Journal of Surgical Research最新文献_第2页

Spin Reporting Is Common in Pilot Randomized Controlled Trials in Surgery: A Methodological Survey 自旋报告在外科随机对照试验中很常见：一项方法学调查。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.019

Tyler McKechnie MD, MSc , Tania Kazi BScH , Victoria Shi MA , Austine Wang BHSc , Sophia Zhang BSc , Alex Thabane MSc , Keean Nanji MD , Phillip Staibano MD, MSc , Lily J. Park MD, MSc , Aristithes Doumouras MD, MPH , Cagla Eskicioglu MD, MSc , Lehana Thabane PhD , Sameer Parpia PhD , Mohit Bhandari MD, PhD

Introduction

Spin reporting has been studied across a variety of study types and domains; however, it has yet to be studied in the context of pilot and feasibility trials. We designed this methodological survey to evaluate spin reporting in surgical pilot and feasibility trials.

Methods

Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from January 1, 2011, to December 31, 2011, and January 1, 2021, to December 31, 2021. Studies were included if they were pilot or feasibility randomized trials evaluating a surgical intervention. The primary objective was to determine the proportion of pilot and feasibility trials utilizing spin reporting defined as primary focus on efficacy as opposed to feasibility, focus on statistically significant findings as opposed to feasibility, and/or presentation of results as feasible despite not actually being feasible. Secondary objectives included determining the type of spin reporting and exploring the association between study characteristics and spin reporting.

Results

After screening 1991 citations, 38 studies from 2011 to 34 studies from 2021 were included. Overall, 59 of the included pilot and feasibility trials (81.9%: 59/72, 95% confidence interval [CI] 71.4-89.3%) utilized spin reporting. Fifty-eight trials (80.6%, 95% CI 69.8-88.2%) primarily focused on efficacy as opposed to feasibility, 34 trials (47.2%, 95% CI 36.1-58.6%) focused on statistically significant findings as opposed to feasibility, and four trials (5.6%, 95% CI 1.8-13.8%) suggested feasibility objectives were met when they were not. Spin was identified in 94.7% (95% CI 81.8-99.5%) and 67.6% (95% CI 50.7-81.0%) of studies published in 2011 and 2021, respectively.

Conclusions

Most pilot and feasibility trials in surgery inappropriately focus on clinical outcomes and statistical significance as opposed to feasibility outcomes for the main future trial. This practice is concerning given that pilot trials are not adequately powered and are intended to serve as exploratory study to increase the likelihood of a successful definitive trial.

简介：Spin报告已经在各种研究类型和领域进行了研究；然而，它还需要在试点和可行性试验的背景下进行研究。我们设计了这个方法学调查来评估外科飞行员和可行性试验中的自旋报告。方法：检索2011年1月1日至2011年12月31日、2021年1月1日至2021年12月31日的Medline、Embase和Cochrane中央对照试验注册库。纳入评估手术干预的试验或可行性随机试验。主要目标是确定利用自旋报告的试点和可行性试验的比例，自旋报告定义为主要关注有效性而不是可行性，关注统计上显著的发现而不是可行性，和/或将结果呈现为可行，尽管实际上并不可行。次要目标包括确定自旋报道的类型和探索研究特征与自旋报道之间的关系。结果：在筛选1991篇引文后，纳入了2011年的38篇研究至2021年的34篇研究。总体而言，纳入的试验和可行性试验中有59项（81.9%:59/72,95%置信区间[CI] 71.4-89.3%）使用了自旋报告。58项试验（80.6%,95% CI 698 -88.2%）主要关注疗效而不是可行性，34项试验（47.2%,95% CI 36.1-58.6%）主要关注统计上显著的发现而不是可行性，4项试验（5.6%,95% CI 1.8-13.8%）表明可行性目标没有得到满足。在2011年和2021年发表的研究中，分别有94.7% （95% CI 81.8-99.5%）和67.6% （95% CI 50.7-81.0%）发现了Spin。结论：大多数外科的试点和可行性试验不恰当地关注临床结果和统计学意义，而不是未来主要试验的可行性结果。这种做法令人担忧，因为试点试验没有足够的动力，旨在作为探索性研究，以增加成功确定试验的可能性。

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引用次数: 0

Characteristics Associated With Early Ileocolonic Resection in Pediatric Crohn's Disease 儿童克罗恩病早期回肠结肠切除术的相关特征

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.11.041

Jessica L. Mueller MD , Amy J. Kaplan BA , Jess L. Kaplan MD , Cornelia L. Griggs MD

Introduction

Pediatric-onset Crohn's disease (CD) has a more severe phenotype than adult-onset, and nearly one-third of pediatric CD patients will require surgical therapy. There is limited data on patient/disease characteristics that are associated with earlier surgical management.

Methods

All pediatric CD patients (<22 yrs) who underwent ileocolectomy from 2005 to 2021 were included. Unadjusted analyses were performed with Pearson chi-squared tests for categorical dependent variables, and t-tests, or analysis of variance, for numerical dependent variables.

Results

One hundred thirty-five pediatric CD patients underwent ileocolectomy. The median time to surgery was 3.75 yrs. Patients treated with early surgery (<3.75 yrs from diagnosis) were older at diagnosis (16.5 versus 11.6 yrs, P < 0.001) yet had surgery at a younger age (16.8 versus 18.9 yrs, P < 0.001). They also were prescribed fewer CD medications (2.0 versus 4.0, P < 0.001), were less likely to have trialed multiple biologics (25.6% versus 54.2%, P = 0.001), had a shorter time from diagnosis to biologic (0.3 versus 3.5 yrs, P < 0.001), and had a shorter interval from biologic to surgery (0.4 versus 2.5 yrs, P < 0.001). Abscess formation was a more common indication for early surgery (39.4% versus 14.7%, P = 0.002), whereas failure to thrive/refractory pain was more common for later surgery (27.3% versus 55.9%, P = 0.001).

Conclusions

Surgical therapy remains an important component of the overall management of pediatric CD. In our cohort, earlier surgical management was associated with earlier use of biologics, a shorter duration between biologic and surgery, and decreased number of overall medications and biologic agents prior to surgery, suggesting a severe disease phenotype refractory to medical management.

儿科发病的克罗恩病（CD）具有比成人发病更严重的表型，近三分之一的儿科CD患者需要手术治疗。与早期手术治疗相关的患者/疾病特征数据有限。方法：所有小儿乳糜泻患者(结果：135例小儿乳糜泻患者行回肠结肠切除术。中位手术时间为3.75年。结论：手术治疗仍然是儿科CD总体治疗的重要组成部分。在我们的队列中，早期手术治疗与早期使用生物制剂、生物制剂和手术之间的持续时间较短、手术前总药物和生物制剂的数量减少有关，这表明严重的疾病表型难以进行药物治疗。

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引用次数: 0

Impact of Locum Tenens Providers on Delivery of Pediatric Surgical Care 门诊医生对儿科外科护理的影响。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.014

Lindsey L. Wolf MD, MPH , David E. Skarda MD, MBA , Jason C. Fisher MD , Scott S. Short MD , Romeo C. Ignacio MD , Hau D. Le MD , Kyle J. Van Arendonk MD, PhD , Kenneth W. Gow MD, MHA , Richard D. Glick MD , Yigit S. Guner MD, MS , Hira Ahmad MD , Melissa E. Danko MD , Cynthia Downard MD, MMSc , Mehul V. Raval MD, MS , Daniel J. Robertson MD , Richard G. Weiss MD , Barrie S. Rich MD , American Association of Pediatrics Section on Surgery Delivery of Surgical Care Committee

Introduction

We sought to understand the impact of locum tenens surgeons on pediatric surgical care delivery.

Methods

We conducted a cross-sectional survey of Children’s Hospital Association pediatric surgical practices. Anonymous electronic surveys were used to investigate locum tenens utilization, primary reason for use, limitations on clinical activities, and variations in practice standards or quality. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between practice characteristics and locum tenens use.

Results

Of 172 practices, 71% (n = 122) completed the survey. Median hospital size was 203 beds (interquartile range = 130-350). Median number of surgeons per practice was 5 (interquartile range = 3-8). Thirty-seven practices (30%) employed locum tenens at primary (n = 27) or satellite (n = 12) sites. Locum tenens utilization was higher in suburban (odds ratio [OR] = 3.78, P = 0.006) and rural (OR = 4.96, P = 0.041) locations and lower at sites with a level 4 neonatal intensive care unit (OR = 0.35, P = 0.035). Most (51%) used locum tenens ≥ 1 time monthly but < 1 time weekly and for ongoing or interim coverage (87%). In total, 14% of practices reported clinical restrictions for locum tenens surgeons, including limitations on extracorporeal membrane oxygenation, neonatal index cases, and operative trauma. Most (76%) practices using locum tenens reported variations in practice standards or quality; all were perceived as negative (57%) or neutral (43%).

Conclusions

Locum tenens providers are utilized most commonly in suburban and rural sites and hospitals without the highest level of neonatal intensive care. While locum tenens surgeons may help maintain access to pediatric surgical care where gaps exist, there may be a need to improve the quality and reliability of care rendered.

前言：我们试图了解儿科外科医生对儿科外科护理交付的影响。方法：我们对儿童医院协会的儿科外科实践进行了横断面调查。使用匿名电子调查来调查诊所医生的使用情况、使用的主要原因、临床活动的限制以及实践标准或质量的变化。采用双变量分析和多变量逻辑回归来评估实践特征与场地使用之间的关联。结果：172名执业医师中，71% （n = 122）完成了调查。医院规模中位数为203张床位（四分位数间距= 130-350）。每次手术的外科医生中位数为5人（四分位数间距= 3-8）。37个实践（30%）在主要站点（n = 27）或卫星站点（n = 12）雇用了现场实习生。郊区地区（优势比[OR] = 3.78, P = 0.006）和农村地区（优势比[OR] = 4.96, P = 0.041）的青少年使用率较高，而有4级新生儿重症监护病房的地区使用率较低（优势比[OR] = 0.35, P = 0.035）。大多数（51%）使用的是每月≥1次但每周< 1次的临时调查，以及持续或临时调查（87%）。总的来说，14%的实践报告了临时儿科医生的临床限制，包括体外膜氧合，新生儿指数病例和手术创伤的限制。大多数（76%）使用临时执业医师的执业报告在执业标准或质量上存在差异；所有人都被认为是消极的（57%）或中立的（43%）。结论：在郊区和农村地区以及没有最高水平新生儿重症监护的医院中，最常见的是利用青少年服务提供者。虽然在存在缺口的地方，临时儿科外科医生可能有助于维持获得儿科外科护理的机会，但可能需要提高所提供护理的质量和可靠性。

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引用次数: 0

Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls 回到基础：历史和物理在老年人地面跌落的治疗中的效用。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.016

Brianna L. Collie MD, Luciana Tito Bustillos MD, Shane L. Collins BA, Nicole B. Lyons MD, Walter A. Ramsey MD, Christopher F. O'Neil MD, Joyce I. Kaufman MD, Jonathan P. Meizoso MD, MSPH, Kenneth G. Proctor PhD, Nicholas Namias MD, MBA

Introduction

Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.

Materials and methods

Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.

Results

In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.

Conclusions

In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.

在老年人群中，跌倒占所有创伤的近3 / 4。我们假设病史和体格可以可靠地识别需要头部和颈椎成像的地面跌倒（GLF）老年患者。材料与方法：回顾性分析某外伤一级中心2018年1月至2021年12月收治的年龄在bb0 ~ 65岁的GLF患者。排除了从高处坠落、转移和受伤后48小时的表现。主要结局是头部或颈椎损伤，由（+）计算机轴向断层扫描（CT）确定。结果：在825例患者中，275例（33%）在家中使用抗凝或抗血小板药物，一半（51%）被认为虚弱，大多数患者在到达前至少有一种合并症。在645例（79%）头部CT检查中，174例（27%）为阳性，20例（11%）需要手术干预。结论：在老年GLF中，GCS评分正常且没有头部外伤或头痛的外部体征表明头部损伤的可能性较低，无论是否存在抗凝治疗。同样，没有颈部症状表明颈椎损伤的可能性很低。因此，在老年GLF后头颈椎损伤的检查中，病史和体格检查是可靠的。

{"title":"Back to Basics: The Utility of History and Physical in the Workup of Geriatric Ground-Level Falls","authors":"Brianna L. Collie MD, Luciana Tito Bustillos MD, Shane L. Collins BA, Nicole B. Lyons MD, Walter A. Ramsey MD, Christopher F. O'Neil MD, Joyce I. Kaufman MD, Jonathan P. Meizoso MD, MSPH, Kenneth G. Proctor PhD, Nicholas Namias MD, MBA","doi":"10.1016/j.jss.2024.12.016","DOIUrl":"10.1016/j.jss.2024.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.</div></div><div><h3>Materials and methods</h3><div>Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at <em>P</em> < 0.05.</div></div><div><h3>Results</h3><div>In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.</div></div><div><h3>Conclusions</h3><div>In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 182-187"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965422","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

Clinical and Demographic Factors Associated Suicide Risk in Patients With Colorectal Cancer 结直肠癌患者自杀风险相关的临床和人口学因素

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.026

Annmarie Butare DO , M. Drew Honaker MD , Sydney Taylor BS , Rebecca A. Snyder MD, MPH , Alexander A. Parikh MD, MPH

Introduction

Mental health is adversely affected by a cancer diagnosis. As the incidence of colorectal cancer (CRC) is on the rise, data regarding mental health and suicide among CRC patients is lacking. The primary aim of this study is to investigate the incidence of suicide among CRC patients in comparison to the general population. The secondary aim is to identify factors that are associated with increased risk of suicide among patients with CRC.

Methods

A cross-sectional study was conducted utilizing the Surveillance, Epidemiology, and End Results Program database from 2000 to 2018. Standardized Mortality Ratios (SMRs) were calculated for 5-y age groups. Cox's cause-specific hazards model was utilized to compare covariates that increased the risk of suicide.

Results

A total of 530,711 patients were included. 289,363 (54%) were male. Overall, there were 782 (0.15%) suicides, of which 687 (88%) occurred in males. The SMR due to suicide was significantly higher in males (SMR 1.60, 95% confidence interval [CI] 1.481-1.722; P < 0.001) including ages 35-49 ys and over 60 ys, however, not in females (SMR 1.12, 95% CI 0.91-1.375; P = 0.276). Factors independently associated with increased suicide risk included distant disease (hazard ratio [HR] 2.57; CI 1.96, 3.39; P=<0.0001), radiation (HR 1.45; CI 1.16, 1.80; P = 0.0009), and increased age (HR 1.05 per 5-y increase; CI 1.02, 1.09; P = 0.0013). Factors associated with decreased risk of suicide included non-Hispanic Black race (HR 0.27; CI 0.18, 0.41; P= <0.0001), Hispanic race (HR 0.31; 95% CI 0.21, 0.45; P=<0.0001), being married (HR 0.56; CI 0.49, 0.65; P=<0.0001), living in metropolitan area (HR 0.74; CI 0.61, 0.90; P = 0.003), and receiving chemotherapy (HR 0.71; CI 0.58, 0.86; P = 0.0001).

Conclusions

Male colorectal patients aged 35-49 ys and over 60 ys are at a higher risk of suicide than the general United States population. Understanding factors that increase a patient's risk for suicide will be important to develop strategies to mitigate this risk and improve overall mental health.

导言癌症诊断会对心理健康产生不利影响。随着结肠直肠癌（CRC）发病率的上升，有关 CRC 患者心理健康和自杀的数据却十分缺乏。本研究的主要目的是调查与普通人群相比，CRC 患者的自杀发生率。次要目的是确定与 CRC 患者自杀风险增加相关的因素：利用 2000 年至 2018 年的监测、流行病学和最终结果计划数据库开展了一项横断面研究。计算了5岁年龄组的标准化死亡率（SMR）。利用考克斯特异性病因危险模型来比较增加自杀风险的协变量：共纳入 530,711 名患者。289,363 人（54%）为男性。总体而言，共有 782 例（0.15%）自杀，其中 687 例（88%）发生在男性身上。男性因自杀而导致的 SMR 明显更高（SMR 1.60，95% 置信区间 [CI] 1.481-1.722；P 结论：男性因自杀而导致的 SMR 明显更高（SMR 1.60，95% 置信区间 [CI] 1.481-1.722）：35-49 岁和 60 岁以上的男性结直肠癌患者的自杀风险高于美国普通人群。了解增加患者自杀风险的因素对于制定降低自杀风险和改善整体心理健康的策略非常重要。

{"title":"Clinical and Demographic Factors Associated Suicide Risk in Patients With Colorectal Cancer","authors":"Annmarie Butare DO , M. Drew Honaker MD , Sydney Taylor BS , Rebecca A. Snyder MD, MPH , Alexander A. Parikh MD, MPH","doi":"10.1016/j.jss.2024.12.026","DOIUrl":"10.1016/j.jss.2024.12.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Mental health is adversely affected by a cancer diagnosis. As the incidence of colorectal cancer (CRC) is on the rise, data regarding mental health and suicide among CRC patients is lacking. The primary aim of this study is to investigate the incidence of suicide among CRC patients in comparison to the general population. The secondary aim is to identify factors that are associated with increased risk of suicide among patients with CRC.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted utilizing the Surveillance, Epidemiology, and End Results Program database from 2000 to 2018. Standardized Mortality Ratios (SMRs) were calculated for 5-y age groups. Cox's cause-specific hazards model was utilized to compare covariates that increased the risk of suicide.</div></div><div><h3>Results</h3><div>A total of 530,711 patients were included. 289,363 (54%) were male. Overall, there were 782 (0.15%) suicides, of which 687 (88%) occurred in males. The SMR due to suicide was significantly higher in males (SMR 1.60, 95% confidence interval [CI] 1.481-1.722; <em>P</em> < 0.001) including ages 35-49 ys and over 60 ys, however, not in females (SMR 1.12, 95% CI 0.91-1.375; <em>P</em> = 0.276). Factors independently associated with increased suicide risk included distant disease (hazard ratio [HR] 2.57; CI 1.96, 3.39; <em>P</em>=<0.0001), radiation (HR 1.45; CI 1.16, 1.80; <em>P</em> = 0.0009), and increased age (HR 1.05 per 5-y increase; CI 1.02, 1.09; <em>P</em> = 0.0013). Factors associated with decreased risk of suicide included non-Hispanic Black race (HR 0.27; CI 0.18, 0.41; <em>P</em>= <0.0001), Hispanic race (HR 0.31; 95% CI 0.21, 0.45; <em>P</em>=<0.0001), being married (HR 0.56; CI 0.49, 0.65; <em>P</em>=<0.0001), living in metropolitan area (HR 0.74; CI 0.61, 0.90; <em>P</em> = 0.003), and receiving chemotherapy (HR 0.71; CI 0.58, 0.86; <em>P</em> = 0.0001).</div></div><div><h3>Conclusions</h3><div>Male colorectal patients aged 35-49 ys and over 60 ys are at a higher risk of suicide than the general United States population. Understanding factors that increase a patient's risk for suicide will be important to develop strategies to mitigate this risk and improve overall mental health.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 217-223"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971264","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

Association Between Blood Type and Mortality Among Severely Injured Patients Enrolled in the Pragmatic Randomized Optimal Platelet and Plasma Ratios Trial 在实用的随机最佳血小板和血浆比率试验中登记的严重损伤患者中，血型与死亡率的关系。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.030

Emily W. Baird MD, MA , Daniel T. Lammers MD , Peter J. Abraham MD , Zain G. Hashmi MBBS , Russell L. Griffin PhD , Shannon W. Stephens EMTP, CCEMTP , Jessica C. Cardenas PhD , Jillian R. Richter PhD , Jan O. Jansen MBBS, PhD , John B. Holcomb MD

Introduction

Previous studies suggested that type O blood may be associated with increased mortality and/or thrombotic complications among trauma patients. The purpose of this analysis was to evaluate the relationship between endogenous blood type, mortality, and complications among patients receiving massive transfusions, using data from the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial.

Materials and Methods

This was a secondary analysis of the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial that included patients with the reported blood type (A, AB, B, or O) data. Outcomes were early and late mortality and clinical complications. Endogenous von Willebrand Factor (vWF) antigen levels, vWF activity, and factor VIII levels were measured with admission labs and compared. Logistical regression was used to assess associations between mortality and blood type.

Results

Among 680 patients, 655 who had admission blood type data were included. 322 (49.2%) were type O, 186 (28.4%) were type A, 27 (4.1%) were type AB, and 120 (18.3%) were type B. The mean age, gender distribution, mechanism of injury, injury severity, and injury patterns were similar between blood types. There were significant racial and ethnic differences (P < 0.001 and P < 0.0018, respectively), and patients with endogenous type O blood had decreased levels of vWF activity and vWF antigen (P = 0.022 and P = 0.016, respectively). Logistical analyses showed no significant associations between blood type and complications, and type O blood was not associated with increased mortality.

Conclusions

We found that endogenous blood type was not associated with increased mortality or clinical complications in severely injured patients requiring massive transfusion based on the data from a large multicenter trial.

先前的研究表明，O型血可能与创伤患者死亡率和/或血栓并发症的增加有关。本分析的目的是评估大量输血患者的内源性血型、死亡率和并发症之间的关系，使用实用随机最佳血小板和血浆比率试验的数据。材料和方法：这是对实用随机最佳血小板和血浆比率试验的二次分析，该试验纳入了报告血型（a、AB、B或O型）的患者。结果是早期和晚期死亡以及临床并发症。入院实验室检测内源性血管性血友病因子（vWF）抗原水平、vWF活性和因子VIII水平并进行比较。使用逻辑回归来评估死亡率与血型之间的关系。结果：680例患者中有入院血型资料的655例。O型322例（49.2%），A型186例（28.4%），AB型27例（4.1%），b型120例（18.3%）。各血型间的平均年龄、性别分布、损伤机制、损伤严重程度、损伤类型相似。结论：根据一项大型多中心试验的数据，我们发现内源性血型与需要大量输血的严重受伤患者死亡率或临床并发症的增加无关。

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引用次数: 0

Standardized Note Template Expedites Completion of Consults for Surgical Fetal Anomalies 标准化笔记模板加快完成手术胎儿异常咨询。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.11.048

Michael B. Gyimah MD, MS , Sarah Peiffer MD, MPH , Shannon M. Larabee MD , Timothy C. Lee MD , Sundeep G. Keswani MD , Alice King MD

Introduction

We developed standardized electronic medical record templates (EMR-temp) for use in ambulatory prenatal surgical consultations for surgical fetal anomalies (SFAs). Our aim was to evaluate EMR-temp impact in provider documentation in prenatal care of SFA.

Methods

Prenatal consultations for SFAs at a single institution were retrospectively reviewed (2019-2022). Disease-specific EMR-templates were developed. Note content and time to encounter closure (TEC) were collected. Descriptive statistics, chi-square, Fisher’s Exact Test, and Wilcoxon rank sum tests were used.

Results

Seven hundred twenty-four prenatal consultations were analyzed, with 131 consultations (18%) using EMR-temp for 55 (42%) congenital diaphragmatic hernia, 50 (38%) congenital lung malformations, 9 (7%) neural tube defects, 8 (6%) gastroschisis, and 9 (7%) heterotaxy. Overall median TEC was 23.9 hs [interquartile range (IQR) 1.3-128.6]. EMR-temp use decreases TEC from 28.4 hs [IQR 1.6-159.4] to 2.07 hs [IQR 0.85-76.2] (P < 0.001). The impact of EMR-temp varies depending on pathology. In congenital diaphragmatic hernia, EMR-temp decreased TEC 61%, from 52.0 [IQR 2.6-171.1] to 20.3 hs [IQR 1.5-55.5] (P = 0.01). In neural tube defect, EMR-temp decreased TEC 98% from 48.6 [IQR 2.6-157.1] to 1.02 hs [IQR 0.5-1.5] (P < 0.001). There were no differences in TEC with EMR-temp use in congenital lung malformation, gastroschisis and heterotaxy (P > 0.05). Across all diseases, EMR-temp had more comprehensive documentation of the following content: pathophysiology (92%), pregnancy planning (92%), delivery planning (84%), postnatal planning (95%), and long-term follow-up (90%) compared to nontemplates (P < 0.01).

Conclusions

EMR templates in SFA consultations improves encounter closure with comprehensive documentation of disease-specific pathophysiology and plans. However, impact varies across pathology, suggesting other factors are also important.

简介：我们开发了标准化的电子病历模板（EMR-temp），用于外科胎儿异常（sfa）的门诊产前外科会诊。我们的目的是评估EMR-temp对SFA产前护理提供者文件的影响。方法：回顾性分析单一机构SFAs产前咨询（2019-2022年）。开发了疾病特异性电子病历模板。收集笔记内容和遭遇关闭时间（TEC）。采用描述性统计、卡方检验、Fisher确切检验和Wilcoxon秩和检验。结果：724个产前咨询被分析，131个咨询（18%）使用EMR-temp诊断55个（42%）先天性膈疝，50个（38%）先天性肺畸形，9个（7%）神经管缺陷，8个（6%）胃裂，9个（7%）异位。总体中位TEC为23.9 hs[四分位间距（IQR） 1.3-128.6]。使用EMR-temp使TEC从28.4 h [IQR 1.6-159.4]降至2.07 h [IQR 0.85-76.2] （P 0.05）。在所有疾病中，EMR-temp与非模板相比，具有更全面的以下内容记录：病理生理（92%）、妊娠计划（92%）、分娩计划（84%）、产后计划（95%）和长期随访（90%）(P结论：SFA会诊中的EMR模板通过对疾病特异性病理生理和计划的全面记录改善了会诊结束。然而，影响因病理而异，这表明其他因素也很重要。

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引用次数: 0

The Gender Disparity in Operative Opportunities for Trainee Surgeons: A Review

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.004

Sherri Xu MD, BBmed , Heidi McAlpine MBBS, BSc (Hons) , Katharine Jann Drummond MBBS, MD, Grad Dip Theol, FRACS

Introduction

Assessing gender disparity in surgical trainees’ operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy.

Methods

A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included.

Results

Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women.

Conclusions

A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.

{"title":"The Gender Disparity in Operative Opportunities for Trainee Surgeons: A Review","authors":"Sherri Xu MD, BBmed , Heidi McAlpine MBBS, BSc (Hons) , Katharine Jann Drummond MBBS, MD, Grad Dip Theol, FRACS","doi":"10.1016/j.jss.2024.12.004","DOIUrl":"10.1016/j.jss.2024.12.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Assessing gender disparity in surgical trainees’ operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included.</div></div><div><h3>Results</h3><div>Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women.</div></div><div><h3>Conclusions</h3><div>A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 327-335"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023904","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

Reducing Postoperative Opioids in Pediatric Laparoscopic Cholecystectomy: A Retrospective, Single-Center Cohort Study

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.028

Derek R. Marlor MD , Elizabeth Edmundson PhD , Nelimar Cruz-Centeno MD , Shai Stewart MD , Jordan P. Fader BS , Jieun Lee MD , Jack C. Senna BS , Tolulope A. Oyetunji MD , Shawn D. St. Peter MD , Jason D. Fraser MD

Introduction

Overprescribing of opioid pain medications can lead to adverse outcomes and contributes to the opioid crisis. We previously reported eliminating opioids in select patients. This retrospective study aimed to compare outcomes in pediatric patients undergoing laparoscopic cholecystectomy (LC) who were and were not prescribed opioid pain medications.

Methods

A retrospective review of pediatric patients <18 ys of age who underwent LC from 2016 to 2022 was performed. Patients who underwent open cholecystectomy or additional surgical procedures performed simultaneously were excluded. Patient demographics, operative details, medication usage, and postoperative complications were recorded. Patients prescribed opioid pain medication at discharge were compared to those who were treated with nonopioid pain medications (i.e., acetaminophen, ibuprofen, and ketorolac).

Results

In total, 511 patients were included, of which 76.9% were prescribed opioids. Patients who were not prescribed opioids more commonly received intravenous ketorolac (81.4% versus 35.6%, P < 0.001), used less postoperative morphine milligram equivalents per kilogram (MME) (0.3 versus 0.4 MME/kg, P = 0.044), had lower rates of postoperative phone calls for pain (6.8% versus 18.8%, P = 0.002), and reported less pain at follow-up (6.8% versus 18.8%, P = 0.002). There were no differences in emergency department visits or hospital readmissions within 30 ds of discharge. Institutional rates of opioid prescriptions following LC decreased over the study duration (97.8% in 2016 to 28.4% in 2022, P < 0.001).

Conclusions

Nonopioid postoperative pain control in pediatric patients undergoing LC is well-tolerated and may be effective in reducing opioid use. In this cohort, nonopioid and opioid pain management modalities had similar postoperative hospital resource utilization. Therefore, opioid use and its resultant complications may potentially be able to be reduced.

{"title":"Reducing Postoperative Opioids in Pediatric Laparoscopic Cholecystectomy: A Retrospective, Single-Center Cohort Study","authors":"Derek R. Marlor MD , Elizabeth Edmundson PhD , Nelimar Cruz-Centeno MD , Shai Stewart MD , Jordan P. Fader BS , Jieun Lee MD , Jack C. Senna BS , Tolulope A. Oyetunji MD , Shawn D. St. Peter MD , Jason D. Fraser MD","doi":"10.1016/j.jss.2024.12.028","DOIUrl":"10.1016/j.jss.2024.12.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Overprescribing of opioid pain medications can lead to adverse outcomes and contributes to the opioid crisis. We previously reported eliminating opioids in select patients. This retrospective study aimed to compare outcomes in pediatric patients undergoing laparoscopic cholecystectomy (LC) who were and were not prescribed opioid pain medications.</div></div><div><h3>Methods</h3><div>A retrospective review of pediatric patients <18 ys of age who underwent LC from 2016 to 2022 was performed. Patients who underwent open cholecystectomy or additional surgical procedures performed simultaneously were excluded. Patient demographics, operative details, medication usage, and postoperative complications were recorded. Patients prescribed opioid pain medication at discharge were compared to those who were treated with nonopioid pain medications (i.e., acetaminophen, ibuprofen, and ketorolac).</div></div><div><h3>Results</h3><div>In total, 511 patients were included, of which 76.9% were prescribed opioids. Patients who were not prescribed opioids more commonly received intravenous ketorolac (81.4% <em>versus</em> 35.6%, <em>P</em> < 0.001), used less postoperative morphine milligram equivalents per kilogram (MME) (0.3 <em>versus</em> 0.4 MME/kg, <em>P</em> = 0.044), had lower rates of postoperative phone calls for pain (6.8% <em>versus</em> 18.8%, <em>P</em> = 0.002), and reported less pain at follow-up (6.8% <em>versus</em> 18.8%, <em>P</em> = 0.002). There were no differences in emergency department visits or hospital readmissions within 30 ds of discharge. Institutional rates of opioid prescriptions following LC decreased over the study duration (97.8% in 2016 to 28.4% in 2022, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Nonopioid postoperative pain control in pediatric patients undergoing LC is well-tolerated and may be effective in reducing opioid use. In this cohort, nonopioid and opioid pain management modalities had similar postoperative hospital resource utilization. Therefore, opioid use and its resultant complications may potentially be able to be reduced.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"306 ","pages":"Pages 580-587"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074823","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 Single-Institution Analysis of Surveillance Practice for Low-Risk Neuroblastic Tumors 低风险神经母细胞肿瘤监测实践的单机构分析。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-02-01 DOI: 10.1016/j.jss.2024.12.021

Shachi Srivatsa MD , Dana Schwartz MD , Sara A. Mansfield MD , Josh Bricker PhD , Grace Mallampalli MD , Keri Streby MD , Nilay Shah MD , Mark Ranalli MD , Kathleen Nicol MD , Jennifer English RN , Lindsay Cole CPNP-PC , Jennifer H. Aldrink MD

Introduction

Currently, few prospective guidelines exist for the surveillance of children with low-risk neuroblastic tumors (LRNBTs), including ganglioneuroma or ganglioneuroblastoma intermixed. This study aims to describe our institutional approach to LRNBT surveillance following surgical resection or nonoperative management. We hypothesize that length of surveillance can be reduced due to low recurrence risk.

Methods

We conducted a retrospective review of patients diagnosed with LRNBT at our institution between January 1, 2010, and December 31, 2022. The majority of patients were followed in our multidisciplinary surgical oncology clinic. We summarized relevant patient data including follow-up imaging modalities and recurrences.

Results

Thirty-eight patients met the inclusion criteria at a median age of diagnosis of 9 ys (interquartile range [IQR]: 5, 12.75). Thirty-seven patients underwent surgical resection, with tumors located in the posterior mediastinum (n = 18), retroperitoneum (n = 14), presacral space (n = 3), pelvis (n = 1), or combined thoracic or retroperitoneal location (n = 1). One patient underwent nonoperative management for a tumor located in the retroperitoneum. Histopathological results demonstrated 18 cases of ganglioneuroma and 20 cases of ganglioneuroblastoma intermixed. The median duration of postoperative follow-up was 27 mos (IQR: 14, 51) and the median clinical visits per year was 2.6 [IQR: 1.5, 3.4). Surveillance imaging was performed at a median frequency of 2.4 times per year (IQR: 1.6, 3.1). Chest radiographs were the most common modality used for thoracic locations (34% of all imaging) and ultrasound was used most commonly for abdominal location (24% of all imaging). During surveillance, one recurrent or residual ganglioneuroma was identified on magnetic resonance imaging at 6.7 mos from presacral resection. This patient underwent repeat surgical resection, and subsequent surveillance demonstrated no further recurrences.

Conclusions

Recurrence was low in this cohort of LRNBT patients. Optimal surveillance strategies for this low-risk pathology would minimize radiation exposure and burden of health-care visits to patients. Further multi-institutional studies are warranted to determine the best imaging modality, as well as the frequency and duration of follow-up visits for LRNBT patients. Future studies should evaluate the acceptability of short-term surveillance for those who achieve complete resection.

导言：目前，对于低危神经母细胞瘤（LRNBTs）（包括神经节细胞瘤或神经节神经母细胞瘤混合瘤）患儿的监测，很少有前瞻性指南。本研究旨在介绍本院在手术切除或非手术治疗后对 LRNBT 进行监护的方法。我们假设，由于复发风险较低，监视时间可以缩短：我们对 2010 年 1 月 1 日至 2022 年 12 月 31 日期间在我院确诊的 LRNBT 患者进行了回顾性研究。大多数患者都在我们的多学科肿瘤外科诊所接受了随访。我们总结了患者的相关数据，包括随访影像学方式和复发情况：38名患者符合纳入标准，诊断年龄中位数为9岁（四分位间距[IQR]：5岁至12.75岁）。37例患者接受了手术切除，肿瘤位于后纵隔（18例）、腹膜后（14例）、骶前间隙（3例）、骨盆（1例）或胸腔或腹膜后联合位置（1例）。一名患者因肿瘤位于腹膜后而接受了非手术治疗。组织病理学结果显示，18例为神经节细胞瘤，20例为神经节神经母细胞瘤混合瘤。术后随访时间的中位数为 27 个月（IQR：14-51），每年门诊量的中位数为 2.6 次（IQR：1.5-3.4）。监测成像的中位频率为每年 2.4 次（IQR：1.6, 3.1）。胸片是胸腔部位最常用的成像方式（占所有成像的 34%），超声波是腹腔部位最常用的成像方式（占所有成像的 24%）。在监测期间，一名患者在骶前切除术后6.7个月时通过磁共振成像发现了复发或残留的神经节瘤。这名患者接受了再次手术切除，随后的监测显示没有再复发：结论：该组 LRNBT 患者的复发率较低。针对这种低风险病理的最佳监控策略将最大限度地减少辐射暴露和患者的就医负担。有必要进一步开展多机构研究，以确定最佳的成像方式以及 LRNBT 患者的随访频率和持续时间。未来的研究应评估对实现完全切除的患者进行短期监测的可接受性。

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引用次数: 0