Journal of Surgical Research最新文献

Introduction: Incisional hernia is a common complication of liver transplant. However, the incidence of incisional hernia following liver transplant in a contemporary national cohort remains to be explored.

Materials and methods: We used 100% fee-for-service Medicare claims to develop a retrospective cohort of beneficiaries who underwent liver transplant between 2016 and 2021. We estimated the cumulative incidence of incisional hernia repair, regarded as a four-fold undercount of true hernia incidence, and evaluated the variation across transplant centers using risk- and reliability-adjusted models accounting for beneficiary demographics, comorbidities, and year of liver transplant.

Results: The study cohort included 14,417 beneficiaries. The 5-y beneficiary-level risk-adjusted cumulative incidence of incisional hernia repair was 6.8% (confidence interval: 6.2-7.3), corresponding to a 27.2% incidence of incisional hernia. The 5-y transplant center-level incidence rate of incisional hernia repair varied 2.8-fold, from 2.9% at the transplant center with the lowest incidence rate to 8.3% at the transplant center with the highest incidence rate.

Conclusions: Incisional hernia remains a common complication of liver transplant with variation across transplant centers suggesting that there are opportunities for quality improvement efforts to identify best practices at transplant centers with comparatively low incidence of incisional hernia following liver transplant.

Introduction: Lung cancer causes the most cancer-related deaths in the United States. For patients with localized disease, expeditious treatment portends improved outcomes. This study explores relationships between patient factors and timely treatment for early-stage non-small cell lung cancer (NSCLC) in a population-based cancer registry.

Methods: All adult patients with localized NSCLC between January 1, 2015, and December 31, 2021, were identified through the Michigan Cancer Surveillance Program. Demographic and social factors were compared between treatment groups. Time-to-treatment was defined as days between diagnosis and initiation of first treatment. Multivariable Poisson regression was used to compare time-to-treatment across race, payer, and rural-urban continuum groups. Subset analysis stratifying by first treatment modality was performed.

Results: A total of 10,618 patients with NSCLC were included, with 4753 undergoing operative resection, 5151 undergoing radiation therapy, and 894 undergoing systemic therapy. Overall mean time-to-treatment was 59.8 d (standard deviation [SD], 34.4), with time-to-surgery 57.4 d (SD, 32.9), time-to-radiation therapy 63.0 d (SD, 35.5), and time-to-systemic therapy 53.4 d (SD, 33.7). Adjusted time-to-treatment was longer in Black patients compared to White patients (incidence rate ratio [IRR]: 1.14, 95% confidence interval [CI]: 1.13-1.15, P < 0.001), longer in Medicaid patients compared to Medicare patients (IRR: 1.07, 95% CI: 1.06-1.09, P < 0.001), and shorter in patients in suburban areas compared to urban areas (IRR: 0.95, 95% CI: 0.94-0.97, P < 0.001). Subset analysis of patients undergoing operative resection yielded similar trends.

Conclusions: Sociodemographic factors, including race, payer, and geography, may influence treatment wait times for patients with NSCLC. This inspires further investigation of systems-based drivers of timely treatment and equitable cancer care.

Introduction: Hypothermic machine perfusion (HMP) is widely used to preserve kidney, liver, and heart grafts, improving post-transplant outcomes. However, its application to lung preservation remains unproven. This study investigates whether HMP can be transferred to lungs as an alternative to static cold storage (SCS).

Materials and methods: In a paired-lung model, lungs from seven swine (n = 14) were randomly assigned to 6 h of either SCS at 4°C or pressure-controlled HMP at 10°C using Perfadex Plus. The HMP system provided continuous perfusion without ventilation or oxygenation at a target pressure of 5 mmHg. Preservation outcomes were assessed using graft weight variation, wet/dry ratio, cone-beam computed tomography, histology, endothelial permeability, biochemical markers, and cytokine levels.

Results: Controlled-pressure HMP was technically feasible and maintained lung temperature at 11.3 ± 1.8°C. However, compared to SCS, HMP induced significantly greater edema (+39.9% versus -2.1%, P < 0.0001), confirmed by computed tomography scores (6.7 ± 1.6 versus 2.2 ± 1.6, P = 0.002) and histology (interlobular septal thickness 246 ± 215 μm versus 150 ± 135 μm, P = 0.015). Lactate and partial pressure of carbondioxide levels were higher, and glucose lower in the HMP perfusate. Interleukin-12/interleukin-23p40 levels were significantly elevated in the HMP group (P = 0.020). Partial pressure of oxygen remained high (200-250 mmHg), indicating preserved alveolar oxygen content. No significant differences were found in endothelial injury markers or vasodilatory responses.

Conclusions: Although HMP for lung grafts is feasible and preserves oxygen content, it is associated with significant interstitial edema when performed without ventilation or oxygenation. These findings suggest that direct transfer of HMP protocols from abdominal organs to the lung may require adaptation, particularly to prevent graft edema.