Journal of Surgical Research最新文献

{"title":"Implementation and Evaluation of a Protocol for the Management of Type C Tracheoesophageal Fistula","authors":"Sage A. Vincent MD ,&nbsp;Lori Silveira PhD, MS ,&nbsp;Samantha Bothwell MS ,&nbsp;Jonathan Roach MD ,&nbsp;Jose Diaz-Miron MD, MSCS ,&nbsp;Stephanie L. Bourque MD, MSCS ,&nbsp;Shannon N. Acker MD","doi":"10.1016/j.jss.2026.01.010","DOIUrl":"10.1016/j.jss.2026.01.010","url":null,"abstract":"<div><h3>Introduction</h3><div>A multidisciplinary protocol for the management of esophageal atresia/tracheoesophageal fistula (EA/TEF) was developed with stakeholders from pediatric surgery and neonatology. Introduced in July 2022, this study aims to assess protocol utilization and association with patient outcomes.</div></div><div><h3>Methods</h3><div>We performed a single-center, retrospective review of neonatal patients who underwent type C EA/TEF repair between 2010 and 2024. Utilization of protocol elements was assessed, as well as clinical outcomes. Preprotocol and postprotocol management and outcomes were compared using logistic regression. A prospective provider survey was administered to assess protocol sustainability and knowledge.</div></div><div><h3>Results</h3><div>There were 103 patients who underwent type C EA/TEF repair, 87 preprotocol and 16 postprotocol implementation. Thoracoscopic repair was more common postprotocol (68.8% <em>versus</em> 31.0%, <em>P</em> = 0.003). Patients were more likely to receive total parenteral nutrition until full enteral feeds were reached (odds ratio 75.6; 95% confidence interval 4.2, 1445; <em>P</em> = 0.003) and receive enteral feeds within 24 h of surgery when transanastomotic tube was in place (odds ratio 3.71; 95% confidence interval 1.04, 13.27; <em>P</em> = 0.043) postprotocol. There was no significant change in outcomes including anastomotic leak and stricture. Providers could correctly identify 2/3 of the EA/TEF protocol elements and 22% reported receiving education on its contents.</div></div><div><h3>Conclusions</h3><div>Implementation of an EA/TEF protocol was associated with a 75 times greater likelihood of patients receiving total parenteral nutrition until full feeds were reached and 3.7 times greater likelihood of starting enteral feeds within 24 h of surgery when transanastomotic tube was in place. There was a shift toward thoracoscopic repair of EA/TEF and no change in clinical outcomes including anastomotic leak and stricture. Implementation and knowledge of the protocol faced challenges and provider surveys identified avenues for improving education strategies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 108-116"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165745","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}

{"title":"Assessing the Association of Age and Preoperative Sodium Level on Colectomy Outcomes: An NSQIP Study","authors":"Amandeep S. Ahluwalia BS,&nbsp;Hari Ramesh MS,&nbsp;Zummar Asad MB, BCh, BAO,&nbsp;Alex I. Halpern MD,&nbsp;Matthew Ng MD,&nbsp;Susan Kartiko MD, PhD, FACS","doi":"10.1016/j.jss.2026.01.012","DOIUrl":"10.1016/j.jss.2026.01.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Preoperative abnormal sodium level is suggested to increase mortality risk in surgeries, including colectomy for colorectal cancer. However, it remains unclear which age groups are most affected by this electrolyte derangement. To bridge this gap and to better risk stratify patients preoperatively, we assessed the association of age on patients with abnormal sodium level undergoing colectomy for colorectal cancer.</div></div><div><h3>Materials and Methods</h3><div>We reviewed the American College of Surgeons National Safety Quality Improvement Program Procedure-Targeted Colectomy database from 2015-2020, identifying patients over the age of 18 who underwent colectomy for primary colon cancer. We dichotomized the group by age, either younger than or 65 y and older. We collected demographics, comorbidities, laboratory values, and operative variables. We performed descriptive statistics, univariate analysis, and multivariable logistic regression with interaction term analysis. Our primary outcome was the relationship between age and 30-d mortality among patients with abnormal sodium levels. We defined statistical significance using two-sided tests as <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>We identified 89,745 patients who underwent colectomy for primary colon cancer, 50,528 of those were aged 65 y and older. On multivariate analysis, we found that age ≥65 y is associated with an increased risk of mortality (odds ratio [OR], 2.574, <em>P</em> &lt; 0.01). We found sodium level to have a U-shaped relationship with increased risk of mortality for both hyponatremia and hypernatremia (hyponatremia OR, 1.38, <em>P</em> &lt; 0.01, hypernatremia OR, 1.878, <em>P</em> &lt; 0.01), controlling for demographics and comorbidities. On multivariate interaction analysis, sodium level did not pose a clinically significant higher mortality risk to patients' age (OR, 1.002, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Advanced age and abnormal sodium level are independently associated with 30-d mortality following colectomy for colon cancer. Furthermore, the association between abnormal sodium levels and mortality does not differ in a clinically meaningful way between younger and older patients. This finding reinforces that abnormal sodium level is associated with an increased mortality risk after colectomy for colon cancer and provides a potential target for further study.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 141-151"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191639","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}

{"title":"Journal of Surgical Research","authors":"","doi":"10.1016/S0022-4804(26)00070-3","DOIUrl":"10.1016/S0022-4804(26)00070-3","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Page iii"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147395679","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}

{"title":"Reasons for Women Surgeon Attrition From the US Workforce","authors":"Elisa Bass BA ,&nbsp;Richard Butterfield MA ,&nbsp;Ruth Bush MD, JD, MPH ,&nbsp;Linda Harris MD ,&nbsp;Palma Shaw MD ,&nbsp;Kellie Brown MD ,&nbsp;Ellen Julian PhD ,&nbsp;Sarah McLaughlin MD ,&nbsp;Young Erben MD","doi":"10.1016/j.jss.2026.01.003","DOIUrl":"10.1016/j.jss.2026.01.003","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 30-39"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119316","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}

{"title":"Reduction of Neuro Check Intervals in Traumatic Brain Injury Patients is Associated With Lowers Delirium Risk","authors":"Jayati Atahar MBBS, MPH ,&nbsp;Jeremy Hayward MD ,&nbsp;Alex I. Halpern MD ,&nbsp;Ahmed Noureldin MD ,&nbsp;Stephanie Boese MSN, RN, CCRN, TCRN ,&nbsp;Susan Kartiko MD, PhD, FACS","doi":"10.1016/j.jss.2026.01.007","DOIUrl":"10.1016/j.jss.2026.01.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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, &lt;em&gt;P&lt;/em&gt; = 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, &lt;em&gt;P&lt;/em&gt; &lt; 0.05), mortality (OR 17.11; 95% CI 1.72-170.77, &lt;em&gt;P&lt;/em&gt; &lt; 0.05), and ICU LOS (2.57 days; 95% CI 1.23-3.92, &lt;em&gt;P&lt;/em&gt; &lt; 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, &lt;em&gt;P&lt;/em&gt; = 0.24).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;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":"2026-03-01","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}

{"title":"Lower Household Income Is Associated With Higher Cardiac and Vascular Mortality After Endovascular Abdominal Aortic Aneurysm Repair","authors":"Jon Vandenberg MD,&nbsp;Houssam Farres MD,&nbsp;Camilo Polania-Sandoval MD,&nbsp;Camila Esquetini-Vernon MD,&nbsp;Hennessy A. Morales-Arroyo BS,&nbsp;Yetzali Claudio-Medina BS,&nbsp;Christopher Jacobs MD,&nbsp;Young Erben MD","doi":"10.1016/j.jss.2026.01.025","DOIUrl":"10.1016/j.jss.2026.01.025","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Poor abdominal aortic aneurysm (AAA) repair outcomes have been associated with socioeconomic disparities, reporting increased mortality and complication rates in more deprived areas. This single-center study evaluated disparities following endovascular aortic repair (EVAR) according to zip code-related income data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a single-center retrospective cohort study between 2014 and 2024 in patients who underwent EVAR or fenestrated EVAR . The primary outcome was cardiac or vascular mortality. Median household income was based on the patient's zip code from the most recent United States census reports. Income data were divided into two groups based on the median household income (MHI). Survival analysis and Cox proportional hazards analysis were performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 244 patients were included and divided into two groups, low-MHI (≤$65,132) and high-MHI (&gt;$65,132). Groups were similar regarding age, sex, body measurement, and comorbidities. Thirty-day aortic-related complications (low-MHI: 3.3%, high-MHI: 1.6%; &lt;em&gt;P&lt;/em&gt; = 0.41) and nonaortic-related complications (low-MHI: 2.5%, high-MHI: 3.3%; &lt;em&gt;P&lt;/em&gt; = 0.70) were similar between groups. Mean follow-up time was 2.6 ± 2.4 y. Mid-term aortic-related complications (low-MHI: 10.7%, high-MHI: 13.1%; &lt;em&gt;P&lt;/em&gt; = 0.55) were not different between groups, as well as reintervention rates (low-MHI: 11.5%, high-MHI: 13.1%; &lt;em&gt;P&lt;/em&gt; = 0.70) were similar. All-cause mortality rates were similar (low-MHI: 23.8%, high-MHI: 21.3%; &lt;em&gt;P&lt;/em&gt; = 0.65); however, cardiac or vascular mortality was significantly higher in low-MHI patients (9.0% &lt;em&gt;versus&lt;/em&gt; 1.6%, &lt;em&gt;P&lt;/em&gt; = 0.01). This difference persisted when comparing time-to-event Kaplan-Meier curves (log-rank test &lt;em&gt;P&lt;/em&gt; = 0.01). In the multivariate Cox regression analysis, age (adjusted hazard ratio: 1.12, 95% confidence interval: 1.03-1.22; &lt;em&gt;P&lt;/em&gt; = 0.01) and low-MHI (adjusted hazard ratio : 5.29, 95% confidence interval: 1.14-24.48; &lt;em&gt;P&lt;/em&gt; = 0.03) remained as significant predictors for cardiac or vascular mortality at follow-up. Cohorts were separated into household income quartiles and quintiles. Regarding the main outcome, a persistent significant difference in cardiac or vascular mortality rates within quartiles was present (quartile 1: 6.6%, quartile 2: 11.5%, quartile 3: 0.0%, quartile 4: 3.3%; &lt;em&gt;P&lt;/em&gt; = 0.03); however, this difference was no longer significant when the data were stratified into quintiles (quintile 1: 6.1%, quintile 2: 10.3%, quintile 3: 3.4%, quintile 4: 4.1%, quintile 5: 0.0%; &lt;em&gt;P&lt;/em&gt; = 0.15).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Lower household income is associated with increased cardiac or vascular mortality when stratified in both dichotomic distribution and quartiles. Further association was not present when income was stratified into quintiles, likely from loss of statistical power. Furth","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 193-199"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213626","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}

{"title":"Association of Unplanned ICU Admission and Clinical Outcomes in Trauma Patients With Severe Sepsis","authors":"Alexander Brown MBS ,&nbsp;Ariel Hus BS ,&nbsp;Ian Bundschu BS ,&nbsp;Logan Rogers BS ,&nbsp;Yumna Indorewala BS ,&nbsp;Alexandra Kata MS ,&nbsp;Sanjan Kumar BS ,&nbsp;Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2026.01.017","DOIUrl":"10.1016/j.jss.2026.01.017","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to evaluate the association between unplanned ICU admission and clinical outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, this study assesses predictors of worsened outcomes in this population.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed the ACS-TQIP database (2017-2023) to analyze outcomes associated with unplanned ICU admission in adult and geriatric trauma patients (ISS ≥ 15) with severe sepsis. The primary outcome was in-hospital mortality, and secondary outcomes included discharge disposition, ICU-LOS, ventilator-free days, and complications.</div></div><div><h3>Results</h3><div>In both adult and geriatric patients, unplanned ICU admission was associated with significantly lower in-hospital mortality (aOR: 0.460, 95% CI: 0.346-0.610, <em>P</em> &lt; 0.001, SE: 0.145) (aOR: 0.657, 95% CI: 0.438-0.987, <em>P</em> = 0.043, SE: 0.207) and more ventilator-free days (β = 5.067, 95% CI: 3.981-6.153, <em>P</em> &lt; 0.001, SE: 0.554) (β = 2.402, 95% CI: 0.625-4.180, <em>P</em> = 0.008, SE: 0.905). Advanced age (over 64 years) (aOR: 1.487, 95% CI: 1.140-1.924, <em>P</em> = 0.003, SE: 0.134), ISS over 25 (aOR: 1.487, 95% CI: 1.251-1.768, <em>P</em> &lt; 0.001, SE: 0.088), and having multiple comorbidities (aOR: 1.402, 95% CI: 1.152-1.706, <em>P</em> &lt; 0.001, SE: 0.100) were found to be associated with worse outcomes.</div></div><div><h3>Conclusions</h3><div>Findings from this national analysis highlighted predictors associated with worsening outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, while unplanned ICU admission was associated with improved outcomes in both adult and geriatric trauma patients with severe sepsis compared to those admitted to hospital floors, its high resource utilization emphasizes the importance of developing targeted care strategies to prevent resource overutilization and clinical deterioration in this patient population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 100-107"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165701","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}

{"title":"Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends","authors":"Nina D. Kosciuszek DO, MS ,&nbsp;Michael Froehlich MD ,&nbsp;Robert P. Moore MD ,&nbsp;Maroun Yammine MD ,&nbsp;Stephanie C. Cardamone MD ,&nbsp;David A. Chesler MD ,&nbsp;James M. Barsi MD ,&nbsp;Jaime P. Doody MD ,&nbsp;Alvin Wong MD ,&nbsp;Michael L. Ernst MD ,&nbsp;Richard J. Scriven MD ,&nbsp;Kristen A. Calabro MD ,&nbsp;Kenneth W. Gow MD, MHA","doi":"10.1016/j.jss.2025.06.094","DOIUrl":"10.1016/j.jss.2025.06.094","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Surgical specialization is critical in medical training, with fellowships as key pathways for career advancement and shaping the pediatric surgical workforce. Given the surgical condition and procedural overlap between subspecialties, skills often complement each other to enhance comprehensive pediatric care. This study examines the balance of supply and demand across pediatric surgical fellowship positions, evaluating trends in individual fields and their collective impact on pediatric surgical care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We analyzed available fellowship match data from 2004 to 2024 across nine pediatric subspecialties: anesthesiology, cardiac surgery, general surgery, gynecology, neurosurgery, orthopedics, otolaryngology, plastic surgery, and urology. Data were obtained from the National Resident Matching Program, San Francisco Match, and the Pediatric Orthopedic Society of North America. Applicant-to-position ratios were calculated, with 1 indicating balance, &gt;1 reflecting higher demand, and &lt;1 indicating lower demand. Statistical analysis was performed using least squares regression and ANOVA in SPSS (IBM SPSS Statistics, Version 29.0.2.0 (IBM Corp, Armonk, NY)). Data are expressed as mean ± standard deviation, where applicable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Nine subspecialties were assessed. Higher demand was found for available positions in pediatric general surgery (1.80 ± 0.23), gynecology (1.35 ± 0.21), and cardiac surgery (1.21 ± 0.46). Specialties with lower demand included urology (0.81 ± 0.08), plastic surgery (0.88 ± 0.13), anesthesiology (0.92 ± 0.20), otolaryngology (0.95 ± 0.14), and neurosurgery (0.96 ± 0.20). An analysis of trends revealed that all specialties experienced a decline in the ratio of applicants to available positions, except for orthopedics, which saw significant decreases in the ratios for anesthesiology, general surgery, and plastic surgery. The average number of unfilled fellowship positions was most notable for anesthesiology (35.2 ± 19.5), orthopedics (16.4 ± 5.5), and otolaryngology (11.2 ± 4.7). The percentage of unfilled positions was notably high for urology (31.9% ± 8.8%), plastic surgery (27.6% ± 11.6%), and otolaryngology (24.0% ± 9.4%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The findings suggest that pediatric general surgery, gynecology, and cardiac surgery continue to attract strong interest, while anesthesiology, orthopedics, otolaryngology, plastic surgery, and urology are seeing fewer applicants than available positions. What is most concerning, however, is that almost all fields have witnessed a decline in interest over time. If it continues, this trend portends poorly for the future of pediatric surgical care, as an imbalance between the decreasing supply of specialists and the growing demand for specialized care could lead to gaps in patient services. Addressing these imbalances is crucial to sustaining a well-rounded, highly qualifi","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 200-212"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958490","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}

{"title":"Lung Cancer Screening in a Rural Academic Health System Reveals Low False-Positive Rates","authors":"Kayla A. Fay MPH ,&nbsp;Karen E. Schifferdecker PhD, MPH ,&nbsp;Linda M. Kinney MPA ,&nbsp;Ellie J. Kyung PhD ,&nbsp;Shoshana H. Bardach PhD ,&nbsp;Maureen B. Boardman MSN, FNP-C, FAANP ,&nbsp;Dagmar Hoegemann Savellano MD ,&nbsp;Connor Bridges BS ,&nbsp;Sean R. Halloran BA ,&nbsp;Samuel Youkilis BA ,&nbsp;Tom Bird ,&nbsp;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":"2026-03-01","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}

{"title":"Ten-Year Single-Center Experience in the Surgical Treatment of Carotid Body Tumors","authors":"Antonio Bozzani MD ,&nbsp;Simone Mauramati MD ,&nbsp;Vittorio Arici MD ,&nbsp;Elvira Visciglia MD ,&nbsp;Matteo Crippa MD ,&nbsp;Rosa Rossini MD ,&nbsp;Marco Benazzo MD ,&nbsp;Antonio V. Sterpetti MD ,&nbsp;Patrizia Morbini MD ,&nbsp;Eloisa Arbustini MD","doi":"10.1016/j.jss.2026.01.014","DOIUrl":"10.1016/j.jss.2026.01.014","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate outcomes in the surgical management of carotid body tumors (CBTs), assess long-term follow-up, and examine the importance of genetic testing for succinate dehydrogenase genes.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively reviewed 36 patients who had undergone resection of CBTs at our institution from 2013 to 2024. Data on patient history, symptoms, clinical features, diagnostic procedures, treatment modality, perioperative and late (persistent neurological disability and recurrence rate) complications, histological findings, DNA test, and secretory activity were analyzed.</div></div><div><h3>Results</h3><div>The average tumor size was 34.1 mm. A familial history of head and neck paragangliomas was present in 7 patients. According to the Shamblin classification, we observed 8/38 (21%) type III, 18/38 (47.4%) type II, and 12/38 (31.6) type I CBTs. Malignancy was present in two patients. No postoperative deaths or strokes occurred. Cranial nerve injury occurred in 8 patients (22.2%). Tumor size greater than 4 cm and Shamblin grade 3 were correlated with cranial nerve complications. The average follow-up period was 112.4 mo (range: 15-169 mo), including yearly clinical evaluations with Doppler carotid ultrasound. During this period, we observed 3 local recurrences and 1 new intrathoracic localization of paraganglioma.</div></div><div><h3>Conclusions</h3><div>Surgery is recommended for all patients with CBT and fit for open surgery. Early detection of small tumors may improve surgical outcomes and reduce complications.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 90-99"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165802","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}