Pub Date : 2026-01-31DOI: 10.1016/j.jss.2026.01.001
Kali Bravo, Julie C McKee, Russell Wells, Shawn Izadi, Benjamin Carr, Sanjay Krishnaswami
Introduction: Opioid stewardship is an important tenet of modern pediatric surgical care. However, the burden of opioid use for common surgical procedures in infants remains undefined. We aimed to compare patterns of opioid administration for a common operation between children recovering on different hospital units.
Methods: We performed a retrospective review of pediatric and neonatal patients at a single children's hospital undergoing isolated laparoscopic gastrostomy tube placement from 2021 to 2023. Opioid exposure was tracked in morphine milligram equivalents per kilogram (MME/kg), intraoperatively and 48 h postoperatively.
Results: A total of 158 ward (aged 0-17 y, median 14 mo) and 51 neonatal intensive care unit (NICU) patients (aged 3 wk to 7 mo, median 3 mo) were included. Intraoperative MME/kg did not differ significantly between the NICU and ward (median 0.46 versus 0.47 MME/kg, P = 0.63), but the postoperative use was significantly higher in the NICU (median 0.28 versus 0.00 MME/kg, P < 0.0001), as was the number of postoperative administrations (median 2 versus 0, P < 0.0001) and opioid exposure time (median 10 versus 2 h, P < 0.0001). Similar trends were observed on subset analysis of NICU versus ward patients ≤12 mo; the median postoperative use (0.28 versus 0.00 MME/kg, P < 0.0001), median number of postoperative administrations (2 versus 0, P < 0.0001), and median time to last dose (10 versus 2 h, P = 0.0002) were all significantly higher in the NICU.
Conclusions: NICU patients had a significantly higher postoperative opioid use than pediatric ward patients after identical surgeries. Further work is needed to identify root causes, validate findings across other procedures and institutions, optimize opioid stewardship, and limit variation across hospital units.
阿片类药物管理是现代儿科外科护理的重要宗旨。然而，在婴儿普通外科手术中使用阿片类药物的负担仍不明确。我们的目的是比较在不同医院康复的儿童在普通手术中使用阿片类药物的模式。方法：我们对2021年至2023年在一家儿童医院接受孤立腹腔镜胃造口管置入的儿童和新生儿患者进行回顾性分析。在术中和术后48小时，以吗啡毫克当量每公斤（MME/kg）追踪阿片类药物暴露。结果：共纳入158例病区患者（年龄0-17岁，中位14个月）和51例新生儿重症监护病房（NICU）患者（年龄3周到7个月，中位3个月）。术中MME/kg在NICU和病房之间没有显著差异（中位数为0.46对0.47 MME/kg, P = 0.63），但术后NICU的MME/kg使用率显著高于NICU（中位数为0.28对0.00 MME/kg, P < 0.0001），术后给药次数（中位数为2对0，P < 0.0001）和阿片类药物暴露时间（中位数为10对2小时，P < 0.0001）。在NICU与病房患者的亚组分析中也观察到类似的趋势；NICU的术后用药中位数（0.28比0.00 MME/kg, P < 0.0001）、术后给药中位数（2比0，P < 0.0001）和至末次给药时间中位数（10比2 h， P = 0.0002）均显著高于NICU。结论：NICU患者术后阿片类药物使用明显高于相同手术后的儿科病房患者。需要进一步的工作来确定根本原因，验证其他程序和机构的发现，优化阿片类药物管理，并限制医院单位之间的差异。
{"title":"Hospital Unit Variation in Pediatric Postoperative Opioid Administration Is Associated With Increased Neonatal Opioid Exposure.","authors":"Kali Bravo, Julie C McKee, Russell Wells, Shawn Izadi, Benjamin Carr, Sanjay Krishnaswami","doi":"10.1016/j.jss.2026.01.001","DOIUrl":"https://doi.org/10.1016/j.jss.2026.01.001","url":null,"abstract":"<p><strong>Introduction: </strong>Opioid stewardship is an important tenet of modern pediatric surgical care. However, the burden of opioid use for common surgical procedures in infants remains undefined. We aimed to compare patterns of opioid administration for a common operation between children recovering on different hospital units.</p><p><strong>Methods: </strong>We performed a retrospective review of pediatric and neonatal patients at a single children's hospital undergoing isolated laparoscopic gastrostomy tube placement from 2021 to 2023. Opioid exposure was tracked in morphine milligram equivalents per kilogram (MME/kg), intraoperatively and 48 h postoperatively.</p><p><strong>Results: </strong>A total of 158 ward (aged 0-17 y, median 14 mo) and 51 neonatal intensive care unit (NICU) patients (aged 3 wk to 7 mo, median 3 mo) were included. Intraoperative MME/kg did not differ significantly between the NICU and ward (median 0.46 versus 0.47 MME/kg, P = 0.63), but the postoperative use was significantly higher in the NICU (median 0.28 versus 0.00 MME/kg, P < 0.0001), as was the number of postoperative administrations (median 2 versus 0, P < 0.0001) and opioid exposure time (median 10 versus 2 h, P < 0.0001). Similar trends were observed on subset analysis of NICU versus ward patients ≤12 mo; the median postoperative use (0.28 versus 0.00 MME/kg, P < 0.0001), median number of postoperative administrations (2 versus 0, P < 0.0001), and median time to last dose (10 versus 2 h, P = 0.0002) were all significantly higher in the NICU.</p><p><strong>Conclusions: </strong>NICU patients had a significantly higher postoperative opioid use than pediatric ward patients after identical surgeries. Further work is needed to identify root causes, validate findings across other procedures and institutions, optimize opioid stewardship, and limit variation across hospital units.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"24-29"},"PeriodicalIF":1.7,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100244","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}
Pub Date : 2026-01-30DOI: 10.1016/j.jss.2026.01.007
Jayati Atahar MBBS, MPH , Jeremy Hayward MD , Alex I. Halpern MD , Ahmed Noureldin MD , Stephanie Boese MSN, RN, CCRN, TCRN , Susan Kartiko MD, PhD, FACS
<div><h3>Introduction</h3><div>Delirium is a common finding among patients with traumatic brain injuries (TBIs). Lack of sleep has been identified as contributing factors to the development of delirium. However, TBI patients in the intensive care unit (ICU) often undergo every-hour neurologic examinations (Q1 neuro checks) that disrupt their sleep. We sought to better understand the association between Q1 neuro check duration and delirium in ICU TBI patients. We hypothesize that shorter duration of Q1 neuro checks in TBI patients would be associated with fewer delirium diagnosis delirium without increased complications.</div></div><div><h3>Methods</h3><div>We performed a single-institution retrospective cohort analysis of ICU patients with TBI who underwent Q1 neuro checks at a level 1 trauma center from December 2021 to July 2023. We excluded minors and patients who died within 24 h of admission, and patients with catastrophic brain injury incompatible with life. We divided the cohort between those who underwent Q1 neuro checks for less than 24 h and those who underwent Q1 neuro checks for greater than 24 h. We used univariate and multivariate analyses to evaluate our primary outcome, delirium. Delirium diagnosis was done by the ICU clinicians based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria. We used multivariate logistic and linear regression models to analyze unplanned return to ICU, intracranial rebleed, other complications, mortality, hospital and ICU length of stay (LOS), and a Cox proportional hazards model to analyze the hazard ratios for all the complications and death.</div></div><div><h3>Results</h3><div>We identified 153 patients, 93 underwent Q1 neuro checks for less than 24 h and 60 underwent Q1 neuro checks for greater than 24 h. On univariate analysis, there was not a significant difference in rates of delirium between the groups who underwent Q1 neuro checks for less than 24 h and for greater than 24 h (odds ratio [OR] 2.15; 95% confidence interval [CI] 0.79-5.91, <em>P</em> = 0.14). However, on multivariate analysis, after controlling patient demographics, initial Glasgow Coma Scale (GCS), Injury Severity Score, injury status, ventilation requirement, and presence of complications; patients undergoing Q1 neuro checks for more than 24 h had a statistically significant increased risk of delirium (OR 9.73; 95% CI 1.14-82.90, <em>P</em> < 0.05), mortality (OR 17.11; 95% CI 1.72-170.77, <em>P</em> < 0.05), and ICU LOS (2.57 days; 95% CI 1.23-3.92, <em>P</em> < 0.05) compared to the Q1 ≤ 24 h group. There was no significant difference in overall complications between the two groups (hazard ratio = 1.52, 95% CI 0.76-3.06, <em>P</em> = 0.24).</div></div><div><h3>Conclusions</h3><div>This study found that Q1 neuro checks for more than 24 h for TBI patients were associated with a significantly increased risk of delirium, mortality, and ICU LOS with no significant increase in overall complic
谵妄是外伤性脑损伤（tbi）患者的常见症状。睡眠不足被认为是导致谵妄的一个因素。然而，重症监护病房（ICU）的TBI患者通常每小时进行一次神经系统检查（Q1神经检查），这会扰乱他们的睡眠。我们试图更好地了解ICU TBI患者Q1神经检查时间与谵妄之间的关系。我们假设较短的TBI患者Q1神经检查时间与较少的谵妄诊断相关，谵妄没有增加并发症。方法对2021年12月至2023年7月在一级创伤中心接受Q1神经检查的ICU TBI患者进行单机构回顾性队列分析。我们排除了未成年人和入院24小时内死亡的患者，以及与生活不相容的灾难性脑损伤患者。我们将队列分为接受Q1神经检查少于24小时和接受Q1神经检查超过24小时的两组。我们使用单变量和多变量分析来评估我们的主要结局——谵妄。谵妄诊断由ICU临床医生根据《精神障碍诊断与统计手册》第5版标准进行。我们采用多变量logistic和线性回归模型分析意外返回ICU、颅内再出血、其他并发症、死亡率、住院和ICU住院时间（LOS），并采用Cox比例风险模型分析所有并发症和死亡的风险比。结果153例患者中，93例患者Q1神经检查时间小于24小时，60例患者Q1神经检查时间大于24小时。单因素分析显示，Q1神经检查时间小于24小时和大于24小时的两组患者谵妄发生率无显著差异（优势比[OR] 2.15； 95%可信区间[CI] 0.79-5.91, P = 0.14）。然而，在多变量分析中，在控制了患者人口统计学、初始格拉斯哥昏迷量表（GCS）、损伤严重程度评分、损伤状态、通气需求和并发症的存在后；与Q1≤24 h组相比，接受Q1神经检查超过24 h的患者谵妄（OR 9.73, 95% CI 1.14-82.90, P < 0.05）、死亡率（OR 17.11, 95% CI 1.72-170.77, P < 0.05）和ICU LOS（2.57天，95% CI 1.23-3.92, P < 0.05）的风险增加具有统计学意义。两组总并发症发生率差异无统计学意义（风险比= 1.52,95% CI 0.76-3.06, P = 0.24）。本研究发现，TBI患者超过24小时的Q1神经检查与谵妄、死亡率和ICU LOS的风险显著增加相关，但总体并发症无显著增加。需要对更大的患者群体进行进一步的研究来证实这些结果，并更好地了解哪些TBI患者将从较短的Q1神经检查时间中受益。
{"title":"Reduction of Neuro Check Intervals in Traumatic Brain Injury Patients is Associated With Lowers Delirium Risk","authors":"Jayati Atahar MBBS, MPH , Jeremy Hayward MD , Alex I. Halpern MD , Ahmed Noureldin MD , Stephanie Boese MSN, RN, CCRN, TCRN , Susan Kartiko MD, PhD, FACS","doi":"10.1016/j.jss.2026.01.007","DOIUrl":"10.1016/j.jss.2026.01.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Delirium is a common finding among patients with traumatic brain injuries (TBIs). Lack of sleep has been identified as contributing factors to the development of delirium. However, TBI patients in the intensive care unit (ICU) often undergo every-hour neurologic examinations (Q1 neuro checks) that disrupt their sleep. We sought to better understand the association between Q1 neuro check duration and delirium in ICU TBI patients. We hypothesize that shorter duration of Q1 neuro checks in TBI patients would be associated with fewer delirium diagnosis delirium without increased complications.</div></div><div><h3>Methods</h3><div>We performed a single-institution retrospective cohort analysis of ICU patients with TBI who underwent Q1 neuro checks at a level 1 trauma center from December 2021 to July 2023. We excluded minors and patients who died within 24 h of admission, and patients with catastrophic brain injury incompatible with life. We divided the cohort between those who underwent Q1 neuro checks for less than 24 h and those who underwent Q1 neuro checks for greater than 24 h. We used univariate and multivariate analyses to evaluate our primary outcome, delirium. Delirium diagnosis was done by the ICU clinicians based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria. We used multivariate logistic and linear regression models to analyze unplanned return to ICU, intracranial rebleed, other complications, mortality, hospital and ICU length of stay (LOS), and a Cox proportional hazards model to analyze the hazard ratios for all the complications and death.</div></div><div><h3>Results</h3><div>We identified 153 patients, 93 underwent Q1 neuro checks for less than 24 h and 60 underwent Q1 neuro checks for greater than 24 h. On univariate analysis, there was not a significant difference in rates of delirium between the groups who underwent Q1 neuro checks for less than 24 h and for greater than 24 h (odds ratio [OR] 2.15; 95% confidence interval [CI] 0.79-5.91, <em>P</em> = 0.14). However, on multivariate analysis, after controlling patient demographics, initial Glasgow Coma Scale (GCS), Injury Severity Score, injury status, ventilation requirement, and presence of complications; patients undergoing Q1 neuro checks for more than 24 h had a statistically significant increased risk of delirium (OR 9.73; 95% CI 1.14-82.90, <em>P</em> < 0.05), mortality (OR 17.11; 95% CI 1.72-170.77, <em>P</em> < 0.05), and ICU LOS (2.57 days; 95% CI 1.23-3.92, <em>P</em> < 0.05) compared to the Q1 ≤ 24 h group. There was no significant difference in overall complications between the two groups (hazard ratio = 1.52, 95% CI 0.76-3.06, <em>P</em> = 0.24).</div></div><div><h3>Conclusions</h3><div>This study found that Q1 neuro checks for more than 24 h for TBI patients were associated with a significantly increased risk of delirium, mortality, and ICU LOS with no significant increase in overall complic","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 10-17"},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146070976","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}
Pub Date : 2026-01-29DOI: 10.1016/j.jss.2025.12.042
Kayla A. Fay MPH , Karen E. Schifferdecker PhD, MPH , Linda M. Kinney MPA , Ellie J. Kyung PhD , Shoshana H. Bardach PhD , Maureen B. Boardman MSN, FNP-C, FAANP , Dagmar Hoegemann Savellano MD , Connor Bridges BS , Sean R. Halloran BA , Samuel Youkilis BA , Tom Bird , Rian M. Hasson MD, MPH
Introduction
Uptake of lung cancer screening (LCS) suffers from the misconception that LCS produces high false-positive findings. The purpose of this study was to assess LCS results to better quantify these rates.
Methods
Retrospective review of patients who underwent LCS at a single, LCS-accredited rural health system from January 2017 to March 2022 was performed. Patient demographics, Lung Reporting and Data Systems (Lung-RADS) score, and follow-up data were reviewed. Using the patient's first LCS scan, the false-positive rate was calculated using Lung-RADS 3 or higher as an indication of a “positive” finding and then calculated using Lung-RADS 4B and 4X alone.
Results
Analyses included 1708 patients, and 89.9% (1536/1708) of these scans were Lung-RADS 1 or 2. Among 80 patients whose first scan resulted in Lung-RADS 3, and 54 patients with Lung-RADS 4a, 61.3% (49/80) and 48.1% (26/54), respectively, received a lower Lung-RADS score on a follow-up scan, allowing them to return to annual screening. Twenty-nine percent (11/38) of those with Lung-RADS 4B or 4X on their first scan were diagnosed with lung cancer. Among the 1708 patients, the false-positive rate on their first scan (Lung-RADS 3 or higher) was 9.4% (159/1695). The rate dropped to 1.6% (27/1695) when only Lung-RADS 4B and 4X was considered a “positive” finding.
Conclusions
Distribution of Lung-RADS scores were in line with national statistics. Results add to mounting evidence that LCS risk of false positives is comparable to mammography, which should encourage clinicians and patients to utilize this life saving screening modality.
{"title":"Lung Cancer Screening in a Rural Academic Health System Reveals Low False-Positive Rates","authors":"Kayla A. Fay MPH , Karen E. Schifferdecker PhD, MPH , Linda M. Kinney MPA , Ellie J. Kyung PhD , Shoshana H. Bardach PhD , Maureen B. Boardman MSN, FNP-C, FAANP , Dagmar Hoegemann Savellano MD , Connor Bridges BS , Sean R. Halloran BA , Samuel Youkilis BA , Tom Bird , Rian M. Hasson MD, MPH","doi":"10.1016/j.jss.2025.12.042","DOIUrl":"10.1016/j.jss.2025.12.042","url":null,"abstract":"<div><h3>Introduction</h3><div>Uptake of lung cancer screening (LCS) suffers from the misconception that LCS produces high false-positive findings. The purpose of this study was to assess LCS results to better quantify these rates.</div></div><div><h3>Methods</h3><div>Retrospective review of patients who underwent LCS at a single, LCS-accredited rural health system from January 2017 to March 2022 was performed. Patient demographics, Lung Reporting and Data Systems (Lung-RADS) score, and follow-up data were reviewed. Using the patient's first LCS scan, the false-positive rate was calculated using Lung-RADS 3 or higher as an indication of a “positive” finding and then calculated using Lung-RADS 4B and 4X alone.</div></div><div><h3>Results</h3><div>Analyses included 1708 patients, and 89.9% (1536/1708) of these scans were Lung-RADS 1 or 2. Among 80 patients whose first scan resulted in Lung-RADS 3, and 54 patients with Lung-RADS 4a, 61.3% (49/80) and 48.1% (26/54), respectively, received a lower Lung-RADS score on a follow-up scan, allowing them to return to annual screening. Twenty-nine percent (11/38) of those with Lung-RADS 4B or 4X on their first scan were diagnosed with lung cancer. Among the 1708 patients, the false-positive rate on their first scan (Lung-RADS 3 or higher) was 9.4% (159/1695). The rate dropped to 1.6% (27/1695) when only Lung-RADS 4B and 4X was considered a “positive” finding.</div></div><div><h3>Conclusions</h3><div>Distribution of Lung-RADS scores were in line with national statistics. Results add to mounting evidence that LCS risk of false positives is comparable to mammography, which should encourage clinicians and patients to utilize this life saving screening modality.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 1-9"},"PeriodicalIF":1.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146070977","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}
Pub Date : 2026-01-24DOI: 10.1016/j.jss.2025.12.024
Xiao-Zhuo Zheng MD , Lei Wu MD , Qi Chen MM , Xiao-Feng Lei MM , Shu-Liang Guo MD
Introduction
Ventilator-induced diaphragmatic dysfunction (VIDD) is associated with diaphragm atrophy and decreased contractility, leading to difficult weaning. Respiratory muscle training could prevent diaphragmatic dysfunction. IGF-1 is correlated with the enhancement of muscle mass and strength. The aim of this study was to investigate the effect of dual-mode ventilation (DMV) on diaphragm function recovery in VIDD rats, and to explore the role of insulin-like growth factor-1 (IGF-1) as an underlying mechanism.
Methods
Adult male Sprague–Dawley rats were used to establish the VIDD model and randomly divided into seven groups. Diaphragm morphology, myofiber cross-sectional area, diaphragm contractility, reactive oxygen species production, superoxide dismutase activity, IGF-1 expression and protein levels related to muscle differentiation and protein synthesis were examined. Adeno-associated virus transfection was used to downregulate IGF-1 expression. Overexpression of IGF-1 was performed by subcutaneous injection of rhIGF-1 to explore the possible mechanism.
Results
DMV increased myofiber cross-sectional area, improved diaphragm contractility, reduced reactive oxygen species production, enhanced superoxide dismutase activity, and upregulated the expression of Myod, Myogenin, MyHC, and a-actinin. DMV also upregulated the protein level of IGF-1 in the diaphragm of VIDD rats. In vivo, IGF-1 knockdown aggravated diaphragmatic dysfunction, increased oxidative stress injury, reduced protein synthesis and muscle differentiation, and decreased p-protein kinase B (Akt)/AKT and p-mammalian target of rapamycin (mTOR)/mTOR expression, while overexpression of IGF-1 reversed these changes.
Conclusions
DMV is beneficial for diaphragm function recovery. And IGF-1 plays an important role in DMV to enhance diaphragm mass and strength of VIDD rats, which may promote protein synthesis and muscle differentiation through activating Akt/mTOR signaling pathway.
{"title":"Dual-Mode Ventilation Promotes Diaphragm Function Recovery in Rats With Ventilator-Induced Diaphragmatic Dysfunction by Upregulating Insulin-Like Growth Factor-1","authors":"Xiao-Zhuo Zheng MD , Lei Wu MD , Qi Chen MM , Xiao-Feng Lei MM , Shu-Liang Guo MD","doi":"10.1016/j.jss.2025.12.024","DOIUrl":"10.1016/j.jss.2025.12.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Ventilator-induced diaphragmatic dysfunction (VIDD) is associated with diaphragm atrophy and decreased contractility, leading to difficult weaning. Respiratory muscle training could prevent diaphragmatic dysfunction. IGF-1 is correlated with the enhancement of muscle mass and strength. The aim of this study was to investigate the effect of dual-mode ventilation (DMV) on diaphragm function recovery in VIDD rats, and to explore the role of insulin-like growth factor-1 (IGF-1) as an underlying mechanism.</div></div><div><h3>Methods</h3><div>Adult male Sprague–Dawley rats were used to establish the VIDD model and randomly divided into seven groups. Diaphragm morphology, myofiber cross-sectional area, diaphragm contractility, reactive oxygen species production, superoxide dismutase activity, IGF-1 expression and protein levels related to muscle differentiation and protein synthesis were examined. Adeno-associated virus transfection was used to downregulate IGF-1 expression. Overexpression of IGF-1 was performed by subcutaneous injection of rhIGF-1 to explore the possible mechanism.</div></div><div><h3>Results</h3><div>DMV increased myofiber cross-sectional area, improved diaphragm contractility, reduced reactive oxygen species production, enhanced superoxide dismutase activity, and upregulated the expression of Myod, Myogenin, MyHC, and a-actinin. DMV also upregulated the protein level of IGF-1 in the diaphragm of VIDD rats. <em>In vivo</em>, IGF-1 knockdown aggravated diaphragmatic dysfunction, increased oxidative stress injury, reduced protein synthesis and muscle differentiation, and decreased p-protein kinase B (Akt)/AKT and p-mammalian target of rapamycin (mTOR)/mTOR expression, while overexpression of IGF-1 reversed these changes.</div></div><div><h3>Conclusions</h3><div>DMV is beneficial for diaphragm function recovery. And IGF-1 plays an important role in DMV to enhance diaphragm mass and strength of VIDD rats, which may promote protein synthesis and muscle differentiation through activating Akt/mTOR signaling pathway.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 346-358"},"PeriodicalIF":1.7,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034671","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}
Pub Date : 2026-01-23DOI: 10.1016/j.jss.2025.12.027
Kerry A. Swanson MD , Madeleine E. Yancy , Daniel M. Alligood MD , Alex J. Park MD , Hannah M. Phelps MD , Jesse D. Vrecenak MD
Introduction
Following gastrostomy tube (GT) removal, persistent gastrocutaneous fistula (GCF) requiring operative closure is a common occurrence. We sought to examine factors associated with the need for operative closure of a GCF in pediatric patients.
Materials and methods
A retrospective case-control study of patients who underwent GT placement and removal from 2018 to 2023 was performed. Direct comparisons and multivariate regression models were used to determine factors associated with the need for operative closure of a GCF.
Results
During the study period, 618 patients underwent GT placement. Of those, only 178 patients subsequently underwent removal and were included. The prevalence of GCF requiring operative closure was 27.5%. Multivariate analysis demonstrated prior and concurrent abdominal surgery were associated with increased odds of GCF (odds ratio [OR] 5.30, 95% confidence interval [CI] 1.27-23.6, P = 0.023; OR 4.50, 95% CI 1.23-17.1, P = 0.024 respectively). Purse-string securement significantly increased the odds of persistent GCF when compared to transabdominal Stamm securement without purse string (OR 8.52, 95% CI 2.73-28.6, P < 0.001) without any difference in GT dislodgement (P = 0.639). Younger age was associated with GCF on comparative cohort analysis (P < 0.001). When stratifying patients as greater or less than 6 mo of age, newborn patients had higher rates of GCF closure (P = 0.025) and shorter durations between placement and removal (P = 0.008).
Conclusions
GCF is associated with younger age, other abdominal surgeries, and securement techniques. Transabdominal securement may be associated with a reduced risk of persistent GCF without associated increase in dislodgment. Given the increased rate of persistent GCF and shorter duration of GT needs in younger patients, discharge with a nasoenteric tube rather than a GT should be considered for children under 6 mo.
在胃造口管（GT）移除后，需要手术关闭的持续性胃皮瘘（GCF）是常见的。我们试图研究与小儿患者GCF手术闭合需要相关的因素。材料与方法对2018年至2023年接受GT放置和取出的患者进行回顾性病例对照研究。使用直接比较和多元回归模型来确定与需要手术关闭GCF相关的因素。结果在研究期间，618例患者接受了GT安置。其中，只有178名患者随后接受了切除手术。需要手术闭合的GCF患病率为27.5%。多因素分析显示，既往和并发腹部手术与GCF发生率增加相关（比值比[OR] 5.30, 95%可信区间[CI] 1.27-23.6, P = 0.023；比值比[OR] 4.50, 95% CI 1.23-17.1, P = 0.024）。与无荷包系带的经腹Stamm固定相比，荷包系带明显增加了持续性GCF的几率（OR 8.52, 95% CI 2.73-28.6, P < 0.001），而GT脱位无差异（P = 0.639）。比较队列分析显示，年龄较小与GCF相关（P < 0.001）。当将患者分为大于或小于6月龄时，新生儿的GCF闭合率更高（P = 0.025），放置和取出之间的持续时间更短（P = 0.008）。结论sgcf与年龄较小、其他腹部手术和安全技术有关。经腹固定可能与持续性GCF的风险降低有关，而不会增加脱出。考虑到年轻患者持续性GCF的发生率增加和GT需要的时间较短，对于6个月以下的儿童，应考虑使用鼻肠管而不是GT出院。
{"title":"Technique and History of Abdominal Surgery are Associated With Need for Gastrocutaneous Fistula Closure Following Gastrostomy Removal: A Case-Control Study","authors":"Kerry A. Swanson MD , Madeleine E. Yancy , Daniel M. Alligood MD , Alex J. Park MD , Hannah M. Phelps MD , Jesse D. Vrecenak MD","doi":"10.1016/j.jss.2025.12.027","DOIUrl":"10.1016/j.jss.2025.12.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Following gastrostomy tube (GT) removal, persistent gastrocutaneous fistula (GCF) requiring operative closure is a common occurrence. We sought to examine factors associated with the need for operative closure of a GCF in pediatric patients.</div></div><div><h3>Materials and methods</h3><div>A retrospective case-control study of patients who underwent GT placement and removal from 2018 to 2023 was performed. Direct comparisons and multivariate regression models were used to determine factors associated with the need for operative closure of a GCF.</div></div><div><h3>Results</h3><div>During the study period, 618 patients underwent GT placement. Of those, only 178 patients subsequently underwent removal and were included. The prevalence of GCF requiring operative closure was 27.5%. Multivariate analysis demonstrated prior and concurrent abdominal surgery were associated with increased odds of GCF (odds ratio [OR] 5.30, 95% confidence interval [CI] 1.27-23.6, <em>P</em> = 0.023; OR 4.50, 95% CI 1.23-17.1, <em>P</em> = 0.024 respectively). Purse-string securement significantly increased the odds of persistent GCF when compared to transabdominal Stamm securement without purse string (OR 8.52, 95% CI 2.73-28.6, <em>P</em> < 0.001) without any difference in GT dislodgement (<em>P</em> = 0.639). Younger age was associated with GCF on comparative cohort analysis (<em>P</em> < 0.001). When stratifying patients as greater or less than 6 mo of age, newborn patients had higher rates of GCF closure (<em>P</em> = 0.025) and shorter durations between placement and removal (<em>P</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>GCF is associated with younger age, other abdominal surgeries, and securement techniques. Transabdominal securement may be associated with a reduced risk of persistent GCF without associated increase in dislodgment. Given the increased rate of persistent GCF and shorter duration of GT needs in younger patients, discharge with a nasoenteric tube rather than a GT should be considered for children under 6 mo.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 331-338"},"PeriodicalIF":1.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035153","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}
Pub Date : 2026-01-23DOI: 10.1016/j.jss.2025.12.041
Yasmin Arda MD, Ikemsinachi C. Nzenwa MBChB, MSc, Vahe S. Panossian MD, Tiemen E.T. Holtrop MD, Haytham M.A. Kaafarani MD, MPH, John O. Hwabejire MD, MPH, George C. Velmahos MD, PhD, Michael P. DeWane MD
Introduction
Diagnostic overshadowing, a type of cognitive bias, happens when a pre-existing medical condition overshadows the evaluation of other potential diagnoses. This study aimed to explore diagnostic overshadowing in trauma due to the impact of substance and alcohol use disorder (SUD) on time to diagnosis and management in patients with blunt splenic injury.
Methods
The 2017-2020 American College of Surgeons Trauma Quality Improvement Project database was used to identify patients ≥18 y with blunt splenic injury who underwent splenectomy. Patients were stratified into those with and without SUD. Delayed diagnosis (time to abdominal computed tomography scan >1 h) and delayed splenectomy (>2 h) were defined using median-based thresholds to measure distributional shifts in care timeliness between groups. Multivariable logistic regression examined the impact of SUD on delayed diagnosis, delayed splenectomy, and outcomes (e.g., mortality, postoperative complications). A sensitivity analysis was conducted by excluding patients with a positive alcohol screen on admission.
Results
Nine thousand two hundred thirty-seven patients were included: 1739 (19%) SUD and 7498 (81%) non-SUD. The median time to splenectomy was 2.4 h (interquartile range = 1.2-7.1) in SUD patients compared with 2 h (interquartile range = 1.1-4.9) in non-SUD patients (P < 0.001). On multivariable analyses, SUD patients were more likely to experience delayed diagnosis (adjusted odds ratio [aOR] = 1.13, 95% confidence interval [CI] = 1.04-1.23), delayed splenectomy (aOR = 1.25, 95% CI = 1.09-1.42), and composite complications (aOR = 1.14, 95% CI = 1.01-1.31) compared with non-SUD patients. After excluding intoxicated patients, those with SUD were still more likely to have delayed diagnosis and management, with a greater risk of delayed splenectomy compared with the overall cohort.
Conclusions
Diagnostic overshadowing, exemplified in blunt splenic injury patients with SUD, can be measured and can negatively impact patient care. Further studies are needed to explore the prevalence and impact of diagnostic overshadowing in trauma patients.
{"title":"Diagnostic Overshadowing: Delayed Management in Substance Use Disorder Patients With Splenic Injury","authors":"Yasmin Arda MD, Ikemsinachi C. Nzenwa MBChB, MSc, Vahe S. Panossian MD, Tiemen E.T. Holtrop MD, Haytham M.A. Kaafarani MD, MPH, John O. Hwabejire MD, MPH, George C. Velmahos MD, PhD, Michael P. DeWane MD","doi":"10.1016/j.jss.2025.12.041","DOIUrl":"10.1016/j.jss.2025.12.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnostic overshadowing, a type of cognitive bias, happens when a pre-existing medical condition overshadows the evaluation of other potential diagnoses. This study aimed to explore diagnostic overshadowing in trauma due to the impact of substance and alcohol use disorder (SUD) on time to diagnosis and management in patients with blunt splenic injury.</div></div><div><h3>Methods</h3><div>The 2017-2020 American College of Surgeons Trauma Quality Improvement Project database was used to identify patients ≥18 y with blunt splenic injury who underwent splenectomy. Patients were stratified into those with and without SUD. Delayed diagnosis (time to abdominal computed tomography scan >1 h) and delayed splenectomy (>2 h) were defined using median-based thresholds to measure distributional shifts in care timeliness between groups. Multivariable logistic regression examined the impact of SUD on delayed diagnosis, delayed splenectomy, and outcomes (e.g., mortality, postoperative complications). A sensitivity analysis was conducted by excluding patients with a positive alcohol screen on admission.</div></div><div><h3>Results</h3><div>Nine thousand two hundred thirty-seven patients were included: 1739 (19%) SUD and 7498 (81%) non-SUD. The median time to splenectomy was 2.4 h (interquartile range = 1.2-7.1) in SUD patients compared with 2 h (interquartile range = 1.1-4.9) in non-SUD patients (<em>P</em> < 0.001). On multivariable analyses, SUD patients were more likely to experience delayed diagnosis (adjusted odds ratio [aOR] = 1.13, 95% confidence interval [CI] = 1.04-1.23), delayed splenectomy (aOR = 1.25, 95% CI = 1.09-1.42), and composite complications (aOR = 1.14, 95% CI = 1.01-1.31) compared with non-SUD patients. After excluding intoxicated patients, those with SUD were still more likely to have delayed diagnosis and management, with a greater risk of delayed splenectomy compared with the overall cohort.</div></div><div><h3>Conclusions</h3><div>Diagnostic overshadowing, exemplified in blunt splenic injury patients with SUD, can be measured and can negatively impact patient care. Further studies are needed to explore the prevalence and impact of diagnostic overshadowing in trauma patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 323-330"},"PeriodicalIF":1.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035046","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}
Pub Date : 2026-01-23DOI: 10.1016/j.jss.2025.12.039
Martha Godfrey MD , Ming-Li Wang MD
Although surgical training programs have formalized curricula for professional knowledge and skills acquisition, there is still a gap in nonclinical knowledge that surgical trainees suffer when transitioning to practice (TTP). Financial literacy is one topic that has been identified by both trainees and program directors as a high-yield topic for TTP. Traditionally, surgical trainees relied on formative experience, self-motivated learning, or one-off local institutional efforts. Due to the high demands of time in surgical training and the frequent accumulation of large amounts of educational debt during this process, financial well-being may be neglected, which can lead to professional and personal stress and burnout. The paucity of formal education on this TTP topic causes surgical graduates to rely on informal mentorship during contract negotiation or expensive legal advice. This situation jeopardizes long-term recruitment and retention of surgeons from nonprivileged backgrounds who are less likely to have access to robust informal financial literacy resources. Financially literate surgeons are more likely to enjoy careers that have longevity and high overall career satisfaction. The topic of financial literacy was the focus of a Hot Topic session during the 2025 Academic Surgical Congress. This article covers the content included in that session, including TTP challenges, employment contract basics, negotiation, compensation models, and insurance. This serves as a real-world guide for those who are preparing for TTP or those interested in supporting the recruitment and retention of the next generation of surgical trainees.
{"title":"Blending Life and the Scalpel: A Financial Literacy Workshop for the Transition Beyond Training","authors":"Martha Godfrey MD , Ming-Li Wang MD","doi":"10.1016/j.jss.2025.12.039","DOIUrl":"10.1016/j.jss.2025.12.039","url":null,"abstract":"<div><div>Although surgical training programs have formalized curricula for professional knowledge and skills acquisition, there is still a gap in nonclinical knowledge that surgical trainees suffer when transitioning to practice (TTP). Financial literacy is one topic that has been identified by both trainees and program directors as a high-yield topic for TTP. Traditionally, surgical trainees relied on formative experience, self-motivated learning, or one-off local institutional efforts. Due to the high demands of time in surgical training and the frequent accumulation of large amounts of educational debt during this process, financial well-being may be neglected, which can lead to professional and personal stress and burnout. The paucity of formal education on this TTP topic causes surgical graduates to rely on informal mentorship during contract negotiation or expensive legal advice. This situation jeopardizes long-term recruitment and retention of surgeons from nonprivileged backgrounds who are less likely to have access to robust informal financial literacy resources. Financially literate surgeons are more likely to enjoy careers that have longevity and high overall career satisfaction. The topic of financial literacy was the focus of a Hot Topic session during the 2025 Academic Surgical Congress. This article covers the content included in that session, including TTP challenges, employment contract basics, negotiation, compensation models, and insurance. This serves as a real-world guide for those who are preparing for TTP or those interested in supporting the recruitment and retention of the next generation of surgical trainees.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 339-345"},"PeriodicalIF":1.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034672","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}
Pub Date : 2026-01-22DOI: 10.1016/j.jss.2025.12.032
Brian P. McKinzie PharmD, BCCCP , Natassha Ebert RN, BSN, PharmD, BCCCP , Felicia N. Williams MD, FACS, FABA , Ian Kratzke MD, MHPE , Jared Gallaher MD, MPH, FACS , Lauren Raff MD, FACS
Background
Evidence suggests that standard enoxaparin dosing for burn and trauma patients results in sub-optimal target thromboprophylactic plasma anti-Xa levels in up to 84% of the patients, potentially leading to increased incidence of venous thromboembolism (VTE). More intensive dosing regimens have been suggested; however, few studies have evaluated these protocols in trauma/burn patient populations.
Methods
A retrospective chart review of an American Burn Association–verified burn and American College of Surgeons–verified level 1 trauma center from June 2022 until July 2023 identified patients initiated on a higher dosing enoxaparin protocol for VTE prophylaxis in accordance with recent Western Trauma Association guidelines. Patients were included if they were at least 18 years of age, dosed according to protocol criteria, and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy.
Results
Two hundred forty five patients were screened with 196 patients included for analysis. 24.5% of the patients dosed according to the protocol did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/mL). Burn patients were more likely to achieve target anti-Xa levels than trauma patients (81.1% versus 65.2%, P = 0.016). An association between severe burns and inability to meet anti-Xa goals was also noted.
Conclusions
Utilization of a higher dose enoxaparin protocol for VTE prophylaxis has an improved likelihood of achieving plasma anti-Xa targets compared to standard dosing strategies, however, almost 23% of the patients were still underdosed. Increased enoxaparin dosing targeted to peak plasma anti-Xa levels and the impact on VTE reduction in severe burn and trauma patients should be further evaluated.
{"title":"Increased Prophylactic Enoxaparin Dosing is Associated With Improved Achievement of Target anti-Xa Levels; Implementation of the Western Trauma Association Venous-Thromboembolism Guidelines","authors":"Brian P. McKinzie PharmD, BCCCP , Natassha Ebert RN, BSN, PharmD, BCCCP , Felicia N. Williams MD, FACS, FABA , Ian Kratzke MD, MHPE , Jared Gallaher MD, MPH, FACS , Lauren Raff MD, FACS","doi":"10.1016/j.jss.2025.12.032","DOIUrl":"10.1016/j.jss.2025.12.032","url":null,"abstract":"<div><h3>Background</h3><div>Evidence suggests that standard enoxaparin dosing for burn and trauma patients results in sub-optimal target thromboprophylactic plasma anti-Xa levels in up to 84% of the patients, potentially leading to increased incidence of venous thromboembolism (VTE). More intensive dosing regimens have been suggested; however, few studies have evaluated these protocols in trauma/burn patient populations.</div></div><div><h3>Methods</h3><div>A retrospective chart review of an American Burn Association–verified burn and American College of Surgeons–verified level 1 trauma center from June 2022 until July 2023 identified patients initiated on a higher dosing enoxaparin protocol for VTE prophylaxis in accordance with recent Western Trauma Association guidelines. Patients were included if they were at least 18 years of age, dosed according to protocol criteria, and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy.</div></div><div><h3>Results</h3><div>Two hundred forty five patients were screened with 196 patients included for analysis. 24.5% of the patients dosed according to the protocol did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/mL). Burn patients were more likely to achieve target anti-Xa levels than trauma patients (81.1% <em>versus</em> 65.2%, <em>P</em> = 0.016). An association between severe burns and inability to meet anti-Xa goals was also noted.</div></div><div><h3>Conclusions</h3><div>Utilization of a higher dose enoxaparin protocol for VTE prophylaxis has an improved likelihood of achieving plasma anti-Xa targets compared to standard dosing strategies, however, almost 23% of the patients were still underdosed. Increased enoxaparin dosing targeted to peak plasma anti-Xa levels and the impact on VTE reduction in severe burn and trauma patients should be further evaluated.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 300-305"},"PeriodicalIF":1.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035154","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}
Pub Date : 2026-01-22DOI: 10.1016/j.jss.2025.12.030
Radhe Shantha Kumar MPhil , Tarsicio Uribe-Leitz MD, MPH , George Molina MD, MPH , Rachel Adler ScD, RD , Clancy J. Clark MD
Introduction
The 2015 transition from International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision (ICD-9 to ICD-10) in the U.S. aimed to improve diagnostic and procedural precision. However, no validated methodology exists for translating complication codes, posing a barrier to longitudinal surgical outcomes research. This study evaluates a structured approach to map ICD-9 to ICD-10 complication codes for high-risk operations, including esophagectomy, pancreaticoduodenectomy, and hepatectomy.
Methods
We developed an 8-step process using the Center for Medicare and Medicaid Services General Equivalence Mappings, incorporating manual review and clinical adjudication. ICD-9 codes representing complications, including cardiovascular, gastrointestinal, pulmonary, renal, infectious, systemic, intraoperative, wound-related, blood transfusion, and postoperative interventions, were mapped to ICD-10 and classified as exact, approximate, or mismatch. This framework was then applied to the National Inpatient Sample to evaluate postoperative complications before and after implementation of ICD-10.
Results
A total of 148 ICD-9 codes mapped to 774 ICD-10 codes. Clinical review identified 63.3% as exact, 33.9% as approximate, and 2.8% as mismatched. The recorded postoperative complication rates appeared lower for esophagectomy (50.6%-44.5%, P < 0.0001), higher for pancreatectomy (44.3%-46.4%, P < 0.01), and similar for hepatectomy (33.4%-32.8%, P = 0.53) with ICD-10 compared to ICD-9. The recorded length of stay and in-hospital mortality were also lower in the ICD-10 era (all P < 0.05).
Conclusions
ICD-10 implementation may improve the capture of specific complications and reflect evolving perioperative care. However, significant discrepancies in code translation underscore the need for validated methods. The mapping framework developed in this study enables reliable complication tracking across coding eras and supports higher-quality surgical outcomes research.
{"title":"Critical Review of International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision System-Based Postoperative Surgical Complication Codes","authors":"Radhe Shantha Kumar MPhil , Tarsicio Uribe-Leitz MD, MPH , George Molina MD, MPH , Rachel Adler ScD, RD , Clancy J. Clark MD","doi":"10.1016/j.jss.2025.12.030","DOIUrl":"10.1016/j.jss.2025.12.030","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2015 transition from International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision (ICD-9 to ICD-10) in the U.S. aimed to improve diagnostic and procedural precision. However, no validated methodology exists for translating complication codes, posing a barrier to longitudinal surgical outcomes research. This study evaluates a structured approach to map ICD-9 to ICD-10 complication codes for high-risk operations, including esophagectomy, pancreaticoduodenectomy, and hepatectomy.</div></div><div><h3>Methods</h3><div>We developed an 8-step process using the Center for Medicare and Medicaid Services General Equivalence Mappings, incorporating manual review and clinical adjudication. ICD-9 codes representing complications, including cardiovascular, gastrointestinal, pulmonary, renal, infectious, systemic, intraoperative, wound-related, blood transfusion, and postoperative interventions, were mapped to ICD-10 and classified as exact, approximate, or mismatch. This framework was then applied to the National Inpatient Sample to evaluate postoperative complications before and after implementation of ICD-10.</div></div><div><h3>Results</h3><div>A total of 148 ICD-9 codes mapped to 774 ICD-10 codes. Clinical review identified 63.3% as exact, 33.9% as approximate, and 2.8% as mismatched. The recorded postoperative complication rates appeared lower for esophagectomy (50.6%-44.5%, <em>P</em> < 0.0001), higher for pancreatectomy (44.3%-46.4%, <em>P</em> < 0.01), and similar for hepatectomy (33.4%-32.8%, <em>P</em> = 0.53) with ICD-10 compared to ICD-9. The recorded length of stay and in-hospital mortality were also lower in the ICD-10 era (all <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>ICD-10 implementation may improve the capture of specific complications and reflect evolving perioperative care. However, significant discrepancies in code translation underscore the need for validated methods. The mapping framework developed in this study enables reliable complication tracking across coding eras and supports higher-quality surgical outcomes research.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 306-317"},"PeriodicalIF":1.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035155","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}
Pub Date : 2026-01-22DOI: 10.1016/j.jss.2025.12.016
Caitlyn Braschi MD , Paul Brosnihan MD , Lara Senekjian MD , Philip Brennan MD , Janelle Cyprich MD , Jessica A. Keeley MD
Introduction
Traumatic liver injuries are associated with significant morbidity and mortality. The value of routine postinjury imaging surveillance is uncertain, as is whether this value increases with higher grade injuries.
Methods
A multicenter retrospective review was performed at two level I trauma centers from 2015 to 2020. Adults with American Association for the Surgery of Trauma grades II-V liver lacerations following blunt trauma were included. Reimaging patterns, need for reintervention, and 30-d outcomes of grades II/III injuries (“lower grade liver injuries,” LGLI) were compared to grades IV/V (“higher grade liver injuries,” HGLI).
Results
A total of 229 patients were included, 69.9% with LGLI and 30.1% with HGLI. Overall mortality was 15.3%. HGLI were more likely to be reimaged (69.2% versus 32.7%, P < 0.001). Comparing lower grade to higher grade injuries, there was no difference in time to reimaging (4 versus 4 d, P = 0.523). Patients with HGLI had more liver-specific complications (23.1% versus 2.0%, P < 0.001) and required more reinterventions (19.2% versus 2.6%, P < 0.001). Length of stay was longer (median 6 (interquartile range 4-13) versus median 10 (interquartile range 5-21), P = 0.044), and 30-d mortality was higher (27.5% versus 10.0%, P < 0.001) for HGLI. In multivariate analysis controlling for extrahepatic injuries, HGLI (odds ratio 3.10, 95% confidence interval 1.38-6.94, P = 0.006) and initial operative or Interventional Radiology management (odds ratio, 4.66; 95% confidence interval, 2.18-9.99, P < 0.001) were independently associated with reimaging.
Conclusions
A majority of patients with higher grade liver injuries undergo repeat imaging in the first several days postinjury and 19% require reintervention. Given the high rate of reintervention, routine imaging surveillance should be considered.
{"title":"Reimaging High-grade Blunt Hepatic Injuries: Revisiting the Role of Routine Surveillance in Modern Nonoperative Management","authors":"Caitlyn Braschi MD , Paul Brosnihan MD , Lara Senekjian MD , Philip Brennan MD , Janelle Cyprich MD , Jessica A. Keeley MD","doi":"10.1016/j.jss.2025.12.016","DOIUrl":"10.1016/j.jss.2025.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic liver injuries are associated with significant morbidity and mortality. The value of routine postinjury imaging surveillance is uncertain, as is whether this value increases with higher grade injuries.</div></div><div><h3>Methods</h3><div>A multicenter retrospective review was performed at two level I trauma centers from 2015 to 2020. Adults with American Association for the Surgery of Trauma grades II-V liver lacerations following blunt trauma were included. Reimaging patterns, need for reintervention, and 30-d outcomes of grades II/III injuries (“lower grade liver injuries,” LGLI) were compared to grades IV/V (“higher grade liver injuries,” HGLI).</div></div><div><h3>Results</h3><div>A total of 229 patients were included, 69.9% with LGLI and 30.1% with HGLI. Overall mortality was 15.3%. HGLI were more likely to be reimaged (69.2% <em>versus</em> 32.7%, <em>P</em> < 0.001). Comparing lower grade to higher grade injuries, there was no difference in time to reimaging (4 <em>versus</em> 4 d, <em>P</em> = 0.523). Patients with HGLI had more liver-specific complications (23.1% <em>versus</em> 2.0%, <em>P</em> < 0.001) and required more reinterventions (19.2% <em>versus</em> 2.6%, <em>P</em> < 0.001). Length of stay was longer (median 6 (interquartile range 4-13) <em>versus</em> median 10 (interquartile range 5-21), <em>P</em> = 0.044), and 30-d mortality was higher (27.5% <em>versus</em> 10.0%, <em>P</em> < 0.001) for HGLI. In multivariate analysis controlling for extrahepatic injuries, HGLI (odds ratio 3.10, 95% confidence interval 1.38-6.94, <em>P</em> = 0.006) and initial operative or Interventional Radiology management (odds ratio, 4.66; 95% confidence interval, 2.18-9.99, <em>P</em> < 0.001) were independently associated with reimaging.</div></div><div><h3>Conclusions</h3><div>A majority of patients with higher grade liver injuries undergo repeat imaging in the first several days postinjury and 19% require reintervention. Given the high rate of reintervention, routine imaging surveillance should be considered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 318-322"},"PeriodicalIF":1.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035045","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}
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