (7.4%) versus 29 (13.8%), P = 0.039) during admission. Primary hospital admission costs were comparable between the music group and the control group (€7749; 95% confidence interval [CI]: 7256-8290 vs. €7723; 95% CI: 7219-8230; mean difference = €27). In addition, the total costs were comparable between both groups (music group €12,078; 95% CI: 10,470-13,733 vs. control group €11,941; 95% CI: 10,701-13,130; mean difference €136). The cost of preventing one case of POD with the music intervention was €415 for the time horizon of the primary admission.

Conclusions

Considering the potential reduction in POD and the comparable costs, music appears to be a cost-effective intervention for preventing POD in elderly hip fracture patients.

术后谵妄（POD）是一个主要的健康问题，与大量的医疗保健费用相关。围手术期音乐是一种很有前途的干预措施，可以降低谵妄的风险。本研究探讨围手术期音乐对于预防老年髋部骨折患者POD是否具有成本效益。方法分析基于一项多中心随机对照试验（荷兰试验注册号：NTR7036）。共纳入399例65岁及以上接受急性髋部骨折手术的患者。音乐组听的是预先录制好的音乐，而对照组听的是标准护理。主要结局是首次入院和入院后90 d随访期间谵妄发生率和医疗费用。次要结果包括谵妄观察筛选量表、疗养院入院和功能独立性。结果入院时音乐组发生spod的次数明显少于对照组（14例（7.4%）vs 29例（13.8%），P = 0.039）。初级住院费用在音乐组和对照组之间具有可比性（7749欧元；95%置信区间[CI]: 7256-8290欧元对7723欧元；95%置信区间：7219-8230欧元；平均差异= 27欧元）。此外，两组之间的总成本具有可比性（音乐组12,078欧元，95% CI: 10,470-13,733，对照组11,941欧元，95% CI: 10,701-13,130，平均差136欧元）。在初次入院的时间范围内，音乐干预预防一例POD的成本为415欧元。结论考虑到POD的潜在降低和相应的费用，音乐似乎是预防老年髋部骨折患者POD的一种经济有效的干预措施。

{"title":"Cost-Effectiveness of Music for Preventing Postoperative Delirium in Elderly Hip Fracture Patients","authors":"Thomas L.A. Dirven MD , Antonia S. Becker MD , Heleen A. van den Brandeler BSc , Victor X. Fu MD PhD , Johannes Jeekel MD PhD , Markus Klimek MD PhD , Michael H.J. Verhofstad MD PhD , Marten J. Poley PhD","doi":"10.1016/j.jss.2025.11.062","DOIUrl":"10.1016/j.jss.2025.11.062","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative delirium (POD) is a major health issue associated with considerable health-care costs. Perioperative music is a promising intervention that decreases the risk of delirium. This study investigates whether perioperative music is a cost-effective intervention for preventing POD in elderly hip fracture patients.</div></div><div><h3>Methods</h3><div>The analysis is based on a multicenter randomized controlled trial (Dutch Trial Register ID: NTR7036). A total of 399 patients aged 65 y or older who underwent acute hip fracture surgery were included. The music group received prerecorded music, whereas the control group received standard-of-care. The primary outcomes were delirium incidence and health-care costs during primary admission and follow-up until 90 d after admission. The secondary outcomes included the Delirium Observational Screening Scale, nursing home admissions, and functional independence.</div></div><div><h3>Results</h3><div>POD occurred significantly less often in the music group compared to the control group (14 (7.4%) <em>versus</em> 29 (13.8%), <em>P</em> = 0.039) during admission. Primary hospital admission costs were comparable between the music group and the control group (€7749; 95% confidence interval [CI]: 7256-8290 vs. €7723; 95% CI: 7219-8230; mean difference = €27). In addition, the total costs were comparable between both groups (music group €12,078; 95% CI: 10,470-13,733 vs. control group €11,941; 95% CI: 10,701-13,130; mean difference €136). The cost of preventing one case of POD with the music intervention was €415 for the time horizon of the primary admission.</div></div><div><h3>Conclusions</h3><div>Considering the potential reduction in POD and the comparable costs, music appears to be a cost-effective intervention for preventing POD in elderly hip fracture patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 474-485"},"PeriodicalIF":1.7,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787887","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

The Dilemma of Dog Bite Wounds: Primary versus Delayed Closure 狗咬伤的困境：原发性与延迟愈合

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-19 DOI: 10.1016/j.jss.2025.11.036

Omar Hejazi MD, Mohammad Al Ma'ani MD, Muhammad Haris Khurshid MD, Francisco Castillo-Diaz MD, Louis J. Magnotti MD, MS, FACS, Bellal Joseph MD, FACS

Introduction

The World Health Organization recommends delayed closure of bite wounds, despite controversial studies that advocate or prohibit this practice. This study aimed to compare the outcomes of primary versus delayed closure of pediatric dog bite wounds.

Methods

This is a retrospective analysis of the trauma registry at a level I trauma center. Pediatric (<18 y) patients with dog bite wounds were included. Patients were stratified based on wound management into primary versus delayed closure groups. Primary outcomes were infectious complications, including fever, local abscess, local erythema (>2 cm), edema, purulent discharge, and a white blood cell count of >12,000. Multivariable regression analyses were performed to identify the independent effect of primary versus delayed closure on the outcomes, adjusting for potential confounding factors.

Results

A total of 86 pediatric patients were identified. The mean (standard deviation) age was 8 (5) and 50% were male. Head and neck were the most involved body region (80.2%), followed by upper extremities (16.3%). The median wound size was 4 [2-7] cm ranging from 0.1 to 26 cm. There was no difference in terms of wound size (P = 0.607) and depth (0.607) between primary and delayed groups. Overall, 66.3% of patients received antibiotics on arrival and 73.3% were discharged on antibiotics. Overall, 54 (62.8%) underwent primary wound closure. Overall, 11.6% developed infectious complications, with no difference between study groups (primary closure: 11.1% versus delayed closure: 12.5%, P = 0.846). The time to closure was not associated with adjusted odds of infectious complications (adjusted odds ratio 0.875, 95% CI [0.23-3.37], P = 0.875).

Conclusions

Despite the current recommendations, there was no association between the timing of wound closure and infectious complications among pediatric patients presenting with dog bites, regardless of wound size and depth. Future efforts should focus on selected wounds that might benefit from delayed closure despite the purported risks of cosmetic effects.

世界卫生组织建议延迟关闭咬伤，尽管有争议的研究支持或禁止这种做法。本研究的目的是比较儿童狗咬伤的初步愈合和延迟愈合的结果。方法回顾性分析某一级创伤中心创伤登记资料。包括小儿（18岁）犬咬伤患者。患者根据伤口处理分为初级缝合组和延迟缝合组。主要结局是感染并发症，包括发热、局部脓肿、局部红斑（2厘米）、水肿、脓性分泌物和白细胞计数1.2万。进行多变量回归分析，以确定初次缝合与延迟缝合对结果的独立影响，并对潜在的混杂因素进行调整。结果共发现86例患儿。平均（标准差）年龄为8(5)岁，50%为男性。头颈部是受累最多的部位（80.2%），其次是上肢（16.3%）。中位创面大小为4 [2-7]cm， 0.1 ~ 26 cm。在创面大小（P = 0.607）和深度（0.607）方面，原发性组和迟发性组之间没有差异。总体而言，66.3%的患者到达时使用抗生素，73.3%的患者出院时使用抗生素。总的来说，54例（62.8%）接受了初次伤口愈合。总体而言，11.6%的患者出现了感染并发症，研究组之间没有差异（原发性闭合：11.1%与延迟闭合：12.5%,P = 0.846）。缝合时间与感染并发症的调整后几率无相关性（调整后优势比为0.875,95% CI [0.23-3.37], P = 0.875）。结论：尽管有目前的建议，但在被狗咬伤的儿科患者中，无论伤口大小和深度如何，伤口愈合的时间与感染并发症之间没有关联。未来的努力应该集中在可能受益于延迟缝合的伤口上，尽管据称有美容效果的风险。

{"title":"The Dilemma of Dog Bite Wounds: Primary versus Delayed Closure","authors":"Omar Hejazi MD, Mohammad Al Ma'ani MD, Muhammad Haris Khurshid MD, Francisco Castillo-Diaz MD, Louis J. Magnotti MD, MS, FACS, Bellal Joseph MD, FACS","doi":"10.1016/j.jss.2025.11.036","DOIUrl":"10.1016/j.jss.2025.11.036","url":null,"abstract":"<div><h3>Introduction</h3><div>The World Health Organization recommends delayed closure of bite wounds, despite controversial studies that advocate or prohibit this practice. This study aimed to compare the outcomes of primary <em>versus</em> delayed closure of pediatric dog bite wounds.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of the trauma registry at a level I trauma center. Pediatric (<18 y) patients with dog bite wounds were included. Patients were stratified based on wound management into primary <em>versus</em> delayed closure groups. Primary outcomes were infectious complications, including fever, local abscess, local erythema (>2 cm), edema, purulent discharge, and a white blood cell count of >12,000. Multivariable regression analyses were performed to identify the independent effect of primary <em>versus</em> delayed closure on the outcomes, adjusting for potential confounding factors.</div></div><div><h3>Results</h3><div>A total of 86 pediatric patients were identified. The mean (standard deviation) age was 8 (5) and 50% were male. Head and neck were the most involved body region (80.2%), followed by upper extremities (16.3%). The median wound size was 4 [2-7] cm ranging from 0.1 to 26 cm. There was no difference in terms of wound size (<em>P</em> = 0.607) and depth (0.607) between primary and delayed groups. Overall, 66.3% of patients received antibiotics on arrival and 73.3% were discharged on antibiotics. Overall, 54 (62.8%) underwent primary wound closure. Overall, 11.6% developed infectious complications, with no difference between study groups (primary closure: 11.1% <em>versus</em> delayed closure: 12.5%, <em>P</em> = 0.846). The time to closure was not associated with adjusted odds of infectious complications (adjusted odds ratio 0.875, 95% CI [0.23-3.37], <em>P</em> = 0.875).</div></div><div><h3>Conclusions</h3><div>Despite the current recommendations, there was no association between the timing of wound closure and infectious complications among pediatric patients presenting with dog bites, regardless of wound size and depth. Future efforts should focus on selected wounds that might benefit from delayed closure despite the purported risks of cosmetic effects.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 467-473"},"PeriodicalIF":1.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787782","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

Prehospital Experience With Left Ventricular Assist Devices 院前使用左心室辅助装置的经验

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-18 DOI: 10.1016/j.jss.2025.11.049

Emily L. Larson MD , Reed Jenkins MD , Alexandra Rizaldi BS , Raymond Zhang EMT , John Thompson EMT , Ruben Troncoso MD MPH , Asa Margolis DO MPH , Ahmet Kilic MD

Introduction

Advancements in the heart failure armamentarium have increased left ventricular assist device (LVAD) use, including in emergency medical services (EMS).

Materials and Methods

We performed a retrospective review of patients with LVADs transported to the emergency department by 911 EMS from 2017 to 2021. Patient LVAD characteristics, EMS characteristics and interventions, and outcomes were reported.

Results

There were 75 EMS transports of 25 patients. LVADs were destination therapy for 87% and used for a median 2.3 y. Patients most frequently presented for chest pain, with LVAD alarms present for 15%. An LVAD assessment was present for 24%. The LVAD team was contacted for 8% and hospital notified for 56%. Eight percent were priority one (immediate life-threat). Median length of stay was 4 d, with 81% admitted. One-year survival after EMS transport was 74.8% (95% confidence interval 61.6%-90.9%), with four in-hospital deaths and 39% returning to the emergency department within 30 d.

Conclusions

This study highlights LVAD patients’ frequent high-acuity presentation to EMS, with associated high mortality and emergency department return. Additionally, it reveals gaps in the EMS care of these patients and provides an important opportunity to partner with EMS agencies to improve clinician education and the care of LVAD patients.

心力衰竭设备的进步增加了左心室辅助装置（LVAD）的使用，包括在紧急医疗服务（EMS）中。材料和方法我们回顾性分析了2017年至2021年通过911 EMS运送到急诊科的lvad患者。报告患者LVAD特征、EMS特征、干预措施和结果。结果25例患者共75次急诊转运。87%的患者将LVAD作为最终治疗手段，使用时间中位数为2.3年。患者最常表现为胸痛，15%的患者出现LVAD警报。24%的患者有LVAD评估。联系LVAD团队的占8%，通知医院的占56%。8%是一级（直接危及生命）。中位住院时间为4天，81%的患者入院。EMS转运后1年生存率为74.8%(95%可信区间61.6%-90.9%)，其中4例院内死亡，39%在30 d内返回急诊室。结论本研究强调LVAD患者频繁出现高急性症状，与高死亡率和高急诊室复诊相关。此外，它揭示了这些患者在EMS护理方面的差距，并提供了与EMS机构合作改善临床医生教育和LVAD患者护理的重要机会。

{"title":"Prehospital Experience With Left Ventricular Assist Devices","authors":"Emily L. Larson MD , Reed Jenkins MD , Alexandra Rizaldi BS , Raymond Zhang EMT , John Thompson EMT , Ruben Troncoso MD MPH , Asa Margolis DO MPH , Ahmet Kilic MD","doi":"10.1016/j.jss.2025.11.049","DOIUrl":"10.1016/j.jss.2025.11.049","url":null,"abstract":"<div><h3>Introduction</h3><div>Advancements in the heart failure armamentarium have increased left ventricular assist device (LVAD) use, including in emergency medical services (EMS).</div></div><div><h3>Materials and Methods</h3><div>We performed a retrospective review of patients with LVADs transported to the emergency department by 911 EMS from 2017 to 2021. Patient LVAD characteristics, EMS characteristics and interventions, and outcomes were reported.</div></div><div><h3>Results</h3><div>There were 75 EMS transports of 25 patients. LVADs were destination therapy for 87% and used for a median 2.3 y. Patients most frequently presented for chest pain, with LVAD alarms present for 15%. An LVAD assessment was present for 24%. The LVAD team was contacted for 8% and hospital notified for 56%. Eight percent were priority one (immediate life-threat). Median length of stay was 4 d, with 81% admitted. One-year survival after EMS transport was 74.8% (95% confidence interval 61.6%-90.9%), with four in-hospital deaths and 39% returning to the emergency department within 30 d.</div></div><div><h3>Conclusions</h3><div>This study highlights LVAD patients’ frequent high-acuity presentation to EMS, with associated high mortality and emergency department return. Additionally, it reveals gaps in the EMS care of these patients and provides an important opportunity to partner with EMS agencies to improve clinician education and the care of LVAD patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 439-445"},"PeriodicalIF":1.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787833","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

Intentions Matter: Long-Term Patient Outcomes After Intentional, Interpersonal Injury 意图的问题：长期的病人结果后故意，人际伤害

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-18 DOI: 10.1016/j.jss.2025.11.063

Colby Wilson, Joseph Kern MD, Kathleen O'Neill MD, PhD, Mark Seamon MD, Elinore Kaufman MD, MSHP

Introduction

Any traumatic injury can lead to long-term challenges with physical health, mental health, and social well-being. Intentional injury due to interpersonal violence can further impair patients’ sense of safety and may hinder recovery. We compared long-term patient-reported outcomes according to injury intent with the hypothesis that mental health outcomes would be worse in those injured by interpersonal violence compared to unintentional injury.

Methods

Beginning in 10/2019, we prospectively collected data on patient demographics, post traumatic stress disorder (PTSD), and patient-reported outcomes using patient reported outcomes measurement information system-29 (PROMIS-29) domains (depression, anxiety, physical function, sleep disturbance, ability to participate in social roles, and pain interference in daily activity) for adult trauma patients admitted to an urban, academic, level 1 trauma center. Participants were screened at the time of injury and at least one follow-up at 6 or 12 mo by January 7, 2024. Injury and treatment characteristics were collected from the institutional trauma registry. We compared patients injured unintentionally to those injured by interpersonal violence using descriptive statistics. Multivariable logistic regression was used to evaluate the contribution of injury intent to those outcomes for which univariate analysis showed a difference at 6 or 12 mo. We screened for PTSD with the PC-PTSD-5, considering a score of ≥3 to be positive. PROMIS-29 outcomes are expressed as the proportion of respondents whose scores were ≥1 standard deviation worse than population norms.

Results

Of 315 participants, 105 were injured by interpersonal violence (gunshot wounds, stabbings, and blunt assaults). Intentionally injured patients were younger (median age 32 versus 50 for unintentional injuries) and more severely injured. Patients with unintentional injury were more often male (85% versus 60% of unintentionally injured patients) and were more often Black (87% versus 53%). At follow-up, 44 (43.6%) of intentionally inured patients screened positive for PTSD, compared to 47 (22.6%) of unintentionally injured patients, P < 0.001. In multivariable analysis accounting for age, gender, and injury severity, intentional injury was associated with a 2.1-fold increase in odds of PTSD (95% confidence interval: 1.1, 3.8). There was no significant association of intent with anxiety or depression.

Conclusions

Intentional injury is associated with higher rates of positive screens for PTSD after trauma. Screening and treatment protocols should attend to the mental health needs of all injured patients, with particular attention to post traumatic stress in survivors of interpersonal violence.

任何创伤性损伤都可能导致身体健康、心理健康和社会福祉的长期挑战。人际暴力造成的故意伤害会进一步损害患者的安全感，并可能阻碍康复。我们比较了患者根据伤害意图报告的长期结果，并假设人际暴力伤害的心理健康结果比非故意伤害更差。方法：从2019年10月开始，我们使用患者报告结果测量信息系统29 （promisi -29）域（抑郁、焦虑、身体功能、睡眠障碍、参与社会角色的能力和日常活动中的疼痛干扰）前瞻性地收集了一个城市学术一级创伤中心收治的成人创伤患者的患者人口统计学、创伤后应激障碍（PTSD）和患者报告结果的数据。参与者在受伤时进行筛查，并在2024年1月7日之前在6个月或12个月时至少进行一次随访。从机构创伤登记处收集损伤和治疗特征。我们用描述性统计比较了无意受伤和人际暴力受伤的患者。使用多变量逻辑回归来评估伤害意图对那些单变量分析在6个月或12个月时显示差异的结果的贡献。我们使用PC-PTSD-5筛选PTSD，认为得分≥3为阳性。promise -29结果表示为得分低于总体标准≥1个标准差的受访者所占比例。结果315名参与者中，105人因人际暴力受伤（枪伤、刺伤和钝器攻击）。故意受伤的患者更年轻（中位年龄为32岁，而非故意伤害的中位年龄为50岁），而且受伤更严重。意外伤害的患者多为男性（85%对60%），黑人多（87%对53%）。在随访中，44名（43.6%）故意受伤患者的PTSD筛查呈阳性，而47名（22.6%）非故意受伤患者，P < 0.001。在考虑年龄、性别和伤害严重程度的多变量分析中，故意伤害与创伤后应激障碍的几率增加2.1倍相关（95%可信区间：1.1,3.8）。意图与焦虑或抑郁之间没有明显的联系。结论：故意伤害与创伤后创伤后应激障碍筛查阳性率较高有关。筛查和治疗方案应顾及所有受伤病人的心理健康需要，特别注意人际暴力幸存者的创伤后应激障碍。

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引用次数: 0