Journal of Surgical Research最新文献_第2页

Surgeon Perspectives on Decisional Antecedents in Preoperative Decision-Making 外科医生对术前决策前因的看法。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-10 DOI: 10.1016/j.jss.2026.01.009

Elizabeth Palmer Kelly PhD , Julia McGee BS , Celia E. Wills PhD, RN , Robert Strouse MFA , Tanya R. Gure MD , Maryanna Klatt PhD , Timothy M. Pawlik MD, MPH, MTS, PhD, MBA

Introduction

Shared decision-making (SDM) is widely endorsed in surgical care, yet it is inconsistently applied. A lack of attention to decisional antecedents, including patients’ beliefs, goals, experiences, emotions, and social context, may contribute to this gap, particularly in time-constrained preoperative settings. The current study sought to characterize surgeon perspectives on decisional antecedents and identify opportunities to strengthen SDM within routine surgical workflows.

Methods

In-depth, semistructured interviews were conducted with surgeons at a single academic medical center. Surgeons were identified through departmental faculty lists and invited by email. Interviews were conducted via Zoom, transcribed verbatim, and analyzed thematically in NVivo using an inductive approach. Two team members independently coded transcripts and developed themes through iterative discussion.

Results

Eighteen surgeons from six subspecialties participated. Five themes characterized how surgeons approached SDM in preoperative consultations: (1) variability in patient engagement, (2) role of decisional antecedents, (3) time and cognitive constraints, (4) value of pre-encounter context, and (5) third parties reveal patient values. Surgeons reported that patients differ widely in their readiness, informational needs, prior experiences, and desired involvement, yet this information was often not available to them because routine workflows provided few opportunities to uncover it. Surgeons viewed decisional antecedents and third-party perspectives (e.g., family, caregivers) as central to SDM but reported structural barriers to incorporate these factors during time-limited consultations.

Conclusions

Pre-visit strategies are needed to surface key contextual factors to support SDM within existing surgical workflows.

共享决策（SDM）在外科护理中得到广泛认可，但应用并不一致。缺乏对包括患者信念、目标、经历、情感和社会背景在内的决定性前因的关注，可能导致这种差距，特别是在术前时间有限的情况下。目前的研究旨在描述外科医生对决定前因的看法，并确定在常规手术工作流程中加强SDM的机会。方法：对单一学术医疗中心的外科医生进行深度、半结构化访谈。外科医生通过院系教员名单确定，并通过电子邮件邀请。访谈通过Zoom进行，逐字转录，并在NVivo中使用归纳方法进行主题分析。两名团队成员独立编码文本，并通过迭代讨论开发主题。结果：来自6个亚专科的18名外科医生参与了调查。五个主题描述了外科医生如何在术前咨询中进行SDM:(1)患者参与的可变性，(2)决策前因的作用，(3)时间和认知约束，(4)相遇前情境的价值，以及(5)第三方揭示患者价值。外科医生报告说，患者在准备情况、信息需求、先前经验和期望参与方面差异很大，但由于常规工作流程提供的机会很少，他们通常无法获得这些信息。外科医生认为决定性的前因和第三方观点（如家庭、护理人员）是SDM的核心，但在时间有限的咨询中，报告了将这些因素纳入其中的结构性障碍。结论：在现有的外科工作流程中，需要制定会诊前策略，以显示关键的背景因素，以支持SDM。

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引用次数: 0

Survival of Patients With Noncolorectal Non-Neuroendocrine Liver Metastases: A Nationwide Cohort Study From the Danish Liver Cancer Group 非结直肠非神经内分泌肝转移患者的生存率：一项来自丹麦肝癌组的全国性队列研究。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-10 DOI: 10.1016/j.jss.2026.01.006

Lauge Hjorth Mikkelsen MD, PhD , Peter Nørgaard Larsen MD , Lucas Alexander Knøfler MD , Torsten Pless MD , Anders Riegels Knudsen MD, PhD , Susanne Dam Nielsen MD, DMSc , Mette Lise Lousdal PhD , Morten Ladekarl MD, DMSc , Mogens Stender MD, PhD , Hans-Christian Pommergaard MD, PhD, DMSc

Introduction

Surgical treatment of noncolorectal, non-neuroendocrine liver metastases (NCNNLM) remains unclear. This nationwide study evaluated the outcome of patients with NCNNLM, evaluated at multidisciplinary team conferences and included in the Danish Liver Cancer Group Database, according to surgery or no surgery.

Methods

We identified all patients with NCNNLM evaluated at multidisciplinary team conferences at the four specialized centers in Denmark between October 2013 and November 2023. Patient characteristics and survival were analyzed using descriptive statistics and illustrated by Kaplan–Meier curves, respectively. Prognostic factors were assessed with logistic regression, Cox regression, and accelerated failure time models.

Results

605 patients were included in the analyses. The median follow-up was 20 mo, none were lost to follow-up. The median age of patients was 64 y, with a female predominance (58%). Most patients (93%) had World Health Organization (WHO) performance status 0-1. The overall 5-y survival rate was 29%, with a median survival of 27 mo. Surgery was performed in 307 patients (51%). Surgical intervention was associated with better survival compared with nonsurgical treatment (median survival 39 versus 13 mo, P < 0.05). Poor prognostic factors included age exceeding 64 y (hazard ratio = 1.022, P < 0.0001) and WHO performance status 2-4 (odds ratio 6.89, P = 0.007).

Conclusions

NCNNLM carries a poor prognosis. Surgery of liver metastasis is associated with improved survival with age, WHO performance status, and primary cancer type serving as important prognostic factors. However, from our study we could not establish a causal effect of surgery and confounding by indication is likely.

非结直肠、非神经内分泌肝转移（NCNNLM）的手术治疗尚不清楚。这项全国性的研究评估了NCNNLM患者的预后，在多学科小组会议上进行了评估，并根据手术或不手术纳入了丹麦肝癌组数据库。方法：我们在2013年10月至2023年11月期间在丹麦四个专业中心的多学科小组会议上评估了所有NCNNLM患者。采用描述性统计和Kaplan-Meier曲线分别分析患者特征和生存率。采用logistic回归、Cox回归和加速失效时间模型评估预后因素。结果：605例患者纳入分析。中位随访时间为20个月，无患者失访。患者中位年龄为64岁，以女性为主（58%）。大多数患者（93%）的世界卫生组织（WHO）绩效状态为0-1。总5年生存率为29%，中位生存期为27个月。307例患者（51%）接受了手术。与非手术治疗相比，手术干预与更好的生存相关（中位生存39个月对13个月，P < 0.05）。不良预后因素包括年龄超过64岁（危险比= 1.022,P < 0.0001）和WHO表现状况2-4（优势比6.89,P = 0.007）。结论：NCNNLM预后较差。肝转移手术与生存率的提高相关，年龄、WHO表现状态和原发癌症类型是重要的预后因素。然而，从我们的研究中，我们不能确定手术的因果效应，并且可能因适应症而混淆。

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引用次数: 0

Rupture Predictors and Clinical Outcomes in Jejunal Artery Aneurysms: A Literature Case Series Review 空肠动脉瘤破裂的预测因素和临床结果：文献病例系列回顾。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-10 DOI: 10.1016/j.jss.2026.01.002

Ana Maria Minaya-Bravo PhD , Cristina Vera-Mansilla MD , Fernando Ruiz-Grande PhD

Introduction

Jejunal artery aneurysms (JAAs) account for 1% of all visceral artery aneurysms (VAAs). Fewer than 100 cases have been reported in the English literature, rupture rates approach 60%, compared with 10%-20% for other VAAs. Their rupture risk and management remain poorly defined.

Methods

We reviewed the English literature from 1944 to June 2025 and identified 44 cases of JAAs with analyzable data. Primary objective was to explore predictors of rupture; secondary objective was management. Given the rarity and heterogeneity of reports, statistical analyses were exploratory. To the best of our knowledge, this is the largest series of JAAs with analyzable data reported to date.

Results

Overall rupture rate was 59%, most (64.7%) measured ≤10 mm and occurred in younger individuals (mean age 41.9 versus 57.3 ys, P = 0.0199). Mortality rate was 9.1% (n = 4), including two with connective tissue disease; 26.9% of ruptured cases had no medical history. Rupture was associated with gastrointestinal hemorrhage (P = 0.0019) but not with pain (P = 0.310). Surgical management most common was: aneurysm excision (47.7%) or bowel resection (27.3%). Embolization was performed in 7 cases, with no mortality.

Conclusions

Most of ruptures occurred in small aneurysms (<10 mm) challenging the conventional 2 cm intervention threshold applied to other VAAs. These findings suggest that arterial wall pathology and unstable flow may contribute to rupture, independently of size. Management should be individualized incorporating patient-specific risk factors and underlying vascular vulnerability. This is consistent with the recent international Society for Vascular Surgery Clinical Practical Guidelines recommendations. Further studies are required to define risk stratification.

空肠动脉瘤（JAAs）占所有内脏动脉瘤（VAAs）的1%。在英国文献中报道的病例不到100例，破裂率接近60%，而其他VAAs的破裂率为10%-20%。它们的破裂风险和管理仍然不明确。方法：回顾1944年至2025年6月的英文文献，找出44例JAAs的可分析资料。主要目的是探讨破裂的预测因素；次要目标是管理。鉴于报告的稀有性和异质性，统计分析是探索性的。据我们所知，这是迄今为止报告的具有可分析数据的最大jaa系列。结果：总破裂率为59%，大多数（64.7%）测量≤10 mm，发生在年轻个体（平均年龄41.9岁对57.3岁，P = 0.0199）。死亡率为9.1% (n = 4)，包括2例结缔组织疾病患者；26.9%的破裂病例无病史。破裂与胃肠道出血相关（P = 0.0019），但与疼痛无关（P = 0.310）。手术治疗最常见的是：动脉瘤切除术（47.7%）或肠切除术（27.3%）。栓塞7例，无死亡病例。结论：动脉瘤破裂多发生在小动脉瘤(

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引用次数: 0

Steroidogenesis in Pediatric Adrenal Rests in the Spermatic Cord 精索内小儿肾上腺激素的形成。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-10 DOI: 10.1016/j.jss.2026.01.020

Tsubasa Shironomae PhD, MD , Yuto Yamazaki PhD, MD , Shinako Takeda PhD, MD , Keiko Ainoya PhD, MD , Junji Takeyama PhD, MD , Kiyohide Sakai PhD, MD , Hironobu Sasano PhD, MD , Takashi Suzuki PhD, MD

Introduction

To evaluate steroidogenesis in pediatric adrenal rests in the spermatic cord.

Methods

We reviewed pediatric patients who underwent surgical exploration of the inguinal and scrotal areas retrospectively. When we detected spermatic cord masses during the surgery, we resected it for pathological evaluation.

Results

We first reviewed clinical records of 249 surgeries in 194 male patients in the retrospective fashion and subsequently detected ten adrenal rests in nine cases. Steroid synthases, androgen receptor, Ki-67 were immunolocalized in nine cases to further explore steroidogenesis and potential effects of androgens. All adrenal rests harbored multiple zonae as in eutopic adrenal cortex with fetal adrenal cortex detected in four-fifth adrenal rests in infancy but none after infancy. Age was significantly negatively correlated with adrenocortical areas evaluated by image analysis (P < 0.0001). Immunoreactivity of aldosterone synthase (CYP11B2), 11-beta-hydroxylase, cytochrome P450 17A1, and sulfotransferase 2A1 was diffusely detected mainly in the areas corresponding to the zona glomerulosa (ZG), the zona fasciculata (ZF), the ZF and zona reticularis, and the zona reticularis and fetal adrenal cortex-like structures, respectively. CYP11B2-positive area ratio tended to decrease from birth to early childhood but increase in prepuberty. Diffuse cytoplasmic androgen receptor immunoreactivity was detected in ZG-like cells in prepubertal specimens. Ki-67 positive cells were mainly detected in the ZG- and ZF-like cells, mostly in infancy.

Conclusions

Androgen-dependent aldosterone biosynthesis may differ between adrenal rests and eutopic adrenal glands, but steroidogenesis in adrenal rests in the spermatic cord is considered normal.

目的：评价精索内小儿肾上腺激素的形成。方法：我们回顾了接受手术探查腹股沟和阴囊区域的儿童患者。当我们在手术中发现精索团块时，我们将其切除以进行病理评估。结果：我们首先回顾了194例男性患者249例手术的临床记录，随后在9例中发现了10例肾上腺休息。9例患者免疫定位类固醇合成酶、雄激素受体、Ki-67，进一步探讨雄激素的类固醇形成及其潜在作用。所有的肾上腺皮质都像异位肾上腺皮质一样有多个带，在婴儿期有四分之五的胎儿肾上腺皮质被检测到，但在婴儿期后没有。年龄与图像分析评估的肾上腺皮质面积呈显著负相关（P < 0.0001）。醛固酮合成酶（CYP11B2）、11- β -羟化酶、细胞色素P450 17A1和硫转移酶2A1的免疫反应性主要分布在肾小球带（ZG）、束状带（ZF）、ZF和网状带以及网状带和胎儿肾上腺皮质样结构对应的区域。cyp11b2阳性面积比在出生后至幼儿期呈下降趋势，在青春期前呈上升趋势。在青春期前的zg样细胞中检测到弥漫性细胞质雄激素受体免疫反应性。Ki-67阳性细胞以ZG-和zf样细胞为主，多见于婴儿期。结论：雄激素依赖性醛固酮生物合成在肾上腺休止点和异位肾上腺之间可能有所不同，但精索肾上腺休止点的甾体生成被认为是正常的。

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引用次数: 0

Acute Care and Colorectal Surgeon Views on Management of Patients With Acute Surgical Conditions. 急症护理与结直肠外科医生对急症手术病人处理的看法。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-09 DOI: 10.1016/j.jss.2025.12.038

Sara Myers, Bachar Halimeh, Sheina Theodore, Olga Beresneva, Veer Sawhney, Samantha Rivard, Sabrina E Sanchez, Jennnifer S Davids

Introduction: Both acute care surgeons (ACS) and colorectal surgeons (CRS) manage patients with acute lower gastrointestinal (GI) surgical conditions. No consensus guidelines exist regarding which service is best suited to manage specific conditions. We investigated surgeon views and practice patterns regarding service allocation for the management of acute lower GI conditions.

Methods: An anonymous survey was emailed to all 237 ACS and CRS at teaching hospitals in New England with both departments (n = 19) in April 2024. Respondents rated 20 conditions on which service should manage each condition and which service usually manages the condition at their institution. Surgeons also assessed factors influencing service allocation. For each condition, the average of each service's responses was calculated and compared between the two specialties. Open-ended responses regarding barriers to creating consensus guidelines were evaluated using qualitative thematic analysis.

Results: The response rate was 41% (n = 96), with 38% ACS (n = 55) and 45% CRS (n = 41). ACS and CRS agreed about who should manage 14 of the 20 surgical conditions. In cases of disagreement, each service preferred to manage the condition, rather than the other service. Although ACS rated CRS availability to be an important factor for decision-making, CRS felt that time of day and day of week were less important.

Conclusions: ACS and CRS in New England agreed on which specialty should manage several acute lower GI surgical conditions and some factors impacting these decisions. These data may be used to develop consensus guidelines to streamline care allocation and potentially limit delays in care.

简介：急性护理外科医生（ACS）和结肠直肠外科医生（CRS）管理急性下胃肠道（GI）手术条件的患者。关于哪种服务最适合管理特定条件，目前还没有一致的指导方针。我们调查了外科医生对急性下消化道疾病管理服务分配的看法和实践模式。方法：于2024年4月通过电子邮件对新英格兰地区教学医院两科共237名ACS和CRS （n = 19）进行匿名调查。受访者对20个条件进行了评级，在这些条件下，服务部门应该管理每个条件，哪些服务部门通常管理他们机构的条件。外科医生还评估了影响服务分配的因素。对于每种情况，计算每种服务响应的平均值，并在两个专业之间进行比较。利用定性专题分析评估了关于建立协商一致准则的障碍的不限成员名额答复。结果：有效率为41% (n = 96)，其中ACS为38% (n = 55)， CRS为45% （n = 41）。ACS和CRS就20种手术条件中的14种由谁来处理达成了一致。在不一致的情况下，每个服务都倾向于管理条件，而不是其他服务。虽然ACS认为CRS的可用性是决策的重要因素，但CRS认为一天中的时间和一周中的哪一天不那么重要。结论：ACS和CRS在新英格兰就哪些专科应该处理几种急性下消化道手术情况以及影响这些决定的一些因素达成一致。这些数据可用于制定共识指南，以简化护理分配和潜在地限制护理延误。

{"title":"Acute Care and Colorectal Surgeon Views on Management of Patients With Acute Surgical Conditions.","authors":"Sara Myers, Bachar Halimeh, Sheina Theodore, Olga Beresneva, Veer Sawhney, Samantha Rivard, Sabrina E Sanchez, Jennnifer S Davids","doi":"10.1016/j.jss.2025.12.038","DOIUrl":"https://doi.org/10.1016/j.jss.2025.12.038","url":null,"abstract":"<p><strong>Introduction: </strong>Both acute care surgeons (ACS) and colorectal surgeons (CRS) manage patients with acute lower gastrointestinal (GI) surgical conditions. No consensus guidelines exist regarding which service is best suited to manage specific conditions. We investigated surgeon views and practice patterns regarding service allocation for the management of acute lower GI conditions.</p><p><strong>Methods: </strong>An anonymous survey was emailed to all 237 ACS and CRS at teaching hospitals in New England with both departments (n = 19) in April 2024. Respondents rated 20 conditions on which service should manage each condition and which service usually manages the condition at their institution. Surgeons also assessed factors influencing service allocation. For each condition, the average of each service's responses was calculated and compared between the two specialties. Open-ended responses regarding barriers to creating consensus guidelines were evaluated using qualitative thematic analysis.</p><p><strong>Results: </strong>The response rate was 41% (n = 96), with 38% ACS (n = 55) and 45% CRS (n = 41). ACS and CRS agreed about who should manage 14 of the 20 surgical conditions. In cases of disagreement, each service preferred to manage the condition, rather than the other service. Although ACS rated CRS availability to be an important factor for decision-making, CRS felt that time of day and day of week were less important.</p><p><strong>Conclusions: </strong>ACS and CRS in New England agreed on which specialty should manage several acute lower GI surgical conditions and some factors impacting these decisions. These data may be used to develop consensus guidelines to streamline care allocation and potentially limit delays in care.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157615","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

Textbook Outcomes After Esophagectomy with Gastric Conduit for Cancer: A 2016-2021 National Surgical Quality Improvement Program Analysis 食管癌胃导管切除术后的预后：2016-2021年国家手术质量改进计划分析

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-06 DOI: 10.1016/j.jss.2025.12.036

James J. Park BA , Giles F. Whalen MD, FACS , Isabel Cristina M. Emmerick PhD , Karl F. Uy MD, FACS , Mark W. Maxfield MD, FACS , Allison Crawford MS , Feiran Lou MD, MS, FACS

Introduction

Textbook outcome (TO) is a composite measure designed to assess the overall short-term outcome of an operation. TO after esophagectomy with gastric conduit using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database has not yet been defined.

Methods

Records in the NSQIP Esophagectomy Procedure-Targeted database from 2016 to 2021 were analyzed. Patients who underwent elective esophagectomies with gastric conduit for resectable esophageal cancer were included. TO was defined as the absence of anastomotic leak, major complications, positive surgical margins, reintervention ≤30 d postsurgery, prolonged hospital stay (> 21 d), postoperative mortality ≤ 30 d after surgery, and readmission ≤ 30 d after discharge.

Results

Of the 6813 patients in the 2016-2021 NSQIP database who underwent esophagectomy, 3733 met study criteria. A total of 2520 (68%) patients achieved TO. The presence of a major complication most frequently prevented the achievement of TO (19%, 692/3733), while the presence of postoperative mortality ≤ 30 d after surgery least frequently prevented achievement of TO (2.3%). The most common complications were organ/space Surgical Site Infection (10%, 372/3733) and unplanned intubation (10%, 366/3733). Of the 493 patients who failed to achieve TO due to one parameter, positive margins (4.7%, 175/3733) and major complications (3.2%, 120/3733) most frequently prevented the achievement of TO. In a multivariable analysis, node stage of 2 or 3 in the TNM staging system, chronic obstructive pulmonary disease, American Society of Anesthesiologists classification of 4, underweight body mass index, Asian race, prolonged operation time, increased preoperative white blood cell, and older age had statistically significant association with failure to achieve TO.

Conclusions

In an analysis of the NSQIP database, 68% of cases resulted in TO. Several factors were associated with failure to achieve TO. Further investigations are needed to test if modifying variables like preoperative weight can lead to improved outcomes.

简介：教科书结果（TO）是一种综合措施，旨在评估一个操作的整体短期结果。根据美国外科医师学会国家手术质量改进计划（NSQIP）数据库，胃导管食管切除术后的TO尚未定义。方法：对NSQIP食管切除术手术目标数据库2016 - 2021年的记录进行分析。可切除食管癌患者接受择期食管切除术和胃导管切除术。TO定义为无吻合口漏、主要并发症、手术切缘阳性、术后再干预≤30 d、住院时间延长（> ~ 21 d）、术后死亡率≤30 d、出院后再入院≤30 d。结果：2016-2021年NSQIP数据库中6813例接受食管切除术的患者中，3733例符合研究标准。共有2520例（68%）患者达到了TO。主要并发症的存在最常阻碍TO的实现（19%,692/3733），而术后死亡率≤30 d的存在最不常阻碍TO的实现（2.3%）。最常见的并发症是器官/空间手术部位感染（10%,372/3733）和计划外插管（10%,366/3733）。在493例因一个参数未能达到to的患者中，阳性切缘（4.7%,175/3733）和主要并发症（3.2%,120/3733）最常阻碍to的实现。在一项多变量分析中，TNM分期系统中的淋巴结分期为2或3、慢性阻塞性肺病、美国麻醉学会分类为4、体重指数过轻、亚洲种族、手术时间延长、术前白细胞升高和年龄较大与未能达到to有统计学意义的关联。结论：在NSQIP数据库的分析中，68%的病例导致TO。有几个因素与未能实现to有关。需要进一步的研究来检验是否修改诸如术前体重之类的变量可以改善预后。

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引用次数: 0

Letter Regarding: Predicting Functional Outcomes in Adult Traumatic Brain Injuries Using the Base Deficit, International Normalized Ratio, and Glasgow Coma Scale Score. 关于：使用基础缺陷、国际标准化比率和格拉斯哥昏迷评分预测成人外伤性脑损伤的功能结局。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-05 DOI: 10.1016/j.jss.2025.11.069

Amir Masoud Karimi, Ali Hosseini

引用次数: 0

Incidence and Risk Factors for Venous Thromboembolism in Hemodynamically Unstable Pelvic Fractures 血流动力学不稳定骨盆骨折中静脉血栓栓塞的发生率和危险因素。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-05 DOI: 10.1016/j.jss.2026.01.008

Rachel A. Holstein MPH , Courtney H. Meyer MD, MPH , Olivia Herrmann BS , Alejandro De Leon Castro MD , James Walker MD , Samuel R. Todd MD , Randi N. Smith MD, MPH , Jonathan Nguyen DO , Jason D. Sciarretta MD

Introduction

Pelvic fractures can cause severe hemorrhage and instability in trauma patients. The association between pelvic fracture morphology, venous thromboembolism (VTE) risk, and clinical outcomes remains unclear. This study evaluates the incidence, risk factors, characteristics, and outcomes of VTE in hemodynamically unstable pelvic fractures.

Methods

This retrospective cohort study included adult trauma patients with blunt pelvic ring disruptions and hemorrhagic shock (systolic blood pressure <90 mmHg) admitted to an American College of Surgeons-verified Level I adult trauma center between January 1, 2022 and May 31, 2023. Demographic and clinical data were abstracted from the electronic medical record. The primary outcome was in-hospital VTE. Secondary outcomes included intensive care unit and hospital length of stay (LOS) and mortality.

Results

Of 133 patients, 32 (24.1%) developed VTE (4.5% deep vein thrombosis alone, 12.8% pulmonary embolism alone, 6.8% both). VTE was diagnosed a median of 7 d after admission. Nearly all patients received early chemoprophylaxis (median initiation hospital day 1), with no differences in timing by VTE status or fracture pattern (P > 0.05). Fracture morphology was not independently associated with VTE. VTE was associated with longer intensive care unit LOS (11.5 versus 5.0 d, P < 0.001) and hospital LOS (20.5 versus 17.0 d, P = 0.028), though mortality did not differ. In multivariable regression, no independent associations were found between VTE and age, sex, body mass index, or injury severity score.

Conclusions

VTE was common despite early chemoprophylaxis. Fracture morphology did not independently predict VTE. Early VTE timing underscores the need for vigilant surveillance and uninterrupted prophylaxis. Prospective studies are needed.

骨盆骨折可导致创伤患者严重出血和不稳定。骨盆骨折形态、静脉血栓栓塞（VTE）风险和临床结果之间的关系尚不清楚。本研究评估血流动力学不稳定骨盆骨折中静脉血栓栓塞的发生率、危险因素、特征和结局。结果：133例患者中，32例（24.1%）发生静脉血栓栓塞（仅深静脉血栓形成4.5%，仅肺栓塞12.8%，两者均为6.8%）。静脉血栓栓塞的诊断中位时间为入院后7天。几乎所有患者都接受了早期化疗预防（中位数开始住院第1天），静脉血栓栓塞状态或骨折类型在时间上没有差异（P < 0.05）。骨折形态与静脉血栓栓塞没有独立的关系。静脉血栓栓塞与较长的重症监护病房LOS （11.5 d对5.0 d, P < 0.001）和医院LOS （20.5 d对17.0 d, P = 0.028）相关，但死亡率没有差异。在多变量回归中，没有发现静脉血栓栓塞与年龄、性别、体重指数或损伤严重程度评分之间的独立关联。结论：静脉血栓栓塞是常见的，尽管早期化疗预防。骨折形态不能独立预测静脉血栓栓塞。静脉血栓栓塞的早期时机强调了警惕监测和不间断预防的必要性。前瞻性研究是必要的。

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引用次数: 0

Preoperative Glucagon-like Peptide-1 Therapy in Bariatric Surgery Patients with Morbid Obesity (PreMO): Rationale and Study Design for a Randomized Controlled Trial 术前胰高血糖素样肽-1治疗减肥手术患者的病态肥胖（PreMO）：一个随机对照试验的基本原理和研究设计。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-04 DOI: 10.1016/j.jss.2026.01.004

Varun Jain MD , Colleen A. McMullen MA, MBA , Joy I. Kimbrough BSN, MBA , Anna K. Rockich PharmD, MS , Daniel L. Davenport PhD , Gregory S. Hawk PhD , Barbara S. Nikolajczyk PhD , Philip A. Kern MD , Simon J. Fisher MD, PhD , Joshua P. Steiner MD , William B. Inabnet III MD, MHA , Marlene E. Starr PhD

Introduction

Bariatric surgery is the most effective treatment modality for individuals with morbid obesity, providing significant and durable weight loss and comorbidity resolution. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide receptor agonists have shown promise as weight loss drugs, in addition to their use in the treatment of metabolic disorders. While multimodal weight management is the standard of care for individuals with morbid obesity, the benefit of antecedent GLP-1 therapy prior to bariatric surgery has not been well-studied. The objective of this study is to conduct a clinical trial testing the hypothesis that preoperative treatment with a dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonist enhances preoperative weight loss and decreases tissue inflammation, resulting in improved postoperative outcomes.

Materials and methods

We designed a randomized controlled trial (RCT) comparing preoperative treatment with tirzepatide versus standard medical care prior to minimally invasive bariatric surgery with a target enrollment of 50 patients randomized 1:1. For 3 mo preoperatively, the control arm will receive standard care in the form of dietary and lifestyle modification recommendations, whereas the treatment arm will receive weekly tirzepatide, in addition to standard care. Blood will be collected at enrollment through 12-mo postoperatively and analyzed for inflammatory and metabolic markers. Tissues (adipose, stomach, and liver) will be collected intraoperatively for transcriptome profiling and histological assessment.

Results

This is an ongoing trial with no reportable results.

Conclusion

Completion of this pilot RCT will provide data to support initiation of a multicenter RCT to determine therapeutic efficacy, and mechanisms of action, by which patients could benefit from preoperative treatment with tirzepatide.

简介：减肥手术是对病态肥胖患者最有效的治疗方式，提供显著和持久的体重减轻和合并症解决。胰高血糖素样肽-1 （GLP-1）和葡萄糖依赖性胰岛素多肽受体激动剂除了用于治疗代谢紊乱外，还显示出作为减肥药物的前景。虽然多模式体重管理是病态肥胖患者的标准治疗方法，但在减肥手术前进行GLP-1治疗的益处尚未得到充分研究。本研究的目的是通过一项临床试验来验证假设，即术前使用双GLP-1/葡萄糖依赖性胰岛素多肽受体激动剂可以促进术前体重减轻，减少组织炎症，从而改善术后预后。材料和方法：我们设计了一项随机对照试验（RCT），比较微创减肥手术前使用替西帕肽的术前治疗与标准医疗护理，目标入组50例患者，按1:1随机分组。术前3个月，对照组将接受饮食和生活方式改变建议形式的标准治疗，而治疗组除标准治疗外，每周接受替西帕肽治疗。从入组到术后12个月采集血液，分析炎症和代谢标志物。术中收集组织（脂肪、胃和肝脏）进行转录组分析和组织学评估。结果：这是一项正在进行的试验，没有报告的结果。结论：该试点RCT的完成将为开展多中心RCT提供数据支持，以确定治疗效果和作用机制，从而使患者能够从替西肽术前治疗中获益。

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引用次数: 0

Gaps in the Electronic Medical Record May Contribute to Low Participation in Lung Cancer Screening 电子病历的空白可能导致肺癌筛查参与率低。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-04 DOI: 10.1016/j.jss.2025.11.074

Kayla A. Fay MPH , Karen E. Schifferdecker PhD, MPH , Linda M. Kinney MPA , Ellie J. Kyung PhD , Sean R. Halloran BA , Samuel Youkilis BA , Shoshana H. Bardach PhD , Amanda N. Perry BA , Maureen B. Boardman MSN, FNP-C, FAANP , Rian M. Hasson MD, MPH

Introduction

Best Practice Advisories (BPAs) are electronic medical record (EMR) tools that help increase uptake of recommended health care behaviors, such as cancer screenings, by identifying eligible patients and alerting providers. However, incomplete/inaccurate documentation within the EMR can be a potential barrier to BPA utility. The purpose of this work was to investigate the effectiveness of a BPA tool to identify eligible patients for lung cancer screening (LCS) using available EMR smoking histories.

Materials and methods

Retrospective observational review was conducted of a BPA programmed to identify LCS-eligible patients at a single quaternary, LCS-accredited, academic medical center. Programming targeted patients aged 50-77 y classified as “current” or “former smokers,” excluding patients with recent lung computed tomography scans and/or lung cancer diagnoses. Data analyzed included frequency of BPA activation and the associated smoking history. Descriptive statistics were used to analyze outcomes.

Results

Between January 2017 and December 2021, there were 25,172 BPA activations, of which 11,701 were removed because they occurred outside a clinical/telehealth visit. This left 14,101 BPAs linked to 3150 patients. EMR information was not sufficient to calculate pack-year history for 48.9% (1541/3150), and the LCS order rate was 2.5% (78/3150). Although pulmonary disease specialists accounted for 13.7% (236/1721) of total LCS orders, the BPA did not activate for them.

Conclusions

Incomplete EMR data entry may contribute to the complexities of identifying LCS-eligible patients. This highlights the value of improving the completeness of EMR smoking history data and conducting targeted BPA audits to understand optimal activation parameters to improve clinician orders for LCS.

简介：最佳实践咨询（bpa）是电子医疗记录（EMR）工具，通过识别符合条件的患者并提醒提供者，有助于提高推荐的医疗保健行为（如癌症筛查）的接受度。然而，EMR中不完整/不准确的文档可能是BPA应用的潜在障碍。这项工作的目的是调查BPA工具的有效性，以确定符合条件的肺癌筛查（LCS）患者使用现有的电子病历吸烟史。材料和方法：回顾性观察性评价BPA程序，以确定lcs合格的患者在一个单一的四级，lcs认可的学术医疗中心。计划的目标患者年龄在50-77岁之间，被归类为“当前”或“曾经吸烟者”，不包括最近进行肺部计算机断层扫描和/或肺癌诊断的患者。分析的数据包括BPA激活的频率和相关的吸烟史。采用描述性统计分析结果。结果：在2017年1月至2021年12月期间，有25,172例BPA激活，其中11,701例因为发生在临床/远程医疗访问之外而被删除。剩下的14101个双酚a与3150名患者有关。48.9%（1541/3150）的EMR信息不足以计算包年历史，LCS订单率为2.5%（78/3150）。虽然肺病专家占总LCS订单的13.7%(236/1721)，但BPA并未为他们激活。结论：不完整的EMR数据输入可能会增加识别lcs合格患者的复杂性。这突出了提高EMR吸烟史数据的完整性和进行有针对性的BPA审计以了解最佳激活参数以改善临床医生对LCS的指示的价值。

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