Journal of Surgical Research最新文献

{"title":"P2Y12 Assay Identifies Patients at Risk for Blood Transfusion Following Cardiac Surgery","authors":"Andrew D. Hawkins MD ,&nbsp;Skylar C. Rodgers MD ,&nbsp;Andrew M. Young MD ,&nbsp;Raymond J. Strobel MD, MSc ,&nbsp;Emily Kaplan BA ,&nbsp;Steven Young MD ,&nbsp;Katherine I. Foley MD MPH ,&nbsp;Raza Ahmad MD ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.jss.2025.10.039","DOIUrl":"10.1016/j.jss.2025.10.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Timing of surgical intervention after administration of P2Y12 inhibitors remains a clinical challenge balancing ischemia and bleeding risks. This study assessed whether preoperative P2Y12 assay results correlate with perioperative transfusions, postoperative chest tube (CT) output, and reoperation for bleeding following cardiac surgery.</div></div><div><h3>Methods</h3><div>All patients undergoing cardiac surgery at a single institution with a preoperative P2Y12 assay value from 2012 to 2022 were included. The P2Y12 assay closest to surgery and relevant bleeding outcomes was obtained. A cutpoint analysis was used to determine a P2Y12 reaction unit (PRU) lab value that identified patients requiring &gt;1 unit of postoperative blood transfusion. A risk-adjusted multivariable regression analyzed bleeding-related outcomes and operative mortality for patients stratified by the PRU cutpoint.</div></div><div><h3>Results</h3><div>There were 729 patients with a median P2Y12 level of 173.0 PRU, 89% of whom underwent coronary artery bypass grafting. Patients with PRU &lt;194 had a greater decrease in postoperative hematocrit, postoperative day 1 CT output, and average daily CT output. A PRU cutpoint of 101 was selected that classified patients requiring postoperative transfusion of ≥1 unit of packed red blood cell (PRBC). In the risk-adjusted analysis, patients with PRU &lt;101 were found to have higher odds of ≥1 unit postoperative PRBC administration (OR 3.2, 95% CI 1.95-5.44; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Preoperative P2Y12 assay can help guide the estimation of postoperative bleeding risk. The cutpoint provided by the reference range may be too conservative, and a lower cutpoint can more accurately identify patients at risk of requiring postoperative PRBC transfusion.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 516-523"},"PeriodicalIF":1.7,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837056","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}

{"title":"Reoperative Parathyroidectomy: Recognizing Unique Risk Profiles","authors":"Tessa Gruen BS ,&nbsp;Tim Kravchenko MD ,&nbsp;Theodore Hu MD, MPhil ,&nbsp;Aayushi Sinha MS ,&nbsp;Steven Xie MD ,&nbsp;Catherine B. Jensen MD, MS ,&nbsp;Susan C. Pitt MD, MPHS ,&nbsp;David T. Hughes MD ,&nbsp;Paul G. Gauger MD ,&nbsp;Hunter J. Underwood MD","doi":"10.1016/j.jss.2025.11.066","DOIUrl":"10.1016/j.jss.2025.11.066","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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) &lt;65 pg/mL and surgical failure as final intraoperative PTH &gt;65 pg/mL. Permanent postoperative hypoparathyroidism (POHP) was defined as PTH &lt;6 pg/mL beyond 6 mo. Operative and clinical notes were reviewed for recurrent laryngeal nerve injury, postoperative neck hematoma, and parathyroid autotransplantation.</div></div><div><h3>Results</h3><div>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 (<em>P</em> &lt; 0.001) and surgical failure (<em>P</em> = 0.03). Time to reoperation was shortest in focused parathyroidectomy patients (<em>P</em> &lt; 0.001). The rate of recurrent laryngeal nerve injury in the overall cohort was 1.9%, and the rate of permanent POHP was 14%.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 508-515"},"PeriodicalIF":1.7,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837132","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}

{"title":"The Utility of Ubiquitin Carboxyl-Terminal Hydrolase L1 as a Marker of Hemorrhagic Shock","authors":"Gregory C. Wetmore MD,&nbsp;Ellen R. Becker MD,&nbsp;Matthew R. Baucom MD,&nbsp;Adam D. Price MD,&nbsp;Robert C. Shondel BS,&nbsp;Maia P. Smith PhD,&nbsp;Rebecca M. Schuster MS,&nbsp;Timothy A. Pritts MD, PhD, FACS,&nbsp;Michael D. Goodman MD, FACS","doi":"10.1016/j.jss.2025.12.003","DOIUrl":"10.1016/j.jss.2025.12.003","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>UCHL1 level was associated with TBI diagnosis at arrival (<em>P</em> = 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 (<em>P</em> &lt; 0.001). In addition, UCHL1 was significantly elevated in the 30-d mortality group at 0, 24, and 72 h (<em>P</em> &lt; 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 (<em>P</em> &lt; 0.002). In addition, lactic acid was also elevated in the 30-d mortality group at all time points (<em>P</em> &lt; 0.04).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 531-539"},"PeriodicalIF":1.7,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837134","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}

{"title":"Abdominal Aortic Trauma Outcomes in a National Trauma Database","authors":"Vahe S. Panossian MD ,&nbsp;Tiemen E.T. Holtrop MD ,&nbsp;Yasmin Arda MD,&nbsp;Ikemsinachi C. Nzenwa MBChB, MSc,&nbsp;Charley Sun BS,&nbsp;Matthew Bartek MD, MPH,&nbsp;Joshua S. Ng-Kamstra MD,&nbsp;Casey M. Luckhurst MD,&nbsp;Michael P. DeWane MD,&nbsp;Haytham MA. Kaafarani MD, MPH,&nbsp;George C. Velmahos MD, PhD,&nbsp;John O. Hwabejire MD, MPH","doi":"10.1016/j.jss.2025.11.067","DOIUrl":"10.1016/j.jss.2025.11.067","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = 0.032), Glasgow Coma Scale ≤8 (aOR, 8.23; 95% CI, 4.50-15.05; <em>P</em> &lt; 0.001), systolic blood pressure &lt;90 mmHg (aOR, 3.76; 95% CI, 2.15-6.59; <em>P</em> &lt; 0.001), blunt trauma (aOR, 3.48; 95% CI, 1.32-9.20; <em>P</em> = 0.012), and gunshot wounds (aOR, 3.87; 95% CI, 1.57-9.50; <em>P</em> = 0.003) were independently associated with increased mortality. EVAR was associated with lower mortality (aOR, 0.33; 95% CI, 0.13-0.83; <em>P</em> = 0.019) compared to open repair.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 524-530"},"PeriodicalIF":1.7,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837133","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}

{"title":"Racial Disparities in Chemotherapy Response in Pancreatic Cancer: A Landmark Survival Analysis","authors":"K. Kerrick Akinola MD ,&nbsp;Varun Pathak MBBS ,&nbsp;Christopher Wu MD ,&nbsp;Chandler McLeod PhD ,&nbsp;Herbert Chen MD ,&nbsp;Smita Bhatia MD ,&nbsp;J. Bart Rose MD ,&nbsp;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 &gt;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> &lt; 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}

{"title":"Re-evaluation of Blood Product Wastage From Massive Transfusion Protocol at a Level 1 Trauma Center: A Retrospective Cohort Study","authors":"Sandra M. Farach MD, MSPH ,&nbsp;Nathan Santiago ,&nbsp;Milad Behbahaninia MD ,&nbsp;Joby J. Chandy MD ,&nbsp;Emma Joiner MSc ,&nbsp;Jose J. Diaz MD ,&nbsp;Enrico Camporesi MD","doi":"10.1016/j.jss.2025.11.053","DOIUrl":"10.1016/j.jss.2025.11.053","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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 <em>U</em> test and categorical variables with the chi-square or Fisher's exact test, with significance set at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>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% <em>versus</em> 1.2%), fresh frozen plasma (5.7% <em>versus</em> 2.3%), and platelets (13.7% <em>versus</em> 2.9%), all <em>P</em> &lt; 0.001. Documentation discrepancies occurred in 88.7% of activations, with 25.8% involving &gt;10-unit mismatches.</div></div><div><h3>Conclusions</h3><div>MTP blood product wastage has significantly decreased, reflecting sustained quality improvement. However, high documentation discrepancies highlight a critical target for process improvement.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 486-492"},"PeriodicalIF":1.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827913","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}

{"title":"The First Step Is Knowing: Quantifying Social Need Through Screening in a Pediatric Surgery Clinic","authors":"Paris D. Rollins MD ,&nbsp;Sarah King DO ,&nbsp;Alicia Majcher MHSA ,&nbsp;Byron D. Hughes MD, MPH ,&nbsp;Erika A. Newman MD ,&nbsp;Erin E. Perone MD","doi":"10.1016/j.jss.2025.11.055","DOIUrl":"10.1016/j.jss.2025.11.055","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 493-499"},"PeriodicalIF":1.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827911","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}

{"title":"Cost-Effectiveness of Music for Preventing Postoperative Delirium in Elderly Hip Fracture Patients","authors":"Thomas L.A. Dirven MD ,&nbsp;Antonia S. Becker MD ,&nbsp;Heleen A. van den Brandeler BSc ,&nbsp;Victor X. Fu MD PhD ,&nbsp;Johannes Jeekel MD PhD ,&nbsp;Markus Klimek MD PhD ,&nbsp;Michael H.J. Verhofstad MD PhD ,&nbsp;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}

{"title":"The Dilemma of Dog Bite Wounds: Primary versus Delayed Closure","authors":"Omar Hejazi MD,&nbsp;Mohammad Al Ma'ani MD,&nbsp;Muhammad Haris Khurshid MD,&nbsp;Francisco Castillo-Diaz MD,&nbsp;Louis J. Magnotti MD, MS, FACS,&nbsp;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 (&lt;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 (&gt;2 cm), edema, purulent discharge, and a white blood cell count of &gt;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}

{"title":"Prehospital Experience With Left Ventricular Assist Devices","authors":"Emily L. Larson MD ,&nbsp;Reed Jenkins MD ,&nbsp;Alexandra Rizaldi BS ,&nbsp;Raymond Zhang EMT ,&nbsp;John Thompson EMT ,&nbsp;Ruben Troncoso MD MPH ,&nbsp;Asa Margolis DO MPH ,&nbsp;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}