Journal of Surgical Research最新文献

Introduction: Patients with primary hyperparathyroidism (PHPT) are prone to low bone mineral density (BMD). This study aimed to explore factors associated with improved bone health after parathyroidectomy (PTx).

Methods: We conducted a retrospective analysis of patients who underwent PTx for PHPT at our institution between 2016 and 2020. Patients who had a dual-energy X-ray absorptiometry (DEXA) scan before and after surgery were included. T score in the lumbar spine, femoral neck, hip, and radius were examined longitudinally.

Results: The cohort included 36 patients, predominantly White (80.6%) and female (97.2%), with an average age of 67 ± 8 ys. Before surgery, 25% were diagnosed with osteoporosis, 50% with osteopenia, and 25% had normal BMD. The mean preoperative calcium was 10.5 ± 0.7 mg/dL, and the median parathyroid hormone was 105 (75, 131) pg/mL. The median interval between the preoperative DEXA scan and surgery was 357 (134, 920) days. There was a significant improvement in the femoral neck T-score after surgery (-1.33 ± 1.05 presurgery versus -1.16 ± 1.19 postsurgery, P = 0.016), but not in other regions. A longer time between the preoperative DEXA scan and surgery was associated with a lower likelihood of T-score improvement after surgery (odds ratio = 0.92, 95% confidence interval 0.85 - 0.99).

Conclusions: PTx improves BMD in the femoral neck of patient with PHPT. Early surgical intervention may be associated with better skeletal outcomes in PHPT.

Introduction: Solitary plasmacytomas are tumors characterized by a local increase of malignant plasma cells in soft tissue or bone and may occur anywhere without evidence of systemic disease. The aim was to focus on the main surgical techniques and outcomes for this rare chest wall tumor.

Methods: Patients with solitary plasmacytoma involving a rib, who were operated for diagnostic or treatment purposes between 2018 and 2023 were retrospectively reviewed.

Results: Of the six patients included, three were male and the median age was 55.6 (range: 32-74) ys. All patients had preoperative positron emission tomography-computed tomography. Two underwent Tru-cut biopsy before surgery, but only one was then diagnosed. Two patients underwent surgery for diagnosis and the remainder underwent resection and reconstruction. In one patient with both rib and sternum involvement, rib and partial sternum resection was performed and the defect was repaired with mesh. During the 24.1 mos average follow-up period, two patients died, both of whom had metastasis preoperatively. The median survival of all patients was 24.1 (range: 3-63) mos.

Conclusions: Solitary plasmacytoma is rarely seen among primary malign tumors of the chest wall. A multidisciplinary approach is important in these cases. Surgical treatment in solitary plasmacytoma has fewer local and systemic side effects compared to radiotherapy and chemotherapy. Therefore, the place of surgery in the treatment of solitary plasmacytoma should be revised. Our findings show that surgery should be considered as not only a palliative treatment, but also a curative one, in solitary plasmacytomas arising in the rib.

Introduction: Pediatric liver transplantation provides substantial survival benefit. An emphasis on value-based practices has become a central theme in many surgical fields, but have not been well-studied in pediatric transplantation. Given an increasing focus on optimizing outcomes while containing costs, defining value in pediatric liver transplantation warrants investigation.

Methods: Pediatric end-stage liver disease -era deceased donor pediatric liver transplant recipients from 2/2002 to 2/2019 were identified using the United Network for Organ Sharing Standard Transplant Analysis file data (n = 5770). Liver centers were divided into volume tertiles (small, medium, and large), and recipients were stratified by age (0-4, 5-11, and 12-18 y). The value for the index transplant episode was defined as % graft survival ≥1 y divided by mean post-transplant length of stay. Nearest-neighbor Mahalanobis metric matching was used to account for confounding when assessing the impact of center volume on value.

Results: Compared to small centers, large centers delivered better outcomes (1-y graft survival 93.7% versus 89.4%, P = 0.017) without increased resource utilization (length of stay 20.8 ± 15.6 d versus 19.6 ± 17.0, P = 0.281) during the 17-y study period. Mahalanobois-matched cohorts demonstrated a volume-value relationship (higher value care with better outcomes and decreased resource utilization) in the 0-4 age group, but not in older recipients. The 0-4 age group comprised the largest proportion of status 1B patients (21.8%, P < 0.001) and the highest utilization rate of partial liver allografts (40.9%, P < 0.001).

Conclusions: There is value in liver transplant volume in very young (0-4 y) deceased donor pediatric patients. Given improved survival of these patients in higher volume centers, regionalization of care may benefit this specific population of recipients.

Introduction: Body mass index (BMI) has been implicated in various cardiovascular conditions, but its association with peripheral artery disease (PAD) in both real-world and genetic studies have been contentious and debated.

Methods: This study enrolled 6707 individuals from the National Health and Nutrition Examination Survey database to investigate the association between BMI and the risk of PAD. The weighted logistic regression, restricted cubic spline, and subgroup analysis were performed using real-world data. Mendelian randomization study was conducted using genetic data from the Genome-Wide Association Study. The inverse variance weighted method was used as the primary analysis approach, and a sensitivity analysis was conducted to identify pleiotropy and heterogeneity bias.

Results: Individuals with PAD had higher mean BMI values compared to those without PAD (28.82 ± 5.87 and 28.31 ± 5.42, P = 0.007). For the categorical variable of BMI, individuals in obesity class 2 (odds ratio [OR] = 1.532, 95% CI = 1.082-2.169; P = 0.013) and obesity class 3 (OR = 2.479, 95% CI = 1.515-4.056; P < 0.001) had a higher risk of PAD analyzed by weighted logistic regression. Subgroup analysis revealed that the association between BMI and PAD persisted. Given that a higher BMI is associated with PAD, we selected obesity for Mendelian randomization analysis and observed that obesity had a relationship with PAD (inverse variance weight: OR = 1.194, 95% CI = 1.099-1.296; P < 0.001). The reliable findings were validated by sensitive analysis (all P > 0.05).

Conclusions: BMI is a robust risk factor for PAD. A higher BMI (especially ≥35 kg/m²) is associated with an increased risk of developing PAD. Meanwhile, there is a causal relationship between obesity and PAD. Interventions are necessary for targeted obesity prevention and management strategies for PAD.

Introduction: Unplanned, delayed readmissions (>30 ds) following oncologic surgeries can increase mortality and care costs and affect hospital quality indices. However, there is a dearth of literature on rectal cancer surgery. Hence, we aimed to assess the risk factors associated with delayed readmissions following rectal cancer surgery to improve targeted interventions, patient outcomes, and quality indices.

Methods: For this case-control study, all adult patients in the US Rectal Cancer Consortium database who underwent surgery and subsequent readmission were included. Multivariable logistic regression described the association of factors associated with delayed readmission. Descriptive statistics were used to ascertain the most common causes of readmission.

Results: Of the 1417 patients included in the analysis, 403 (28.4%) patients were readmitted postoperatively. Among these, 101 (25.1%) patients had delayed readmission. The median length of stay for early readmission was significantly longer when compared to delayed readmission (4 versus 2 ds, P < 0.01). American Society of Anesthesiologists-Physical Status score > II [odds ratio = 1.81] was associated with an increased risk of delayed readmissions, while intraoperative pelvic drain placement [odds ratio = 0.57] was associated with a reduced risk. Surgical site infection was the most common cause of delayed (18.4%) and early readmissions (27.4%).

Conclusions: The risk of readmission following surgery for rectal cancer extends beyond the commonly tracked 30 ds, with up to a quarter of readmissions happening more than 30 ds after surgery. Surgical site infection continues to be the leading cause of both early and delayed readmission, underscoring the need to double down on infection prevention bundles.

Background: Radioactive iodine (RAI) is a common treatment for various thyroid diseases. Previous studies have suggested susceptibility of parathyroid glands to the mutagenic effect of RAI and the development of primary hyperparathyroidism (PHPT). We tested the possible link between prior RAI treatment, disease presentation, and treatment outcomes.

Methods: A retrospective analysis of 704 individuals who underwent parathyroidectomy for PHPT at a tertiary care center between the years 2015 and 2023 was performed. Preoperative and postoperative parameters, including demographic characteristics, biochemical markers, imaging data, and surgical and pathology findings were collected and analyzed to compare differences in patients who had previous RAI treatment and those who did not (non-RAI). Univariate statistical analyses were performed.

Results: Twenty-nine patients had a history of RAI treatment. Indications for RAI treatment included hyperthyroidism (n = 18), papillary thyroid cancer (n = 6), subacute thyroiditis (n = 1), follicular cancer (n = 1), and toxic goiter (n = 1). Average latency time between RAI exposure and development of PHPT was 18.4 ys. On comparison of the two groups, there was no difference in age, sex, race/ethnicity, day of surgery body mass index, preoperative parathyroid hormone, calcium, glomerular filtration rate, creatinine, vitamin D, or phosphate levels. There was also no difference in preoperative diagnosis of osteoporosis or nephrolithiasis. Postoperatively, there was no difference in parathyroid hormone, calcium, or creatinine levels, or in rate of cure. There was significantly higher chance of unilateral exploration in the operating room (75.9% RAI, 54.1% non-RAI, P = 0.02) and increased rate of single-gland disease in the RAI group, although the latter finding was not statistically significant (79.3% RAI, 65.2% non-RAI, P = 0.12). There was no difference in adenoma size as noted on the pathology report (greatest dimension 1.7 cm RAI, 1.7 cm non-RAI, P = 0.28). Subgroup analysis of the RAI group based on reason for RAI treatment (cancer versus hyperthyroidism) showed no statistically significant differences in the examined demographic or clinical data.

Conclusions: There does not seem to be a relationship between prior RAI treatment and the clinical presentation of PHPT. Additionally, differences in RAI dose do not appear to be associated with a change in clinical presentation. Our study revalidates that age and latency are inversely related, which is a previously shown finding. Clinicians may be reassured that patients with prior RAI history may not have differences in clinical characteristics, disease presentation, or treatment outcomes.

Introduction: Minimally invasive techniques, such as percutaneous endoscopic discectomy, are increasingly utilized for treating focal thoracic ossification of the ligamentum flavum (TOLF), where their safety and efficacy needs to be further confirmed. The purpose of this study was to investigate the safety and efficacy of percutaneous posterolateral transforaminal endoscopic surgery under local anesthesia for treating focal TOLF.

Methods: This case series study reviewed medical records of 12 cases diagnosed with focal TOLF who underwent percutaneous posterolateral transforaminal endoscopic surgery under local anesthesia from December 2016 to July 2019 at Fuzhou Second Hospital. Outcomes were functional status and complications. Functional status was evaluated by Epstein criteria and the Japanese Orthopedic Association score 1 d after surgery. The median follow-up time was 58.5 (47, 62) mo.

Results: Patients' median age was 65 (47, 70) y and 58.3% were female. The median surgical duration was 156 min and intraoperative blood loss was 10-30 mL. The Japanese Orthopedic Association score improved significantly from preoperatively to postoperatively (6 [5, 6] to 12.5 [12, 13], P < 0.001). Based on Epstein's criteria, treatment outcomes were excellent in nine cases, good in two cases, and fair in one case. All included patients returned to free movement from the second day after surgery. No severe complications were reported during follow-up.

Conclusions: Percutaneous posterolateral transforaminal endoscopic surgery under local anesthesia can achieve satisfactory safety and efficacy for treating TOLF. No severe complication was noticed during long-term follow-up.

Introduction: Uncertainties exist regarding the optimal management strategy for patients with thromboangiitis obliterans (TAOs). The aim of this study was to investigate the safety and effectiveness of common interventions used for treating patients with TAO.

Methods: Endovascular treatment, revascularization, sympathectomy, stem cell therapy (SCT), and nonsurgical interventions were selected for inclusion in the study. Changes in mean visual analogue scale score and ankle brachial index (ABI) values were evaluated. In addition, the rate of ulcer healing, postintervention amputation, and overall complication rates were compared across interventions.

Results: A total of 1262 TAO patients (1159 males, 84 females), with a mean age of 38.4 ± 7.8 ys, were included in this systematic review. With an amputation rate of 16.6%, the endovascular treatment group showed statistically significant improvements in mean ABI and visual analogue scale scores (P < 0.05). There was a greater increase in ABI postoperatively with endovascular treatment compared to SCT (P < 0.05), and also a greater increase in ABI postoperatively with revascularization compared to SCT (P < 0.05). Meta-regression showed that both endovascular treatment and open surgical revascularization were superior to stem cell treatment for postoperative mean ABI improvement (P < 0.05). Interestingly, the rate of postoperative amputation was lower in the SCT group compared with the other two interventions.

Conclusions: Our results indicated that all three interventions may be a reasonable therapeutic option for TAO. Endovascular intervention and open revascularization demonstrated superior outcomes.