Journal of Surgical Research最新文献_第3页

Reasons for Women Surgeon Attrition From the US Workforce 美国女性外科医生减少的原因

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-03 DOI: 10.1016/j.jss.2026.01.003

Elisa Bass BA , Richard Butterfield MA , Ruth Bush MD, JD, MPH , Linda Harris MD , Palma Shaw MD , Kellie Brown MD , Ellen Julian PhD , Sarah McLaughlin MD , Young Erben MD

Introduction

With a projected shortage of over 30,000 surgeons by 2034, understanding and reducing nonretirement attrition is critical to maintaining a sustainable surgical workforce. Prior studies show higher attrition rates among women surgeons but have limited insight into the reasons behind these decisions. This study aims to identify the factors contributing to consideration of workforce attrition among women surgeons and to highlight modifiable elements that may support retention.

Methods

An anonymous online survey was distributed to the Association of Women Surgeons email list and women surgeons’ WhatsApp groups between October and December 2024. Respondents were asked whether they had considered leaving the surgical workforce for reasons unrelated to retirement and about factors contributing to both their consideration of leaving and their decision to remain. Responses were analyzed using descriptive statistics and chi-square tests.

Results

The response rate was 15%. Of 371 total female respondents, 242 (65%) reported having considered or currently considering leaving surgery. The top reasons cited were poor work-life balance (71%), overly demanding work (57%), and discrimination or mistreatment (50%), among whom 96% reported gender-based discrimination. Primary factors for staying included financial necessity (61%), good patient relationships (60%), and collegial support (54%). Among those who considered but decided not to leave, improved work-life balance (43%), increased compensation (26%), and improved workplace relationships (26%) were the most common influences.

Conclusions

Attrition among women surgeons stems from systemic challenges. Interventions targeting work-life balance, compensation, and workplace inclusion may meaningfully support retention and help sustain a diverse and effective surgical workforce.

到2034年，预计将有超过30,000名外科医生短缺，了解和减少非退休人员流失对于维持可持续的外科劳动力至关重要。先前的研究表明，女性外科医生的流失率更高，但对这些决定背后的原因了解有限。本研究旨在确定影响女性外科医生劳动力流失的因素，并强调可能支持保留的可修改因素。方法：于2024年10月至12月向女外科医生协会电子邮件列表和女外科医生WhatsApp群进行匿名在线调查。受访者被问及他们是否考虑过因与退休无关的原因离开外科工作队伍，以及导致他们考虑离开和决定留下的因素。采用描述性统计和卡方检验对反应进行分析。结果：有效率为15%。在371名女性受访者中，242名（65%）表示曾考虑或正在考虑放弃手术。最主要的原因是工作与生活不平衡（71%），工作要求过高（57%），以及歧视或虐待（50%），其中96%的人表示存在性别歧视。留下来的主要因素包括经济需要（61%）、良好的患者关系（60%）和大学支持（54%）。在那些考虑过但决定不离开的人中，改善工作与生活的平衡（43%）、增加薪酬（26%）和改善职场关系（26%）是最常见的影响因素。结论：女性外科医生的磨耗源于系统性挑战。针对工作与生活平衡、薪酬和工作场所包容性的干预措施可能会有意地支持保留并帮助维持多样化和有效的外科工作人员队伍。

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引用次数: 0

Cutting Costs, Saving Lives: A Surgeon's Guide to the Foundations of Cost-effectiveness Analysis 削减成本，拯救生命：外科医生成本效益分析基础指南

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/j.jss.2025.12.044

Yang Zhang MScPH, Grace E. Ratcliff MPH, Jinyi Zhu PhD

Introduction

As surgical care faces increasing financial scrutiny, there is a growing need for clinicians to understand the economic value of interventions. Cost-effectiveness analysis (CEA) provides a structured approach to comparing clinical strategies in terms of both outcomes and costs; however, these methods remain underutilized and underappreciated in many surgical disciplines.

Materials and Methods

This article introduces foundational concepts in CEA, including comparative evaluation, quality-adjusted and disability-adjusted life years, cost estimation, incremental cost-effectiveness ratios, and modeling techniques such as decision trees, Markov models, and microsimulation. We also explain the role of sensitivity analyses in addressing uncertainty. Concepts are illustrated with examples relevant to surgical and policy decision-making.

Results

The explainer provides a structured framework for interpreting and critiquing CEAs, highlighting how model structure, perspective, and assumptions affect conclusions about value. It provides guidance for critically appraising published CEAs and understanding their implications for clinical practice, resource allocation, and guideline development.

Conclusions

This article serves as a practical entry point for clinicians, researchers, and decision-makers seeking to understand and apply cost-effectiveness methods. It is intended to build foundational fluency in economic evaluation and support more informed engagement with value-based care, policy design, and evidence appraisal.

随着外科护理面临越来越多的财务审查，临床医生越来越需要了解干预措施的经济价值。成本效益分析（CEA）提供了一种结构化的方法来比较临床策略的结果和成本；然而，这些方法在许多外科学科中仍未得到充分利用和重视。材料和方法本文介绍了CEA的基本概念，包括比较评估、质量调整和残疾调整寿命年、成本估算、增量成本-效果比，以及决策树、马尔可夫模型和微观模拟等建模技术。我们还解释了敏感性分析在解决不确定性中的作用。概念与相关的手术和政策决策的例子说明。结果解释者提供了一个结构化的框架来解释和批评cea，强调模型结构、视角和假设如何影响关于价值的结论。它为批判性地评价已发表的cea和理解它们对临床实践、资源分配和指南制定的影响提供了指导。本文为临床医生、研究人员和决策者寻求理解和应用成本效益方法提供了一个实用的切入点。它旨在建立经济评估的基础流畅性，并支持更知情地参与基于价值的护理、政策设计和证据评估。

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引用次数: 0

On The Cover 封面上

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/S0022-4804(26)00041-7

引用次数: 0

Plasma Proteomic Signatures for Diverticulitis Risk Stratification 憩室炎风险分层的血浆蛋白质组学特征。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/j.jss.2025.06.093

Thomas E. Ueland MD , John P. Shelley PhD , Jonathan D. Mosley MD, PhD , Jamie R. Robinson MD, PhD , Eric R. Gamazon PhD , Lillias H. Maguire MD , Richard Peek MD , Alexander T. Hawkins MD, MPH

Introduction

Approaches for risk stratification in diverticulitis have emphasized lifestyle factors, with a possible emerging role for molecular signatures. We aimed to evaluate whether plasma proteomic profiles complement dietary and genetic factors in diverticulitis risk stratification.

Materials and methods

This UK Biobank study derived a plasma proteomic risk score for severe diverticulitis (operative or recurrent inpatient disease). The cohort was split into a training set for derivation and an independent testing set for evaluation. Differential expression and gene set enrichment analysis identified pathway-level differences, while least absolute shrinkage and selector operator models calculated the score. To evaluate utility in stratification, the proteomic risk score was included in Cox regression models with demographics, lifestyle factors, and genetic risk. A phenome-wide association study explored for conditions associated with diverticulitis proteomic signatures.

Results

Among 43,539 patients and 1459 plasma proteins measured at enrollment, there were 551 cases of severe diverticulitis throughout follow-up. Differential expression analysis implicated extracellular matrix and neuronal pathways, while least absolute shrinkage and selector operator regression retained 151 proteins. This proteomic risk score was associated with greater risk of severe diverticulitis (hazard ratio [95% confidence interval], 1.48 [1.18-1.87]), and a full model with proteomic and genetic factors improved upon a base model with demographic and lifestyle factors (maximum at 5-y area under the receiver operating characteristics curve [95% confidence interval], training set: 0.83 [0.79-0.86] versus 0.69 [0.64-0.73]; testing set 0.75 versus 0.70; P < 0.01) In the phenome-wide association study, elevated proteomic risk for diverticulitis was associated with renal dysfunction and cardiometabolic traits.

Conclusions

Plasma proteomic profiles complemented genetic and lifestyle factors in diverticulitis risk stratification.

导论：憩室炎风险分层的方法强调了生活方式因素，并可能在分子特征方面发挥新的作用。我们的目的是评估血浆蛋白质组谱是否补充了饮食和遗传因素在憩室炎风险分层中的作用。材料和方法：这项英国生物银行研究得出了严重憩室炎（手术或复发性住院疾病）的血浆蛋白质组学风险评分。队列被分成一个训练集用于推导和一个独立的测试集用于评估。差异表达和基因集富集分析确定了途径水平的差异，而最小绝对收缩和选择算子模型计算了分数。为了评估分层的效用，将蛋白质组学风险评分纳入人口统计学、生活方式因素和遗传风险的Cox回归模型中。一项全现象关联研究探讨了与憩室炎相关的蛋白质组学特征。结果：在43,539例患者和1459例血浆蛋白中，随访期间有551例重度憩室炎。差异表达分析涉及细胞外基质和神经元通路，而最小绝对收缩和选择算子回归保留了151个蛋白质。该蛋白质组学风险评分与严重憩室炎的高风险相关（风险比[95%置信区间]，1.48[1.18-1.87]），一个包含蛋白质组学和遗传因素的完整模型在包含人口统计学和生活方式因素的基础模型上得到了改进(在受试者工作特征曲线下的5 y区域最大[95%置信区间]，训练集：0.83[0.79-0.86]对0.69[0.64-0.73]，测试集：0.75对0.70；P < 0.01)在全表型相关性研究中，憩室炎的蛋白质组学风险升高与肾功能障碍和心脏代谢特征相关。结论：血浆蛋白质组学特征补充了遗传和生活方式因素在憩室炎风险分层中的作用。

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引用次数: 0

In-Person and Virtual Interview Format for General Surgery Residency From an Applicant Perspective 从申请人的角度来看，普通外科住院医师的面对面和虚拟面试形式。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/j.jss.2025.12.034

Maya Hammoud MD, Adam Ayoub BS, Robert Sawyer MD, Saad Shebrain MD

Introduction

While residency interviews have historically been in person, the majority of residency interviews transitioned to virtual interviews (VTIs) due to the COVID-19 pandemic. Since that time, in-person interviews (IPIs) have slowly been reintroduced. This study assesses applicant perceptions of VTI versus IPI formats.

Methods

Applicants to a single general surgery residency program were surveyed regarding factors that were important for ranking the programs, experience with IPI and VTI platforms, experience at our institution, and decision-making in choosing the program for interview and ranking. Primary outcomes evaluated were the differences between IPI and VTI from an applicant perspective.

Results

Of the 229 applicants interviewed at our institution and ranked for 18 y-1 positions in the 2022-23, 2023-24, and 2024-2025 match cycles, 61 applicants (27%) responded with complete data to our survey (23 IPI, 30 VTI). Applicants in both groups (IPI versus VTI) reported fellowship prospects after graduation and geographic location to be important or extremely important in ranking programs (87.1%. versus 80.0%, P = 0.347). Applicants reported similar overall experiences at our institution. Candidates were more satisfied with in-person preinterview meeting with residents (93.5% IPI versus 63.3% VTI, P = 0.0043) and in-person hospital tours (80.6% IPI versus 53.3% VTI, P = 0.0244). More than half of applicants who interviewed virtually agreed or strongly agreed that financial considerations impacted their format selection, compared to one-third in the IPI (P = 0.221). Finally, more virtual interviewees agreed/strongly agreed that they would not have interviewed if not offered that format compared to IPI (30% VTI, 9% IPI, P = 0.11).

Conclusions

Overall, from the applicant perspective, there are few statistically significant differences between IPI and VTI. IPI is associated with better experiences at preinterview social events and during the hospital tours, but there was no difference in applicants’ abilities to rank the program based on interview format. Both IPI and VTI should continue to be offered.

导语：虽然住院医师面试历来都是面对面的，但由于COVID-19大流行，大多数住院医师面试都转变为虚拟面试（VTIs）。从那时起，面对面访谈（ipi）逐渐被重新引入。本研究评估了申请人对VTI和IPI格式的看法。方法：对单个普外科住院医师项目的申请人进行调查，包括对项目排名重要的因素、使用IPI和VTI平台的经验、在我院的经验以及选择项目进行面试和排名的决策。评估的主要结果是从申请人的角度来看IPI和VTI的差异。结果：在我校接受采访的229名申请人中，在2022-23、2023-24和2024-2025匹配周期中排名18 y-1职位，61名申请人（27%）对我们的调查（23名IPI， 30名VTI）做出了完整的回应。两组申请人（IPI和VTI）都表示，毕业后的奖学金前景和地理位置在排名项目中是重要或极其重要的（87.1%）。对比80.0%,P = 0.347)。申请人在我们机构的总体经历相似。面试前与住院医师面对面会面（93.5% IPI比63.3% VTI, P = 0.0043）和面对面医院参观（80.6% IPI比53.3% VTI, P = 0.0244）对应聘者更满意。超过一半的受访者几乎同意或强烈同意经济因素影响了他们的格式选择，而在IPI中只有三分之一（P = 0.221）。最后，与IPI相比，更多的虚拟受访者同意或强烈同意，如果没有这种形式，他们就不会接受采访（30% VTI, 9% IPI, P = 0.11）。结论：总的来说，从申请人的角度来看，IPI和VTI之间没有统计学意义上的差异。在面试前的社交活动和医院参观期间，IPI与更好的体验有关，但申请人根据面试形式对项目进行排名的能力没有差异。应继续提供IPI和VTI。

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引用次数: 0

Journal of Surgical Research 外科研究杂志

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/S0022-4804(26)00039-9

引用次数: 0

Liver Remnant Hypertrophy: A Model-Based Evaluation of Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Liver Venous Deprivation 残肝肥厚：基于模型的肝分割和门静脉结扎对肝切除术和肝静脉剥夺的评估

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/j.jss.2025.12.043

Savannah R. Smith MD , Sarah M. Cheney MD , Juan M. Sarmiento MD, FACS

Introduction

Patients undergoing major hepatectomy require a future liver remnant (FLR) of at least 30%. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are hypertrophy techniques for inadequate FLR. We sought to evaluate the cost-effectiveness of these techniques in patients with FLR <30%.

Methods

Via Markov modeling, we assessed clinical and economic outcomes of ALPPS and LVD. Quality-adjusted life years (QALYs), costs (2022 USD), and incremental cost-effectiveness ratios (ICERs) were assessed. We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters.

Results

LVD resulted in 0.60 QALYs and $42,500; ALPPS accumulated 0.58 QALYs and $126,500. LVD was therefore preferred in the base case. Though LVD reduced costs, fewer simulated patients achieved hepatectomy due to disease progression while awaiting hypertrophy. If time to adequate hypertrophy for LVD was <30 d, LVD substantially increased QALYs compared to ALPPS.

Conclusions

LVD and ALPPS are both acceptable techniques. LVD is preferred from a cost-effectiveness standpoint; however, if time to adequate hypertrophy were reduced or patient selection optimized to ensure at least 90% of LVD patients achieve hepatectomy, LVD would substantially improve QALYs while still saving costs compared to ALPPS.

接受大肝切除术的患者要求未来肝残余（FLR）至少为30%。分阶段肝切除术（ALPPS）和肝静脉剥夺（LVD）相关联的肝分区和门静脉结扎是治疗FLR不足的肥厚技术。我们试图评估这些技术在FLR <；30%患者中的成本-效果。方法通过马尔可夫模型评估ALPPS和LVD的临床和经济效果。评估了质量调整生命年（QALYs）、成本（2022美元）和增量成本-效果比（ICERs）。我们进行了敏感性分析，以评估我们的模型对输入参数变化的稳健性。结果slvd产生0.60个qaly和42,500美元；ALPPS累计获得了0.58个QALYs和126,500美元。因此，在基本情况下首选LVD。虽然LVD降低了成本，但较少的模拟患者在等待肥厚时因疾病进展而实现肝切除术。如果LVD达到充分肥厚的时间为30天，与ALPPS相比，LVD显著增加了QALYs。结论slvd和ALPPS都是可行的方法。从成本效益的角度来看，LVD是首选；然而，如果减少到足够肥厚的时间或优化患者选择以确保至少90%的LVD患者实现肝切除术，LVD将大大改善QALYs，同时与ALPPS相比仍节省成本。

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引用次数: 0

Letter Regarding: Impact of Etiology on Predictive Models for Acute Pancreatitis Severity: A Retrospective Study 关于“病因学对急性胰腺炎严重程度预测模型的影响：一项回顾性研究”的信函。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-02-01 DOI: 10.1016/j.jss.2025.11.070

Xingyu Huang MD

引用次数: 0

Risks of Failure in Advanced Trauma Life Support Courses 晚期创伤生命支持课程失败的风险

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-31 DOI: 10.1016/j.jss.2026.01.005

Zachary C. Newman MD , David V. Deshpande BS , Jim Doherty MD , Sanja Nikolich MD , Leah Carey Tatebe MD , David A. Hampton MD, MEng , Judith Brasic RN , Timothy P. Plackett DO, MPH

Introduction

The Advanced Trauma Life Support (ATLS) course is the common standard for care and disposition of trauma patients across both designated and nondesignated trauma centers. Evidence of individual student risk factors for ATLS course performance are minimal.

Methods

A retrospective study was conducted using ATLS course data for hybrid student and refresher courses taught in 2022-2023 from a single American College of Surgeons Regional Committee on Trauma. Marginal performance was defined as a post-test score of < 80% on the written examination or failing the practical test on the first attempt. Univariable analysis by predictor was completed using the

χ^{2}

test and Mann–Whitney U tests, as appropriate. Multivariable analysis was completed with logistic regression analysis.

Results

Among 996 students in the study, 191 (19%) were identified as having marginal ATLS course performance. Marginal performance was significantly more common in the student course (24%) than in the refresher course (9%). Marginal performers differed by medical degree and training status, medical specialty, and level of their home institution trauma center designation. In regression analysis, lower pretest score was associated with higher odds of marginal performance. As compared to advanced practice providers, an attending physician status was associated with lower odds of marginal performance.

Conclusions

Marginal performance varies by specialty, training level, and home institution trauma center designation. Future work is needed to identify and support at-risk students in both initial and refresher hybrid ATLS courses.

高级创伤生命支持（ATLS）课程是指定和非指定创伤中心护理和处置创伤患者的通用标准。个别学生影响ATLS课程表现的风险因素的证据很少。方法回顾性研究美国外科医师学会创伤区域委员会2022-2023年混合型学生和进修课程的ATLS课程资料。边际成绩被定义为测试后笔试成绩达到80%或第一次实践测试不及格。采用χ2检验和Mann-Whitney U检验完成预测因子单变量分析。采用logistic回归分析完成多变量分析。结果996名学生中，191名（19%）被确定为ATLS课程表现不佳。边际表现在学生课程（24%）中明显比在进修课程（9%）中更为常见。边缘表现者在医学学位和培训状况、医学专业和家庭机构创伤中心指定水平上存在差异。在回归分析中，较低的预试得分与较高的边际表现几率相关。与高级执业医师相比，主治医师的身份与较低的边际绩效相关。结论创伤患者的边缘性表现因专科、培训水平和家庭创伤中心名称而异。未来的工作需要识别和支持有风险的学生在初始和进修混合ATLS课程。

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引用次数: 0

Hospital Unit Variation in Pediatric Postoperative Opioid Administration Is Associated With Increased Neonatal Opioid Exposure 儿科术后阿片类药物给药的医院单位差异与新生儿阿片类药物暴露增加有关。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-31 DOI: 10.1016/j.jss.2026.01.001

Kali Bravo HBS, Julie C. McKee RN, MS, CPNP-AC/PC, Russell Wells BS, MCR, Shawn Izadi MD, MPH, Benjamin Carr MD, Sanjay Krishnaswami MD

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。

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引用次数: 0