Journal of Surgical Research最新文献_第4页

Long-term Particulate Matter Exposure and Prolonged Length of Stay After Surgery—A Novel Association 长期颗粒物暴露与术后住院时间延长——一种新的联系。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-21 DOI: 10.1016/j.jss.2025.12.035

Wendelyn M. Oslock MD, MBA, MSPH , Lauren Wood MPH , Arundhati Sawant MBBS , Nathan C. English MBChB , Bayley A. Jones MD, MSPH , Victor Perim MD , Colin Martin MD , Daniel I. Chu MD, MSPH , Ruzmyn Vilcassim MS, PhD

Introduction

Air pollution negatively impacts health outcomes for chronic conditions and has been linked to the development of surgically managed diseases. Its impact on surgical outcomes, however, is not well understood.

Methods

In this cross-sectional study, we linked institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to publicly available air pollutant data from 2006 to 2021. We compared the length of stay (LOS), 30-day complications, and readmission for patients undergoing colorectal surgery based on patient home county exposure to particulate matter <2.5 μm in diameter (PM_2.5) during the year of their operation. Patient demographics, comorbidities, procedural characteristics, as well as social vulnerability were included. Statistical analysis included chi-square tests, Kruskal–Wallis rank sum, Pearson correlation, as well as logistical and linear regression modeling.

Results

A total of 1892 surgical encounters were linked to PM_2.5. Overall, patients were a median 58.7 years of age, 53% female, 35% Black, 45% had private insurance, and 71% came from areas with a high Social Vulnerability Index. Most procedures were elective (77%) and open (54%). The median LOS was 5 days (interquartile range, 3-9) with a 30-day readmission rate of 12% and 30% of patients experiencing at least one complication. On multivariable analysis, PM_2.5 exposure was associated with LOS. Compared to patients from areas with low PM_2.5, those from moderately elevated and high PM_2.5 had an incidence rate ratio of 1.08 [95% confidence interval: 1.04-1.13] and 1.08 [1.02-1.15], respectively.

Conclusions

Air pollution is associated with longer LOS following colorectal surgery. Although readmission and complication rates were not found to be statistically significant, the limited sample size warrants larger study populations.

空气污染对慢性疾病的健康结果产生负面影响，并与手术治疗疾病的发展有关。然而，它对手术结果的影响尚不清楚。方法：在这项横断面研究中，我们将美国外科医师学会国家手术质量改进计划（ACS-NSQIP）的机构数据与2006年至2021年公开的空气污染物数据联系起来。我们比较了结直肠手术患者的住院时间（LOS）、30天并发症和再入院情况（基于患者所在县在手术期间暴露于颗粒物2.5）。包括患者人口统计、合并症、手术特征以及社会脆弱性。统计分析包括卡方检验、Kruskal-Wallis秩和、Pearson相关以及logistic和线性回归模型。结果：共有1892例外科手术与PM2.5有关。总体而言，患者的中位年龄为58.7岁，53%为女性，35%为黑人，45%有私人保险，71%来自社会脆弱性指数高的地区。大多数手术是选择性的（77%）和开放性的（54%）。中位生存期为5天（四分位数范围3-9），30天再入院率为12%，30%的患者出现至少一种并发症。在多变量分析中，PM2.5暴露与LOS相关。与低PM2.5地区患者相比，PM2.5中度升高地区和高PM2.5地区患者的发病率比分别为1.08[95%可信区间：1.04-1.13]和1.08[1.02-1.15]。结论：空气污染与结直肠手术后较长的LOS有关。虽然再入院率和并发症发生率没有统计学意义，但有限的样本量保证了更大的研究人群。

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引用次数: 0

Beyond the Basics of Cost-effectiveness Methods: Advanced Methods for Surgical Decision-making 超越成本效益方法的基础：手术决策的先进方法。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jss.2025.11.073

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

Introduction

As the scope and goals of health care evaluation expand, traditional cost-effectiveness analysis (CEA) methods, which typically evaluate interventions based on their cost per quality-adjusted life year gained, often fall short in capturing the real-world complexities of surgical decision-making. Building on our companion article on foundational CEA, there is an increasing need for advanced analytic tools that incorporate uncertainty, system constraints, and equity considerations.

Methods

In this article, we explain a curated set of advanced methods building on our companion introductory article. These include value of information analysis, discrete event simulation, and equity-informative economic evaluations (including distributional and extended CEA). For each method, we describe the underlying analytic framework, explain its relevance to real-world surgical decision-making, and illustrate its application using published examples from surgical or health policy contexts.

Results

These methods enhance the relevance and interpretability of economic evaluations by enabling analysts to quantify the value of future research, simulate care delivery in resource-constrained systems, and incorporate equity concerns into economic decision-making. A summary table compares the full suite of methods across both explainers for ease of reference.

Conclusions

Advanced CEA methods provide important tools for addressing challenges in modern surgical and policy decision-making. This explainer aims to equip surgeons and surgical health services researchers with practical insight into when and how to apply these approaches to improve the rigor, realism, and ethical relevance of economic evaluations.

导论：随着医疗保健评估的范围和目标的扩大，传统的成本效益分析（CEA）方法通常根据获得的每个质量调整生命年的成本来评估干预措施，在捕捉手术决策的现实世界复杂性方面往往不足。在我们关于基础CEA的同伴文章的基础上，对包含不确定性、系统约束和公平性考虑的高级分析工具的需求正在增加。方法：在本文中，我们将在我们的介绍性文章的基础上介绍一组经过策划的高级方法。这些包括信息分析、离散事件模拟和公平信息经济评估（包括分布和扩展CEA）的价值。对于每种方法，我们都描述了潜在的分析框架，解释了其与现实世界手术决策的相关性，并使用来自外科或卫生政策背景的已发表示例说明了其应用。结果：这些方法增强了经济评估的相关性和可解释性，使分析人员能够量化未来研究的价值，模拟资源受限系统中的护理提供，并将公平问题纳入经济决策。汇总表比较了两个解释器的全套方法，以便于参考。结论：先进的CEA方法为解决现代外科和政策决策中的挑战提供了重要的工具。本解释器旨在为外科医生和外科健康服务研究人员提供实用的见解，帮助他们了解何时以及如何应用这些方法来提高经济评估的严谨性、现实性和伦理相关性。

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引用次数: 0

Assessing Racial Bias Within American Society of Anesthesiologists Classification 评估美国麻醉师协会分类中的种族偏见。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jss.2025.12.040

Michael A. Jacobs MS , Brenna N. McKaig BS , Susanne Schmidt PhD , Paula K. Shireman MD, MBA, MS , James W. Ibinson MD, PhD , Jessica H. Maxwell MD, MPH , Daniel E. Hall MD, MDiv, MHSc

Introduction

The American Society of Anesthesiologists (ASA) classification system is widely used to evaluate surgical risk, make patient care decisions, and determine reimbursement. However, race/ethnicity bias in ASA class is largely unexplored, with potential ramifications for healthcare disparities.

Methods

In a retrospective cohort study of 350,187 Veterans Health Administration surgical cases and 4,051,185 non–Veterans Health Administration cases, race/ethnicity groups were matched on the components of the Risk Analysis Index, a surgical frailty measure, and preoperative acute serious conditions, conditions associated with urgent/emergent surgeries, to evaluate differences in ASA class.

Results

After matching, Black cases had higher ASA class versus White cases (adjusted odds ratios = 1.37 and 1.07, 95% confidence intervals = 1.37-1.38 and 1.04-1.09, P < 0.001). Hispanic cases had lower ASA class versus White cases (adjusted odds ratios = 0.96 and 0.96, 95% confidence intervals = 0.96-0.97 and 0.93-0.99, P < 0.001 and 0.008), though the effect changed sign in a sensitivity analysis.

Conclusions

ASA class varies by race/ethnicity, representing bias that could drive health disparities. Given the matching strategy used, such bias may have practical implications for patient outcomes and quality improvement. For Black patients, a higher ASA class may drive increased preoperative testing, surgical delays, and increased costs. For Hispanic patients, a lower ASA class may drive reduced preoperative screening and riskier outpatient procedures. For some purposes, the ASA class may need to be replaced with other measures of patient morbidity. For others, ASA class may need to be revised and assigned by automated systems with safeguards against race/ethnicity bias.

简介：美国麻醉医师学会（ASA）分类系统被广泛用于评估手术风险、制定患者护理决策和确定报销。然而，ASA类的种族/民族偏见在很大程度上未被探索，具有潜在的医疗差异后果。方法：对350,187例退伍军人卫生管理局手术病例和4,051,185例非退伍军人卫生管理局病例进行回顾性队列研究，在风险分析指数（一种手术虚弱指标）和术前急性严重情况（与紧急/紧急手术相关的情况）的组成部分上匹配种族/民族，以评估ASA等级的差异。结果：匹配后，黑人患者ASA等级高于白人患者（校正比值比分别为1.37和1.07,95%可信区间分别为1.37 ~ 1.38和1.04 ~ 1.09,P < 0.001）。西班牙裔患者的ASA等级低于白人患者（校正优势比= 0.96和0.96,95%可信区间= 0.96-0.97和0.93-0.99,P < 0.001和0.008），尽管在敏感性分析中效果改变了符号。结论：ASA等级因种族/民族而异，代表可能导致健康差异的偏见。考虑到所使用的匹配策略，这种偏差可能对患者结果和质量改进具有实际意义。对于黑人患者，ASA等级较高可能会导致术前检查增加、手术延误和费用增加。对于西班牙裔患者，较低的ASA等级可能会减少术前筛查和更危险的门诊手术。出于某些目的，ASA分级可能需要用其他衡量患者发病率的指标来代替。对其他人来说，ASA等级可能需要修改，并由自动化系统分配，以防止种族/民族偏见。

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引用次数: 0

Spontaneous Splenic Ruptures: A Contemporary Systematic Review 自发性脾破裂：当代系统回顾。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jss.2025.12.029

Marti Pastak , Sten Saar MD, PhD , Edgar Lipping MD, PhD , Peep Talving MD, PhD

Introduction

Spontaneous splenic rupture (SSR) is a rare, life-threatening condition. The current study aims to provide a comprehensive recent overview of SSR.

Methods

A comprehensive search was performed in PubMed (MEDLINE), Google Scholar, and Scopus to identify relevant case reports and case series published during the last decade (January 1, 2015-July 1, 2025).

Results

We identified 351 eligible studies with 400 cases of SSR. The two most common etiologies for SSR were infectious (25.6%) and neoplastic (22.9%) conditions. Drug- or treatment-related etiologies were reported in 19% of cases, and noninfectious inflammatory conditions in 14.6%. Idiopathic SSRs accounted for 4.1% of the cases. Other less frequent, noncategorized etiologies accounted for the remaining 13.7% of the cases. Abdominal pain was the most common symptom, reported in 94.6% of the patients. Overall, 74.4% of the patients were subjected to splenectomy, followed by conservative management in 12.3%, angioembolization in 10.8%, and spleen-preserving surgery in 1.3%. The overall SSR-related mortality rate was 8.7% (95% confidence interval: 6.2%–12.1%).

Conclusions

Infectious and neoplastic causes comprise the most common etiologies of SSR. Compared with previous studies the rate of drug- or treatment-related etiologies has evolved, which may be related to the wider use of antiplatelet and anticoagulant drugs, particularly novel direct oral anticoagulants. The rate of angioembolization has significantly increased, whereas splenectomy numbers have declined. Neoplastic etiology and age over 50 years were associated with higher mortality on multivariate analysis. Overall, SSR-related mortality has decreased.

自发性脾破裂（SSR）是一种罕见的危及生命的疾病。本研究的目的是提供一个全面的SSR的最新概况。方法：综合检索PubMed （MEDLINE）、谷歌Scholar和Scopus，确定近十年（2015年1月1日- 2025年7月1日）发表的相关病例报告和病例系列。结果：共筛选到351份符合条件的研究，其中SSR病例400例。SSR最常见的两种病因是感染性（25.6%）和肿瘤性（22.9%）。19%的病例报告了药物或治疗相关的病因，14.6%的病例报告了非感染性炎症。特发性SSRs占4.1%。其他不常见的、未分类的病因占其余13.7%的病例。腹痛是最常见的症状，占94.6%。总体而言，74.4%的患者行脾切除术，12.3%的患者行保守治疗，10.8%的患者行血管栓塞，1.3%的患者行保脾手术。ssr相关的总死亡率为8.7%（95%可信区间：6.2%-12.1%）。结论：感染性和肿瘤性原因是SSR最常见的病因。与以往的研究相比，与药物或治疗相关的病因率发生了变化，这可能与抗血小板和抗凝药物，特别是新型直接口服抗凝药物的广泛使用有关。血管栓塞的比例显著增加，而脾切除术的数量下降。多变量分析显示，肿瘤病因和50岁以上的年龄与较高的死亡率相关。总体而言，与ssr相关的死亡率有所下降。

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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 : 2026-01-20 DOI: 10.1016/j.jss.2025.11.070

Xingyu Huang

引用次数: 0

Beyond the Injury - Exploring the Foundations of Health-Related Quality of Life in Older Adults and Their Caregivers 超越伤害-探索老年人及其照顾者健康相关生活质量的基础。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jss.2025.12.033

Krista L. Haines DO, MA , Carrie Dombeck MA , Gi Jung Shin BA , Rachel Morris MD , Suresh Agarwal MD , Christopher Cox MD, MPH , Bryce Reeve PhD , Kenneth Schmader MD , Amy Corneli PhD

Background

Older adults (aged ≥65 years) represent 21% of the trauma admissions in the United States, yet little is known about their health-related quality of life at baseline prior to injury. This study aimed to describe the pre-injury daily activities and social engagement of older adult trauma patients and their caregivers.

Materials and Methods

We conducted a longitudinal mixed-methods study including critically injured older adult trauma patients (aged ≥60) and their self-identified caregivers (aged ≥55). This manuscript reports qualitative findings from baseline semi-structured interviews with 16 patient-caregiver dyads enrolled at a single academic trauma center. Interviews were transcribed and analyzed using applied thematic analysis.

Results

Two themes emerged: (1) older adults maintained active and socially engaged routines before injury and (2) family relationships were a consistent source of connection and support. Prior to injury, most participants reported involvement in physically and cognitively engaging tasks, including exercise, volunteering, spiritual activities, and caregiving responsibilities. Family interactions, irrespective of frequency, provided comfort and meaning for participants.

Conclusions

Older adult trauma patients and caregivers engaged in a wide range of meaningful daily activities and social roles prior to injury. These findings underscore the importance of contextualizing health-related quality of life following injury within the lived experiences of older trauma patients.

背景：在美国，老年人（≥65岁）占创伤入院患者的21%，但他们在受伤前的基线健康相关生活质量知之甚少。本研究旨在描述老年创伤患者及其照顾者损伤前的日常活动和社会参与。材料和方法：我们进行了一项纵向混合方法研究，包括严重受伤的老年创伤患者（年龄≥60岁）及其自我认定的照顾者（年龄≥55岁）。本文报告了在单一学术创伤中心登记的16对患者-护理人员的基线半结构化访谈的定性结果。访谈记录和分析使用应用专题分析。结果：出现了两个主题：(1)老年人在受伤前保持积极和社会参与的日常活动；(2)家庭关系是联系和支持的一致来源。在受伤之前，大多数参与者报告参与了身体和认知方面的任务，包括锻炼、志愿服务、精神活动和照顾责任。家庭互动，无论频率如何，都为参与者提供了安慰和意义。结论：老年创伤患者和护理人员在损伤前参与了广泛的有意义的日常活动和社会角色。这些发现强调了在老年创伤患者的生活经历中，将受伤后与健康相关的生活质量置于背景下的重要性。

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引用次数: 0

Frailty Index Predicts Withdrawal of Life-Sustaining Therapy in Geriatric Patients With Rib Fractures 衰弱指数预测老年肋骨骨折患者停止生命维持治疗。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-19 DOI: 10.1016/j.jss.2025.12.028

Reid Bartholomew MD , Jeffery Nelson MD , Saskya Byerly MD , Dina M. Filiberto MD

Introduction

Geriatric patients with rib fractures have a high morbidity and mortality. The 5-item–modified frailty index (mFI-5) is associated with increased complications and mortality in trauma patients. We aim to determine predictors of withdrawal of life-sustaining therapy (WDLST) in geriatric patients with rib fractures.

Materials and methods

Patients were stratified by WDLST and compared. We conducted a multivariable logistic regression (MLR) to determine predictors of WDLST.

Results

A total of 4707 patients were included, 92 (2%) patients underwent WDLST. MLR found history of advanced directive and injury severity score are associated with WDLST. On MLR, mFI-5 score of >0.4 (adjusted odds ratio = 2.55, 95% confidence interval 1.31-4.96, P = 0.006), which is equivalent to having >2 risk factors, was associated with WDLST. The WDLST cohort had higher mortality (88% versus 1%, P < 0.0001).

Conclusions

The severity of injury and older age are associated with WDLST. The mFI-5 is a tool that may be useful to obtain earlier palliative care intervention.

老年肋骨骨折患者有很高的发病率和死亡率。5项修正的衰弱指数（mFI-5）与创伤患者并发症和死亡率的增加有关。我们的目的是确定老年肋骨骨折患者停止生命维持治疗（WDLST）的预测因素。材料与方法：采用WDLST对患者进行分层比较。我们进行了多变量逻辑回归（MLR）来确定WDLST的预测因子。结果：共纳入4707例患者，92例（2%）患者行WDLST。MLR发现晚期指示史和损伤严重程度评分与WDLST相关。在MLR上，mFI-5评分> - 0.4（校正优势比= 2.55,95%可信区间1.31-4.96,P = 0.006），相当于存在> - 2危险因素，与WDLST相关。WDLST组的死亡率更高（88%对1%，P < 0.0001）。结论：损伤严重程度和年龄与WDLST相关。mFI-5是一种可能有助于获得早期姑息治疗干预的工具。

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引用次数: 0

A Structured Guide to Univariate Test Selection Based on Normality, Variance Homogeneity, and Graphical Data Exploration 基于正态性、方差同质性和图形数据探索的单变量测试选择的结构化指南。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-19 DOI: 10.1016/j.jss.2025.10.053

Javier Arredondo Montero MD, PhD

Introduction

The credibility of surgical research depends on appropriate statistical methodology. However, univariate statistical tests are frequently applied inconsistently, and key assumptions—particularly normality and variance homogeneity—are often misunderstood or inadequately assessed. These methodological shortcomings can distort inference, undermine internal validity, and compromise the clinical interpretability of research findings.

Methods

This article presents a structured, assumption-based framework to guide univariate statistical test selection in surgical research. The approach integrates visual data exploration (histograms, Q–Q plots, violin plots) with formal assumption testing, including the Shapiro-Wilk test for normality and Levene’s test for variance homogeneity, explicitly addressing the sample-size dependence of normality tests, which may lack power in small samples and overdetect trivial deviations in large datasets. The framework addresses common pitfalls related to distributional shape (including bimodality), outliers, data transformation, and the treatment of ordinal variables. When standard assumptions are violated, the framework discusses robust alternatives—such as Welch’s tests, nonparametric approaches, and modern robust estimators—to preserve valid and interpretable statistical inference.

Results

The proposed framework yields a practical decision algorithm, supported by summary tables and illustrative figures, that links data characteristics to appropriate univariate tests and summary measures. By emphasizing combined visual and statistical assessment, the framework clarifies when parametric, robust parametric, or nonparametric methods are most suitable and highlights frequent sources of misinterpretation in the surgical literature.

Conclusions

An assumption-driven approach to univariate test selection enhances statistical rigor, transparency, and reproducibility in surgical research. By aligning test choice and data summarization with underlying distributional properties, this framework supports more reliable statistical inference and clinically meaningful interpretation of univariate analyses.

引言：外科研究的可信度取决于适当的统计方法。然而，单变量统计检验的应用经常不一致，关键假设——特别是正态性和方差同质性——经常被误解或评估不充分。这些方法学上的缺陷会扭曲推理，破坏内部有效性，并损害研究结果的临床可解释性。方法：本文提出了一个结构化的、基于假设的框架来指导外科研究中单变量统计检验的选择。该方法将视觉数据探索（直方图、Q-Q图、小提琴图）与正式假设检验（包括Shapiro-Wilk正态性检验和Levene方差同质性检验）相结合，明确解决了正态性检验的样本量依赖性，这在小样本中可能缺乏能力，在大数据集中可能过度检测微不足道的偏差。该框架解决了与分布形状（包括双峰）、异常值、数据转换和有序变量处理相关的常见缺陷。当标准假设被违反时，该框架讨论健壮的替代方案，如韦尔奇检验、非参数方法和现代健壮估计，以保持有效和可解释的统计推断。结果：提议的框架产生了一个实用的决策算法，由汇总表和说明性数字支持，将数据特征与适当的单变量测试和汇总措施联系起来。通过强调视觉和统计评估的结合，该框架阐明了参数、稳健参数或非参数方法何时最合适，并强调了外科文献中常见的误解来源。结论：在外科研究中，假设驱动的方法可以提高统计严谨性、透明度和可重复性。通过将测试选择和数据汇总与潜在的分布特性结合起来，该框架支持更可靠的统计推断和对单变量分析有临床意义的解释。

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引用次数: 0

Case-Crossover Design for Assessing Associations With Short-Term, Intermediate-Term, and Long-Term Exposures 评估短期、中期和长期暴露相关性的病例交叉设计

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-17 DOI: 10.1016/j.jss.2025.11.072

Yaguang Wei PhD , Joel D. Schwartz PhD , Min Zhang PhD , Robert O. Wright MD, MPH

Introduction

The case-crossover design is a widely applicable design for observational studies. Its major advantages include robustness against unmeasured time-invariant and slowly varying confounders, as well as high statistical efficiency, both attributable to its self-controlled nature.

Methods

In this tutorial, we illustrate applications of the case-crossover design not only for assessing associations with short-term exposures, for which it was originally developed, but also for intermediate- and long-term exposures, using examples from our published studies. We further discuss key methodological considerations for its practical implementation.

Results

We presented two subtypes of the case-crossover design, time-stratified and symmetric bidirectional, illustrated through examples of published studies evaluating the associations between air pollution exposures and the risk of hypertension hospitalization. As the exposure time frame extends from short to long term, the ability of the case-crossover design to inherently adjust for slowly varying confounders through self-matching diminishes. Consequently, additional confounders should be included in the regression model. Several considerations are important when using the case-crossover design: first, analyses are restricted to discordant individuals whose exposures differ between the case and control periods; second, there should be no underlying time trend in exposure within the time scheme of case and control periods.

Conclusions

Despite these limitations, the case-crossover design remains an attractive method for observational studies as it inherently adjusts for unmeasured time invariant and slowly varying confounders, such as genetics. While the examples focus on air pollution, the broad applicability of the case-crossover design makes it a valuable approach in various fields, including clinical research.

病例交叉设计是一种广泛适用于观察性研究的设计。它的主要优点包括对不可测量的时不变和缓慢变化的混杂因素的鲁棒性，以及高统计效率，这两者都归因于它的自我控制性质。方法在本教程中，我们举例说明病例交叉设计的应用，不仅用于评估与短期暴露的关联，它最初是为短期暴露而开发的，而且还用于中期和长期暴露，使用我们发表的研究中的例子。我们进一步讨论其实际实施的关键方法考虑因素。结果通过已发表的评估空气污染暴露与高血压住院风险之间关系的研究实例，我们提出了病例交叉设计的两种亚型，即时间分层和对称双向。随着暴露时间从短期延长到长期，病例交叉设计通过自匹配对缓慢变化的混杂因素进行固有调整的能力减弱。因此，在回归模型中应该包括额外的混杂因素。在使用病例交叉设计时，有几个重要的考虑因素：首先，分析仅限于在病例和对照期间暴露不同的不一致个体；第二，在病例期和对照期的时间方案内，暴露量不存在潜在的时间趋势。尽管存在这些局限性，病例交叉设计仍然是一种有吸引力的观察性研究方法，因为它固有地调整了未测量的时不变和缓慢变化的混杂因素，如遗传学。虽然这些例子集中在空气污染上，但病例交叉设计的广泛适用性使其在包括临床研究在内的各个领域都有价值。

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引用次数: 0

Expanding the Methodology Toolkit for Surgical Research in a Data-Rich Era 在数据丰富的时代扩展外科研究的方法论工具包

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-17 DOI: 10.1016/j.jss.2025.12.037

Kanhua Yin MD, MPH , Lakshika Tennakoon MD, MPhil, DrPH , Amro M. Abdelrahman MBBS, MS

Introduction

The volume and variety of available data sources in surgical research continue to expand. While these advances enable increasingly sophisticated analyses, they also introduce substantial methodological complexity, which often exceeds the training in biostatistics and data science for surgeon investigators. Inefficiencies in collaboration between surgeons and methodological experts further compound these challenges.

Methods

This special edition was developed to address these gaps by providing clear, introductory, and clinically grounded explanations of emerging research methodologies, each illustrated with surgery-relevant examples.

Results

The included articles cover high-impact topics, such as cost-effectiveness analysis, causal inference, spatial analysis, natural language processing, and modern survival analysis. Together, they aim to improve methodological literacy and promote more effective interdisciplinary collaboration in surgical research.

Conclusions

By making modern research methods more accessible, understandable, and clinically relevant, this issue seeks to support rigorous study design, sound interpretation, and evidence-based decision making within the surgical community.

外科研究中可用数据源的数量和种类不断扩大。虽然这些进步使分析变得越来越复杂，但它们也引入了大量的方法复杂性，这往往超出了外科医生调查员在生物统计学和数据科学方面的培训。外科医生和方法学专家之间的合作效率低下进一步加剧了这些挑战。方法：本特别版旨在通过对新兴研究方法提供清晰、介绍性和临床基础的解释来解决这些差距，每种方法都配有与手术相关的例子。结果纳入的文章涵盖了成本效益分析、因果推理、空间分析、自然语言处理和现代生存分析等高影响主题。他们的共同目标是提高方法素养，促进外科研究中更有效的跨学科合作。通过使现代研究方法更容易获得、理解和临床相关，本问题旨在支持外科社区严格的研究设计、合理的解释和基于证据的决策。

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引用次数: 0