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Intensive Care Unit Readmissions in a Level I Trauma Center. 一级创伤中心重症监护室的再入院率。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-25 DOI: 10.1016/j.jss.2024.09.074
Benjamin Moore, Kacee J Daniels, Blake Martinez, Kevin W Sexton, Kyle J Kalkwarf, Matthew Roberts, Stephen M Bowman, Hanna K Jensen

Introduction: Intensive care unit (ICU) readmissions are associated with increased morbidity and mortality rates, longer hospitalization, and increased health-care expenditures. This study sought to present a large cohort of trauma patients readmitted to the ICU, characterizing risk factors and providing quality improvement strategies to limit ICU readmission.

Methods: A retrospective cohort analysis was conducted on adult trauma patients admitted to the ICU at a single level I trauma center from 2014 to 2021. Patients were split into readmission and no readmission groups. Patients experiencing readmission were compared to a similar group that was not readmitted using descriptive statistics and logistic regression.

Results: In this study, 3632 patients were included and 278 (7.7%) were readmitted to the ICU. Significant differences were found in age, Elixhauser Comorbidity score, number of days on a ventilator, and number of patients requiring ventilator support. Furthermore, logistic regression showed that increasing age and the Elixhauser Comorbidity Score were associated with an increased likelihood of ICU readmission. Over the study period, the ICU readmission rate increased while the ICU length decreased.

Conclusions: Age, Elixhauser Comorbidity score, and ventilator use were all significant risk factors for ICU readmission. During our study period, a concerning trend of increasing ICU readmissions and decreased ICU length of stay was found. By identifying this trend, our institution was able to employ mitigation strategies that have successfully reversed the trend in ICU readmissions, decreasing the rate below the national average.

简介:重症监护病房(ICU)再入院与发病率和死亡率的增加、住院时间的延长以及医疗费用的增加有关。本研究旨在对重症监护室再入院的创伤患者进行大规模队列分析,确定风险因素的特征,并提供质量改进策略,以限制重症监护室再入院率:方法:研究人员对 2014 年至 2021 年在一家一级创伤中心重症监护室住院的成年创伤患者进行了回顾性队列分析。患者被分为再入院组和未再入院组。使用描述性统计和逻辑回归法将再次入院的患者与未再次入院的同类患者进行比较:本研究共纳入 3632 例患者,其中 278 例(7.7%)再次入住重症监护病房。在年龄、Elixhauser 合并症评分、使用呼吸机天数和需要呼吸机支持的患者人数方面发现了显著差异。此外,逻辑回归显示,年龄和埃利克豪斯综合症评分的增加与再次入住重症监护室的可能性增加有关。在研究期间,ICU 再入院率上升,而 ICU 病程缩短:结论:年龄、Elixhauser 疾病综合评分和呼吸机的使用都是 ICU 再入院的重要风险因素。在我们的研究期间,发现了一个令人担忧的趋势,即 ICU 再入院率增加,而 ICU 留院时间缩短。在发现这一趋势后,我院采取了一些缓解策略,成功扭转了重症监护室再入院率的趋势,使其低于全国平均水平。
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引用次数: 0
National Health Insurance Claim of Pediatric Appendectomy With Mandatory Diagnosis-Related Group Payment System in Korea 韩国小儿阑尾切除术的国民健康保险理赔与强制诊断相关团体支付系统。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.076

Introduction

Enforcement of diagnosis-related group system for appendectomy under the National Health Insurance Service has gradually widened and since July 2013 it has been enforced in all medical institutions in Korea. We have analyzed Health Insurance Review & Assessment Service data to observe changes in claim patterns of pediatric appendectomy during this period.

Methods

All claims data for appendectomy of patients younger than 18 y from 2011 to 2015 were collected. We analyzed the following factors of all cases: age, gender, length of hospital stay, medical cost, method of insurance claim and region.

Results

A total of 112,143 claims were made for appendectomy during the study period. In that, 66,510 (59.3%) were boys and 45,633 (40.7%) were girls. Median length of stay was 5 d and median sum of reimbursement of each claim was 2,198,630 won. Annual number of claims for appendectomy showed a steady decline from 24,888 in 2011 to 19,070 in 2015. Median sum of reimbursement of each claim was 1,862,615, 1,975,500, 2,233,360, 2,376,700, and 2,468,000 won, respectively from 2011 to 2015. Reimbursement for complicated appendectomy increased from 4400 out of 24,888 cases (17.7%) in 2011 to 3865 out of 19,070 cases (20.3%) in 2015. Overall medical cost of all reimbursement for pediatric appendectomy increased from 46,113,202,580 to 47,572,253,300 won.

Conclusions

Following the universal enforcement of the diagnosis-related group claim system for appendectomy by the National Health Insurance Service, we observed an increase in the median sum of reimbursement per claim and a rise in the rate of claims for complicated appendectomies. These changes were associated with an overall increase in national medical costs.
简介自 2013 年 7 月起,韩国所有医疗机构都开始实施阑尾切除术的诊断相关组制度。我们分析了健康保险审查和评估服务数据,以观察在此期间小儿阑尾切除术索赔模式的变化:方法:我们收集了 2011 年至 2015 年所有 18 岁以下阑尾切除术的索赔数据。我们分析了所有病例的以下因素:年龄、性别、住院时间、医疗费用、保险理赔方式和地区:研究期间,共有 112,143 例阑尾切除术索赔。其中,66,510 人(59.3%)为男孩,45,633 人(40.7%)为女孩。住院时间中位数为 5 天,每份报销申请的报销金额中位数为 2,198,630 韩元。阑尾切除术的年报销次数从 2011 年的 24 888 例稳步下降至 2015 年的 19 070 例。从 2011 年到 2015 年,每项报销金额的中位数分别为 186.2615 万韩元、197.55 万韩元、223.336 万韩元、237.67 万韩元和 246.8 万韩元。复杂阑尾切除术的报销比例从 2011 年的 24888 例中的 4400 例(17.7%)增至 2015 年的 19070 例中的 3865 例(20.3%)。小儿阑尾切除术所有报销的总体医疗费用从 4611320.58 万韩元增加到 475722.53 万韩元:在国民健康保险服务机构普遍实施阑尾切除术诊断相关分组报销制度后,我们观察到每次报销的中位数增加,复杂阑尾切除术的报销率上升。这些变化与全国医疗费用的总体增长有关。
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引用次数: 0
Prevalence and Extent of Industry Funding to Program Directors Across Pediatric Surgical Specialties 小儿外科各专业项目主任获得行业资助的普遍性和程度。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.073

Introduction

Industry funding in surgical education offers benefits but presents conflicts of interest. This study defines the prevalence and extent of industry funding to fellowship program directors (FPDs) across pediatric surgical specialties.

Materials and methods

This was a retrospective cross-sectional analysis of FPDs in pediatric surgical specialties. Data were amalgamated from the Centers for Medicare and Medicaid Services and the Accreditation Council for Graduate Medical Education. Characteristics of FPDs were obtained from academic websites and medical licensing boards. Personal industry payments from 2016 to 2022 were analyzed, and temporal trends were elucidated. Comparisons were made by year, surgical specialty, and control groups with nonparametric tests.

Results

A total of 241 FPDs were identified, with 206 (85%) receiving industry payments over the study period. The specialties with the highest prevalence of industry funding to FPDs were pediatric orthopedic surgery (100%), pediatric urology (96%), and pediatric surgery (85%). Total industry payments aggregated to $7.3 million dollars with the majority awarded to pediatric orthopedic surgery (91%). Most industry payments were for royalties or licensing (57%) and consulting fees (31%). Median total industry payments per FPD differed between subspecialties (P < 0.001) and was highest in pediatric orthopedic surgery ($7009, interquartile range [IQR], $1771-$50,239) and lowest in pediatric otolaryngology ($116, IQR, $75-$1626). Male FPDs had higher median total industry payments than female FPDs ($1643, IQR, $172-$8731 versus $193, IQR, $84-$712, P < 0.001).

Conclusions

Industry payments to FPDs in pediatric surgical specialties are highly prevalent, but the magnitude varies by specialty. Future work is needed to establish mechanisms that promote equitable partnerships between academia and industry for pediatric surgery training.
导言:外科教育中的行业资助有其好处,但也存在利益冲突。本研究对各小儿外科专业的研究金项目主任(FPD)获得行业资助的普遍性和程度进行了界定:这是一项对儿科外科专业 FPD 的回顾性横断面分析。数据由美国医疗保险与医疗补助服务中心(Centers for Medicare and Medicaid Services)和美国研究生医学教育认证委员会(Accreditation Council for Graduate Medical Education)提供。FPD 的特征来自学术网站和医疗许可委员会。分析了 2016 年至 2022 年的个人行业支付情况,并阐明了时间趋势。通过非参数检验对年份、外科专业和对照组进行了比较:共确定了 241 例 FPD,其中 206 例(85%)在研究期间接受了行业付款。向FPD提供行业资助最多的专业是小儿骨科(100%)、小儿泌尿科(96%)和小儿外科(85%)。行业资助总额达 730 万美元,其中大部分用于小儿骨科手术(91%)。大部分行业付款用于版税或许可(57%)和咨询费(31%)。各亚专科的每个 FPD 行业付款总额中位数各不相同(P 结论):行业向小儿外科专科的 FPD 支付费用的现象非常普遍,但不同专科的支付金额不同。未来需要建立机制,促进学术界和业界在小儿外科培训方面的公平合作。
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引用次数: 0
Use of Deep Learning to Identify Peripheral Arterial Disease Cases From Narrative Clinical Notes 利用深度学习从叙事性临床笔记中识别外周动脉疾病病例。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.062
<div><h3>Introduction</h3><div>Peripheral arterial disease (PAD) is the leading cause of amputation in the United States. Despite affecting 8.5 million Americans and more than 200 million people globally, there are significant gaps in awareness by both patients and providers. Ongoing efforts to raise PAD awareness among both the public and health-care professionals have not met widespread success. Thus, there is a need for alternative methods for identifying PAD patients. One potentially promising strategy leverages natural language processing (NLP) to digitally screen patients for PAD. Prior approaches have applied keyword search (KWS) to billing codes or unstructured clinical narratives to identify patients with PAD. However, KWS is limited by its lack of flexibility, the need for manual algorithm development, inconsistent validation, and an inherent failure to capture patients with undiagnosed PAD. Recent advances in deep learning (DL) allow modern NLP models to learn a conceptual representation of the verbiage associated with PAD. This capability may overcome the characteristic constraints of applying strict rule-based algorithms (i.e., searching for a disease-defining set of keywords or billing codes) to real-world clinical data. Herein, we investigate the use of DL to identify patients with PAD from unstructured notes in the electronic health record (EHR).</div></div><div><h3>Methods</h3><div>Using EHR data from a statewide health information exchange, we first created a dataset of all patients with diagnostic or procedural codes (International Classification of Diseases version 9 or 10 or Current Procedural Terminology) for PAD. This study population was then subdivided into training (70%) and testing (30%) cohorts. We based ground truth labels (PAD <em>versus</em> no PAD) on the presence of a primary diagnostic or procedural billing code for PAD at the encounter level. We implemented our KWS-based identification strategy using the currently published state-of-the-art algorithm for identifying PAD cases from unstructured EHR data. We developed a DL model using a BioMed-RoBERTa base that was fine-tuned on the training cohort. We compared the performance of the KWS algorithm to our DL model on a binary classification task (PAD <em>versus</em> no PAD).</div></div><div><h3>Results</h3><div>Our study included 484,363 encounters across 71,355 patients represented in 2,268,062 notes. For the task of correctly identifying PAD related notes in our testing set, the DL outperformed KWS on all model performance measures (Sens 0.70 <em>versus</em> 0.62; Spec 0.99 <em>versus</em> 0.94; PPV 0.82 <em>versus</em> 0.69; NPV 0.97 <em>versus</em> 0.96; Accuracy 0.96 <em>versus</em> 0.91; <em>P</em> value for all comparisons <0.001).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that DL outperforms KWS for identifying PAD cases from clinical narratives. Future planned work derived from this project will develop models to stage patients based
导言:在美国,外周动脉疾病(PAD)是导致截肢的主要原因。尽管该病影响着 850 万美国人和全球 2 亿多人,但患者和医护人员对该病的认识仍有很大差距。目前,提高公众和医疗保健专业人员对 PAD 认识的努力尚未取得广泛成功。因此,有必要采用其他方法来识别 PAD 患者。利用自然语言处理(NLP)对 PAD 患者进行数字筛查是一种很有前景的策略。之前的方法将关键词搜索(KWS)应用于账单代码或非结构化临床叙述,以识别 PAD 患者。然而,KWS 的局限性在于缺乏灵活性、需要人工开发算法、验证不一致以及无法捕捉未确诊的 PAD 患者。深度学习(DL)的最新进展使现代 NLP 模型能够学习与 PAD 相关的语言的概念表述。这种能力可以克服将严格的基于规则的算法(即搜索一组疾病定义的关键字或账单代码)应用于真实世界临床数据时所受到的限制。在此,我们研究了使用 DL 从电子健康记录(EHR)中的非结构化笔记中识别出 PAD 患者的方法:方法:利用全州范围内健康信息交换中心的电子病历数据,我们首先创建了一个数据集,其中包含所有具有 PAD 诊断或手术代码(国际疾病分类版本 9 或 10 或当前手术术语)的患者。然后将该研究人群细分为训练组群(70%)和测试组群(30%)。我们根据会诊水平上是否存在 PAD 的主要诊断或程序计费代码来确定基本事实标签(PAD 与无 PAD)。我们使用目前已发表的最先进算法实施了基于 KWS 的识别策略,该算法用于从非结构化 EHR 数据中识别 PAD 病例。我们使用 BioMed-RoBERTa 基础开发了一个 DL 模型,该模型在训练队列中进行了微调。我们比较了 KWS 算法和我们的 DL 模型在二元分类任务(PAD 与无 PAD)上的性能:我们的研究包括 2,268,062 张病历中 71,355 名患者的 484,363 次就诊。对于在测试集中正确识别 PAD 相关笔记的任务,DL 在所有模型性能指标上均优于 KWS(Sens 0.70 对 0.62;Spec 0.99 对 0.94;PPV 0.82 对 0.69;NPV 0.97 对 0.96;Accuracy 0.96 对 0.91;所有比较的 P 值 结论:我们的研究结果表明,DL 在所有模型性能指标上均优于 KWS:我们的研究结果表明,在从临床叙述中识别 PAD 病例方面,DL 优于 KWS。本项目的未来计划工作将开发基于临床评分系统的患者分期模型。
{"title":"Use of Deep Learning to Identify Peripheral Arterial Disease Cases From Narrative Clinical Notes","authors":"","doi":"10.1016/j.jss.2024.09.062","DOIUrl":"10.1016/j.jss.2024.09.062","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Peripheral arterial disease (PAD) is the leading cause of amputation in the United States. Despite affecting 8.5 million Americans and more than 200 million people globally, there are significant gaps in awareness by both patients and providers. Ongoing efforts to raise PAD awareness among both the public and health-care professionals have not met widespread success. Thus, there is a need for alternative methods for identifying PAD patients. One potentially promising strategy leverages natural language processing (NLP) to digitally screen patients for PAD. Prior approaches have applied keyword search (KWS) to billing codes or unstructured clinical narratives to identify patients with PAD. However, KWS is limited by its lack of flexibility, the need for manual algorithm development, inconsistent validation, and an inherent failure to capture patients with undiagnosed PAD. Recent advances in deep learning (DL) allow modern NLP models to learn a conceptual representation of the verbiage associated with PAD. This capability may overcome the characteristic constraints of applying strict rule-based algorithms (i.e., searching for a disease-defining set of keywords or billing codes) to real-world clinical data. Herein, we investigate the use of DL to identify patients with PAD from unstructured notes in the electronic health record (EHR).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using EHR data from a statewide health information exchange, we first created a dataset of all patients with diagnostic or procedural codes (International Classification of Diseases version 9 or 10 or Current Procedural Terminology) for PAD. This study population was then subdivided into training (70%) and testing (30%) cohorts. We based ground truth labels (PAD &lt;em&gt;versus&lt;/em&gt; no PAD) on the presence of a primary diagnostic or procedural billing code for PAD at the encounter level. We implemented our KWS-based identification strategy using the currently published state-of-the-art algorithm for identifying PAD cases from unstructured EHR data. We developed a DL model using a BioMed-RoBERTa base that was fine-tuned on the training cohort. We compared the performance of the KWS algorithm to our DL model on a binary classification task (PAD &lt;em&gt;versus&lt;/em&gt; no PAD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our study included 484,363 encounters across 71,355 patients represented in 2,268,062 notes. For the task of correctly identifying PAD related notes in our testing set, the DL outperformed KWS on all model performance measures (Sens 0.70 &lt;em&gt;versus&lt;/em&gt; 0.62; Spec 0.99 &lt;em&gt;versus&lt;/em&gt; 0.94; PPV 0.82 &lt;em&gt;versus&lt;/em&gt; 0.69; NPV 0.97 &lt;em&gt;versus&lt;/em&gt; 0.96; Accuracy 0.96 &lt;em&gt;versus&lt;/em&gt; 0.91; &lt;em&gt;P&lt;/em&gt; value for all comparisons &lt;0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our findings suggest that DL outperforms KWS for identifying PAD cases from clinical narratives. Future planned work derived from this project will develop models to stage patients based","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502721","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
Can Concurrent Traumatic Hemopneumothorax be Safely Observed? 能否安全地观察并发创伤性血气胸?
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.085
Abdul Hafiz Al Tannir, Morgan Tentis, Morgan Maring, Bryce Patin, Elise A Biesboer, Simin Golestani, Courtney J Pokrzywa, Jacob Peschman, Patrick B Murphy, Rachel S Morris, Thomas W Carver, Marc A de Moya

Introduction: The cooccurrence of a traumatic hemothorax (HTX) and pneumothorax (PTX) is extremely common (70%). Prior work shows the safety of observing small HTX (≤300 cubic centimeters) and PTX (≤35 mm) in isolation. Accordingly, we sought to assess the safety of observation of concurrent small hemopneumothorax(HPTX).

Methods: We conducted a single-center retrospective study from 2015 to 2021 at a level I trauma center. Patients with a computed tomography (CT) scan confirmed that HPTXwas included in the study. Exclusion criteria included tube thoracostomy (TT) prior to CT scan, TT placement for rib fixation, PTX>35 mm, HTX>300 cubic centimeters, and death within 72 h of admission. The study group was stratified into either initial observation or early TT, which is defined as TT placement immediately after initial CT scan. Primary outcome was observation failure.

Results: A total of 353 patients met the inclusion criteria, of whom 261 (74%) were initially observed. The initial observation cohort had a lower pulmonary morbidity rate (9% versus 14%; P = 0.04) and a shorter hospital (7 versus 10 d, P < 0.001) and intensive care unit (2 versus 4 d, P = 0.01) length of stay (LOS) when compared to those with initial TT placement. Sixty-eight (26%) patients failed observation, with a worsening HTXon repeat imaging (45%) being the most common reason. Compared to those who received an early TT, those who failed observation had a similar pulmonary morbidity and need for video-assisted thoracoscopic surgery, TT duration, LOS, readmission, and mortality rates.

Conclusions: Initial observation of concurrent small traumatic HPTX had a lower pulmonary morbidity and LOS but was found to have a clinically significant failure rate. Patients who failed observation had similar outcomes to those who received an early TT.

导言:创伤性血气胸(HTX)和气胸(PTX)同时发生的情况极为常见(70%)。先前的研究表明,单独观察小的 HTX(≤300 立方厘米)和 PTX(≤35 毫米)是安全的。因此,我们试图评估同时观察小血气胸(HPTX)的安全性:我们在一家一级创伤中心开展了一项单中心回顾性研究(2015-2021 年)。经计算机断层扫描(CT)证实为 HPTX 的患者被纳入研究范围。排除标准包括 CT 扫描前进行管式胸腔造口术(TT)、为肋骨固定而置入 TT、PTX>35 毫米、HTX>300 立方厘米以及入院 72 小时内死亡。研究组被分为初始观察组和早期TT组,早期TT组的定义是在初始CT扫描后立即进行TT置管。主要结果为观察失败:共有 353 名患者符合纳入标准,其中 261 人(74%)接受了初始观察。与初次置入 TT 的患者相比,初次观察组的肺部发病率较低(9% 对 14%; P = 0.04),住院时间(7 天对 10 天,P < 0.001)和重症监护室住院时间(2 天对 4 天,P = 0.01)较短。68例(26%)患者未能通过观察,最常见的原因是重复造影显示 HTX 恶化(45%)。与接受早期 TT 的患者相比,观察失败者的肺部发病率、视频辅助胸腔镜手术需求、TT 持续时间、住院时间、再入院率和死亡率相似:并发小创伤性 HPTX 的初始观察肺部发病率和 LOS 均较低,但发现有临床意义的失败率。观察失败的患者与接受早期TT的患者结果相似。
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引用次数: 0
National Trend of Surgical Stabilization of Rib Fractures: Indications, Approaches, and Disparities 全国肋骨骨折手术稳定趋势:适应症、方法和差异。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.080

Introduction

Rib fractures are among the most frequent injuries in trauma. This study aims to assess the current nationwide trends in operative rib fixation and identify predictors of surgical stabilization of rib fractures (SSRFs).

Methods

A 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program database was performed. Adult trauma patients who had at least one rib fracture were included. We analyzed data regarding type of SSRF including open and thoracoscopic approaches and its trends.

Results

A total of 780,275 patients were identified, of which 15,339 patients (1.9%) were managed with SSRF. Trends of both open and endoscopic approaches were increasing during the study period. Patients with ≤2 rib fractures had a decreasing rate of SSRF. Flail chest (odds ratio = 13.42, P < 0.001) was the strongest predictor of SSRF.

Conclusions

SSRF is gaining popularity in the management of chest trauma. The presence of a flail segment and multiplicity of rib fractures is among the predictors of SSRF.
简介肋骨骨折是创伤中最常见的损伤之一。本研究旨在评估目前全国范围内肋骨手术固定的趋势,并确定肋骨骨折手术稳定(SSRFs)的预测因素:对创伤质量改进计划数据库进行了为期 5 年(2017-2021 年)的回顾性分析。纳入了至少有一处肋骨骨折的成人创伤患者。我们分析了有关 SSRF 类型(包括开放式和胸腔镜方法)及其趋势的数据:结果:共确定了 780,275 名患者,其中 15,339 名患者(1.9%)接受了 SSRF 治疗。在研究期间,开放式和内窥镜方法均呈上升趋势。肋骨骨折≤2根的患者采用SSRF的比例有所下降。胸部外翻(几率比 13.42,PSSRF 在胸部创伤的治疗中越来越受欢迎。胸廓外翻和多发性肋骨骨折是预测 SSRF 的因素之一。
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引用次数: 0
A National Analysis of Pediatric Traumatic Duodenal Injuries 全国小儿创伤性十二指肠损伤分析。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.048

Introduction

Traumatic duodenal injuries can be difficult to diagnose and manage due to their severity, rarity, and complexity. This study aimed to analyze demographic and clinical characteristics of children with duodenal injuries using a weighted, national database.

Methods

Cases of duodenal injury in patients <18 y of age were identified in a cross-sectional analysis of the 2016 Kids’ Inpatient Database using International Classification of Diseases, 10th Revision Clinical Modification codes. These were compared to all other trauma hospitalizations age <18 y old through multivariable logistic regression to determine odds of hospitalization for duodenal injuries. Secondary analysis was performed on patients with nonaccidental trauma (NAT).

Results

Duodenal injury patients (n = 237) were frequently older, male, or victims of NAT. They had a higher injury severity score, and longer length of stay. The most common mechanism was motor vehicle collision. Patients with duodenal injuries more often had concomitant lung, liver, pancreas, and large bowel injuries. They more frequently underwent laparotomy, large bowel resection, required parenteral nutrition, and received more blood transfusions. NAT subanalysis demonstrated that as compared to non-NAT duodenal injuries, those with duodenal injuries due to NAT were younger, more often in the Northeast, and more often had government insurance. Multivariable logistic regression demonstrated increased odds of hospitalization of duodenal injury for males as compared to females (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI] 1.31-2.67), older age (aOR 1.04, 95% CI 1.01-1.07), and victims of NAT (aOR 4.18, 95% CI 2.19-7.97)

Conclusions

Pediatric duodenal injuries most commonly occur in male patients as a result of motor vehicle collisions. Duodenal injury in patients under 3 y of age should raise the index of suspicion for NAT. These injuries overall are severe, are associated with other significant injuries that require intervention, and have a longer length of stay as compared to all other trauma hospitalizations.
导言:十二指肠外伤因其严重性、罕见性和复杂性而难以诊断和处理。本研究旨在利用全国性加权数据库分析十二指肠损伤患儿的人口统计学和临床特征:十二指肠损伤患者的临床修订代码。将这些病例与所有其他外伤住院病例进行比较:十二指肠损伤患者(n = 237)多为老年人、男性或 NAT 受害者。他们的损伤严重程度评分更高,住院时间更长。最常见的受伤机制是机动车碰撞。十二指肠损伤患者通常同时伴有肺、肝、胰腺和大肠损伤。他们更常接受开腹手术和大肠切除术,需要肠外营养,并接受更多的输血。NAT子分析表明,与非NAT十二指肠损伤相比,NAT导致的十二指肠损伤患者更年轻,更多发生在东北部,更多购买了政府保险。多变量逻辑回归显示,与女性相比,男性十二指肠损伤住院的几率更高(调整后的几率比 [aOR] 1.88;95% 置信区间 [CI] 1.31-2.67),年龄更大(aOR 1.04,95% CI 1.01-1.07),并且是 NAT 的受害者(aOR 4.18,95% CI 2.19-7.97) 结论:小儿十二指肠损伤最常见于男性患者,是机动车碰撞的结果。3 岁以下患者的十二指肠损伤应提高对 NAT 的怀疑指数。与其他所有创伤住院患者相比,这些损伤总体上较为严重,并伴有其他需要干预的重大损伤,住院时间也较长。
{"title":"A National Analysis of Pediatric Traumatic Duodenal Injuries","authors":"","doi":"10.1016/j.jss.2024.09.048","DOIUrl":"10.1016/j.jss.2024.09.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic duodenal injuries can be difficult to diagnose and manage due to their severity, rarity, and complexity. This study aimed to analyze demographic and clinical characteristics of children with duodenal injuries using a weighted, national database.</div></div><div><h3>Methods</h3><div>Cases of duodenal injury in patients &lt;18 y of age were identified in a cross-sectional analysis of the 2016 Kids’ Inpatient Database using International Classification of Diseases, 10<sup>th</sup> Revision Clinical Modification codes. These were compared to all other trauma hospitalizations age &lt;18 y old through multivariable logistic regression to determine odds of hospitalization for duodenal injuries. Secondary analysis was performed on patients with nonaccidental trauma (NAT).</div></div><div><h3>Results</h3><div>Duodenal injury patients (<em>n</em> = 237) were frequently older, male, or victims of NAT. They had a higher injury severity score, and longer length of stay. The most common mechanism was motor vehicle collision. Patients with duodenal injuries more often had concomitant lung, liver, pancreas, and large bowel injuries. They more frequently underwent laparotomy, large bowel resection, required parenteral nutrition, and received more blood transfusions. NAT subanalysis demonstrated that as compared to non-NAT duodenal injuries, those with duodenal injuries due to NAT were younger, more often in the Northeast, and more often had government insurance. Multivariable logistic regression demonstrated increased odds of hospitalization of duodenal injury for males as compared to females (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI] 1.31-2.67), older age (aOR 1.04, 95% CI 1.01-1.07), and victims of NAT (aOR 4.18, 95% CI 2.19-7.97)</div></div><div><h3>Conclusions</h3><div>Pediatric duodenal injuries most commonly occur in male patients as a result of motor vehicle collisions. Duodenal injury in patients under 3 y of age should raise the index of suspicion for NAT. These injuries overall are severe, are associated with other significant injuries that require intervention, and have a longer length of stay as compared to all other trauma hospitalizations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502688","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
A Comparative Analysis of Zip Code Discordance in Pediatric Gunshot Wounds 小儿枪伤中邮政编码不一致的比较分析。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-24 DOI: 10.1016/j.jss.2024.09.054

Introduction

With the rate of pediatric gun violence rising, it is imperative to investigate current trauma intervention strategies. For example, previous trauma studies have used zip codes of residence as a proxy for the zip code of injury. This study aims to look at relationships between zip codes of injury and residence specifically in pediatric patients with gunshot wounds.

Methods

A retrospective review was performed on two trauma registries: one children's hospital and one primary adult hospital in an urban city. Pediatric patients <15 y old with a gunshot wound from January 2016 to April 2023 were included. Zip code discordance (ZCD) was defined as the patient's zip code of injury differing from their zip code of residence; associations between ZCD and clinical variables were analyzed.

Results

Of the 238 patients included in this study, ZCD was observed in 40.3% of patients. Overall, there was a predominance of non-Hispanic, Black males; however, there were significantly more Black patients with ZCD (92.7% versus 79.6%, P = 0.02). Adjusted analysis revealed that ZCD was associated with a longer hospital length of stay (odds ratio 1.41, 95% confidence interval 1.19-1.67, P < 0.01) and a higher likelihood of mortality (odds ratio 6.79, 95% confidence interval 2.39-23.1, P < 0.01).

Conclusions

These findings reveal differences between pediatric patients with and without ZCD, emphasizing the importance of accurate zip code reporting. Future studies should investigate why the associations between ZCD and clinical outcomes occurred.
导言:随着小儿枪支暴力事件的增加,研究当前的创伤干预策略势在必行。例如,以前的创伤研究使用居住地的邮政编码来代替受伤地的邮政编码。本研究旨在调查受伤邮政编码与居住地之间的关系,特别是在儿科枪伤患者中的关系:方法:对两个创伤登记处进行了回顾性审查:一个是儿童医院,另一个是城市中的主要成人医院。儿科患者本研究共纳入 238 名患者,其中 40.3% 的患者出现 ZCD。总体而言,非西班牙裔的黑人男性居多;但是,患有 ZCD 的黑人患者明显较多(92.7% 对 79.6%,P = 0.02)。调整后的分析表明,ZCD 与较长的住院时间有关(几率比 1.41,95% 置信区间 1.19-1.67,P 结论:ZCD 与较长的住院时间有关:这些发现揭示了有 ZCD 和没有 ZCD 的儿科患者之间的差异,强调了准确报告邮政编码的重要性。未来的研究应探讨为什么会出现 ZCD 与临床结果之间的关联。
{"title":"A Comparative Analysis of Zip Code Discordance in Pediatric Gunshot Wounds","authors":"","doi":"10.1016/j.jss.2024.09.054","DOIUrl":"10.1016/j.jss.2024.09.054","url":null,"abstract":"<div><h3>Introduction</h3><div>With the rate of pediatric gun violence rising, it is imperative to investigate current trauma intervention strategies. For example, previous trauma studies have used zip codes of residence as a proxy for the zip code of injury. This study aims to look at relationships between zip codes of injury and residence specifically in pediatric patients with gunshot wounds.</div></div><div><h3>Methods</h3><div>A retrospective review was performed on two trauma registries: one children's hospital and one primary adult hospital in an urban city. Pediatric patients &lt;15 y old with a gunshot wound from January 2016 to April 2023 were included. Zip code discordance (ZCD) was defined as the patient's zip code of injury differing from their zip code of residence; associations between ZCD and clinical variables were analyzed.</div></div><div><h3>Results</h3><div>Of the 238 patients included in this study, ZCD was observed in 40.3% of patients. Overall, there was a predominance of non-Hispanic, Black males; however, there were significantly more Black patients with ZCD (92.7% <em>versus</em> 79.6%, <em>P</em> = 0.02). Adjusted analysis revealed that ZCD was associated with a longer hospital length of stay (odds ratio 1.41, 95% confidence interval 1.19-1.67, <em>P</em> &lt; 0.01) and a higher likelihood of mortality (odds ratio 6.79, 95% confidence interval 2.39-23.1, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>These findings reveal differences between pediatric patients with and without ZCD, emphasizing the importance of accurate zip code reporting. Future studies should investigate why the associations between ZCD and clinical outcomes occurred.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502687","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
In-Hospital Drug Use Affects a Broad Patient Population and the Health Care System 院内用药影响着广大患者和医疗保健系统。
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-23 DOI: 10.1016/j.jss.2024.09.077

Introduction

Patients who suffer from addiction sometimes take illicit substances while in the hospital (in-hospital drug use [IHDU]), which can lead to unnecessary work-up and preventable treatments when symptoms develop. The purpose of this study was to define the frequency and scope of this problem, who it affects, and its impact on the medical system.

Methods

We reviewed all incident reports from our large, urban level 1 trauma center that involved a patient being found with illicit substances in the hospital between January 2020 and January 2023. Reports were included if patients were witnessed taking the illicit substance or if they admitted to taking one in the hospital. Individual medical charts were then reviewed to determine the details of the incident and the response of the medical team.

Results

Thirty-one incidents meeting the inclusion criteria were found. Of the patients involved, 74.2% were male and ranged in age from 21 to 82 years old. The admitting services included internal or family medicine (48.4%), trauma (32.3%), surgical intensive care unit (ICU) (6.5%), medical ICU (6.5%), obstetrics and gynecology (3.2%), and plastic surgery (3.2%). Interventions ranged from no intervention to transfer to the ICU and intubation. 29.0% had visitors immediately prior to the incident, which may be how the substances were obtained. 16.1% left against medical advice after having their drugs confiscated.

Conclusions

Our findings suggest that a broad range of patients are at risk for IHDU, and that IHDU can lead to medical complications, additional medical expense, or patients at risk of incomplete care due to leaving against medical advice. Future work is necessary to understand patient outcomes and financial implications of IHDU, as well as to develop tools to identify those patients most at risk.
导言:成瘾患者有时会在住院期间服用违禁药物(院内药物使用 [IHDU]),这可能导致不必要的检查和在出现症状时可预防的治疗。本研究的目的是确定这一问题的发生频率和范围、影响人群及其对医疗系统的影响:我们审查了我们这个大型城市一级创伤中心在 2020 年 1 月至 2023 年 1 月期间的所有事件报告,这些报告涉及在医院内发现患者服用违禁药物。如果患者被目击服用违禁药物或承认在医院服用违禁药物,则报告将被纳入其中。然后对个人病历进行审查,以确定事件的细节和医疗团队的应对措施:结果:共发现 31 起符合纳入标准的事件。其中 74.2% 的患者为男性,年龄从 21 岁到 82 岁不等。收治部门包括内科或家庭医学科(48.4%)、创伤科(32.3%)、外科重症监护室(6.5%)、内科重症监护室(6.5%)、妇产科(3.2%)和整形外科(3.2%)。干预措施从无干预到转入重症监护室和插管不等。29.0%的患者在事件发生前有访客,这可能是他们获得药物的途径。16.1%的患者在药物被没收后违背医嘱离开:我们的研究结果表明,许多患者都有发生 IHDU 的风险,IHDU 可能会导致医疗并发症、额外的医疗费用,或者患者因违背医嘱离开而面临护理不完整的风险。今后有必要开展工作,以了解 IHDU 的患者预后和财务影响,并开发工具来识别风险最高的患者。
{"title":"In-Hospital Drug Use Affects a Broad Patient Population and the Health Care System","authors":"","doi":"10.1016/j.jss.2024.09.077","DOIUrl":"10.1016/j.jss.2024.09.077","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who suffer from addiction sometimes take illicit substances while in the hospital (in-hospital drug use [IHDU]), which can lead to unnecessary work-up and preventable treatments when symptoms develop. The purpose of this study was to define the frequency and scope of this problem, who it affects, and its impact on the medical system.</div></div><div><h3>Methods</h3><div>We reviewed all incident reports from our large, urban level 1 trauma center that involved a patient being found with illicit substances in the hospital between January 2020 and January 2023. Reports were included if patients were witnessed taking the illicit substance or if they admitted to taking one in the hospital. Individual medical charts were then reviewed to determine the details of the incident and the response of the medical team.</div></div><div><h3>Results</h3><div>Thirty-one incidents meeting the inclusion criteria were found. Of the patients involved, 74.2% were male and ranged in age from 21 to 82 years old. The admitting services included internal or family medicine (48.4%), trauma (32.3%), surgical intensive care unit (ICU) (6.5%), medical ICU (6.5%), obstetrics and gynecology (3.2%), and plastic surgery (3.2%). Interventions ranged from no intervention to transfer to the ICU and intubation. 29.0% had visitors immediately prior to the incident, which may be how the substances were obtained. 16.1% left against medical advice after having their drugs confiscated.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that a broad range of patients are at risk for IHDU, and that IHDU can lead to medical complications, additional medical expense, or patients at risk of incomplete care due to leaving against medical advice. Future work is necessary to understand patient outcomes and financial implications of IHDU, as well as to develop tools to identify those patients most at risk.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502710","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
Comparison Between Billroth II and Billroth II + Braun Anastomosis in Gastrectomy for Gastric Cancer 比洛斯 II 与比洛斯 II + 博朗吻合术在胃癌胃切除术中的应用比较
IF 1.8 3区 医学 Q2 SURGERY Pub Date : 2024-10-22 DOI: 10.1016/j.jss.2024.09.044
<div><h3>Introduction</h3><div>Distal gastrectomy remains the predominant therapeutic approach for gastric cancer, with digestive tract reconstruction as an integral procedure. The implementation of Braun anastomosis following Billroth II anastomosis is common in distal gastrectomy. This retrospective cohort study evaluated the clinical utility of Braun anastomosis by comparing the outcomes and quality of life between Billroth II (B-II) and Billroth II with Braun (B-IIB) anastomosis in the treatment of gastric cancer.</div></div><div><h3>Methods</h3><div>A retrospective cohort study examined clinical and pathological data from 377 patients who underwent distal gastrectomy for gastric cancer treatment at The Affiliated Lihuili Hospital, Ningbo University, from October 2016 to October 2021.185 patients received B-II anastomosis, while the other 192 received B-IIB anastomosis, forming the B-II and B-IIB groups, respectively. Baseline characteristics, perioperative variables, short-term and long-term complications, and nutritional indicators at 1 mo and 1 y postsurgery were compared across both groups. Additionally, gastric endoscopy results at 6 mo and 1 y postsurgery were evaluated. Quality of life at 1 y postsurgery was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30.</div></div><div><h3>Results</h3><div>Baseline characteristics between the two groups revealed no statistically significant differences (all <em>P ></em> 0.05), confirming their equivalence. All 377 patients successfully underwent curative distal gastrectomy for gastric cancer without intraoperative procedural modifications. No intraoperative complications or perioperative mortality occurred. Notable differences included extended operative time (222.1 ± 41.0 vs. 199.4 ± 24.9 min, <em>P</em> < 0.001), reduced postoperative nasogastric tube removal time (1.8 ± 0.9 vs. 2.2 ± 1.1 d, <em>P</em> < 0.001), decreased average gastric drainage volume (100.7 ± 35.2 vs. 112.2 ± 32.0 mL, <em>P</em> = 0.001), and increased incidence of internal hernia and ileus (4.7% vs. 1.1% and 8.3% vs. 3.2%, <em>P</em> = 0.038 and <em>P</em> = 0.035) in the B-IIB group compared to the B-II group. No significant differences were observed in estimated blood loss, lymph node dissection, postoperative flatus time, transition to a semiliquid diet, length of hospital stay, or short-term and long-term complications (all <em>P</em> > 0.05). Nutritional assessments conducted 1 mo and 1 y postsurgery indicated no statistically significant differences in body mass index, total protein, and serum albumin levels between the two groups (all <em>P</em> > 0.05). Gastric endoscopy evaluations at 6 mo and 1 y postsurgery, including food residue grade, gastritis severity, extent of gastritis, and bile reflux, demonstrated no significant discrepancies between the groups (all <em>P</em> > 0.05). At the 1-y follow-up, neither group exhibited tumor r
简介:远端胃切除术仍是胃癌的主要治疗方法,消化道重建是其中一项不可或缺的手术。在远端胃切除术中,继比洛氏 II 型吻合术之后采用布劳恩吻合术的情况很普遍。这项回顾性队列研究通过比较比洛斯 II(B-II)和比洛斯 II 加布劳恩(B-IIB)吻合术在胃癌治疗中的疗效和生活质量,评估了布劳恩吻合术的临床实用性:一项回顾性队列研究对2016年10月至2021年10月在宁波大学附属李惠利医院接受远端胃切除术治疗胃癌的377例患者的临床和病理资料进行了研究,其中185例患者接受了B-II吻合术,另外192例患者接受了B-IIB吻合术,分别组成B-II组和B-IIB组。对两组患者的基线特征、围手术期变量、短期和长期并发症以及术后1个月和1年的营养指标进行了比较。此外,还评估了术后6个月和1年的胃内镜检查结果。术后1年的生活质量采用欧洲癌症研究和治疗组织生活质量问卷--核心30进行评估:结果:两组患者的基线特征在统计学上无显著差异(P>0.05),证实了两组患者的等同性。所有377名胃癌患者均成功接受了根治性远端胃切除术,术中未进行任何程序修改。术中未出现并发症或围术期死亡率。显著差异包括手术时间延长(222.1 ± 41.0 分钟 vs. 199.4 ± 24.9 分钟,P 0.05)。术后 1 个月和 1 年的营养评估显示,两组患者的体重指数、总蛋白和血清白蛋白水平差异无统计学意义(均 P > 0.05)。手术后 6 个月和 1 年的胃内镜评估(包括食物残渣等级、胃炎严重程度、胃炎范围和胆汁反流)显示,两组之间没有显著差异(所有 P > 0.05)。在 1 年的随访中,两组患者均未出现肿瘤复发、肿瘤相关疾病死亡、术后并发症或其他疾病。此外,使用欧洲癌症研究和治疗组织生活质量问卷-核心进行的生活质量评估显示,两组在不同领域或项目上没有显著差异(所有P>0.05):结论:B-II和B-IIB吻合术的对比分析表明,术中参数、术后营养结果、胃内镜结果或术后生活质量均无明显差异。不过,采用博朗吻合术会延长手术时间,并可能增加术后内疝的可能性。
{"title":"Comparison Between Billroth II and Billroth II + Braun Anastomosis in Gastrectomy for Gastric Cancer","authors":"","doi":"10.1016/j.jss.2024.09.044","DOIUrl":"10.1016/j.jss.2024.09.044","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Distal gastrectomy remains the predominant therapeutic approach for gastric cancer, with digestive tract reconstruction as an integral procedure. The implementation of Braun anastomosis following Billroth II anastomosis is common in distal gastrectomy. This retrospective cohort study evaluated the clinical utility of Braun anastomosis by comparing the outcomes and quality of life between Billroth II (B-II) and Billroth II with Braun (B-IIB) anastomosis in the treatment of gastric cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective cohort study examined clinical and pathological data from 377 patients who underwent distal gastrectomy for gastric cancer treatment at The Affiliated Lihuili Hospital, Ningbo University, from October 2016 to October 2021.185 patients received B-II anastomosis, while the other 192 received B-IIB anastomosis, forming the B-II and B-IIB groups, respectively. Baseline characteristics, perioperative variables, short-term and long-term complications, and nutritional indicators at 1 mo and 1 y postsurgery were compared across both groups. Additionally, gastric endoscopy results at 6 mo and 1 y postsurgery were evaluated. Quality of life at 1 y postsurgery was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Baseline characteristics between the two groups revealed no statistically significant differences (all &lt;em&gt;P &gt;&lt;/em&gt; 0.05), confirming their equivalence. All 377 patients successfully underwent curative distal gastrectomy for gastric cancer without intraoperative procedural modifications. No intraoperative complications or perioperative mortality occurred. Notable differences included extended operative time (222.1 ± 41.0 vs. 199.4 ± 24.9 min, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), reduced postoperative nasogastric tube removal time (1.8 ± 0.9 vs. 2.2 ± 1.1 d, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), decreased average gastric drainage volume (100.7 ± 35.2 vs. 112.2 ± 32.0 mL, &lt;em&gt;P&lt;/em&gt; = 0.001), and increased incidence of internal hernia and ileus (4.7% vs. 1.1% and 8.3% vs. 3.2%, &lt;em&gt;P&lt;/em&gt; = 0.038 and &lt;em&gt;P&lt;/em&gt; = 0.035) in the B-IIB group compared to the B-II group. No significant differences were observed in estimated blood loss, lymph node dissection, postoperative flatus time, transition to a semiliquid diet, length of hospital stay, or short-term and long-term complications (all &lt;em&gt;P&lt;/em&gt; &gt; 0.05). Nutritional assessments conducted 1 mo and 1 y postsurgery indicated no statistically significant differences in body mass index, total protein, and serum albumin levels between the two groups (all &lt;em&gt;P&lt;/em&gt; &gt; 0.05). Gastric endoscopy evaluations at 6 mo and 1 y postsurgery, including food residue grade, gastritis severity, extent of gastritis, and bile reflux, demonstrated no significant discrepancies between the groups (all &lt;em&gt;P&lt;/em&gt; &gt; 0.05). At the 1-y follow-up, neither group exhibited tumor r","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Surgical Research
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