Pub Date : 2025-12-16DOI: 10.1016/j.jss.2025.11.048
Wenwen Wang MS , Ziyang Ye PhD , Genpeng Li PhD , Tao Wei PhD , Jingqiang Zhu PhD , Zhihui Li PhD , Huairong Tang PhD , Jianyong Lei PhD
Introduction
Lobectomy (LT) is not generally recommended for papillary thyroid cancer (PTC) patients with intermediate-risk features, although there is no high-level evidence showing that this approach is inferior. This study aimed to examine the association between the extent of thyroidectomy and the outcomes of intermediate-risk PTC patients.
Methods
Using the Surveillance, Epidemiology, and End Results database data (2004–2020), 8543 intermediate-risk PTC patients were stratified into LT and total thyroidectomy (TT) groups. Propensity score matching generated 1557 matched pairs. Cancer-specific survival (CSS) was analyzed via Kaplan–Meier and Cox regression.
Results
No significant CSS difference emerged between LT and TT in original (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.82–3.74, P = 0.144) or propensity score matching cohorts. Subgroup analyses confirmed comparable CSS for patients aged ≥55 y (HR = 1.55, 95% CI = 0.64-3.78, P = 0.327), tumors >40 mm (HR = 5.24, 95% CI = 0.69-39.87, P = 0.074), and lymph node metastasis (HR = 1.15, 95% CI = 0.42-3.09, P = 0.788).
Conclusions
TT was not associated with a CSS advantage for PTC patients with intermediate-risk features.
虽然没有高水平的证据表明这种方法是劣势的，但对于具有中等危险特征的甲状腺乳头状癌（PTC）患者，通常不推荐采用叶切除术（LT）。本研究旨在探讨甲状腺切除术程度与中危PTC患者预后之间的关系。方法：利用监测、流行病学和最终结果数据库（2004-2020）的数据，将8543例中等风险PTC患者分层分为LT组和甲状腺全切除术（TT）组。倾向评分匹配产生了1557对匹配的配对。通过Kaplan-Meier和Cox回归分析癌症特异性生存（CSS）。结果：LT和TT在原始队列（风险比[HR] = 0.76, 95%可信区间[CI] = 0.82-3.74, P = 0.144）或倾向评分匹配队列中没有显著的CSS差异。亚组分析证实，年龄≥55岁的患者（HR = 1.55, 95% CI = 0.64-3.78, P = 0.327）、肿瘤bbb40 mm （HR = 5.24, 95% CI = 0.69-39.87, P = 0.074）和淋巴结转移（HR = 1.15, 95% CI = 0.42-3.09, P = 0.788）的CSS具有可比性。结论：TT与具有中危特征的PTC患者的CSS优势无关。
{"title":"Clinical Outcomes of Lobectomy for Papillary Thyroid Cancer Patients With Intermediate-Risk Features","authors":"Wenwen Wang MS , Ziyang Ye PhD , Genpeng Li PhD , Tao Wei PhD , Jingqiang Zhu PhD , Zhihui Li PhD , Huairong Tang PhD , Jianyong Lei PhD","doi":"10.1016/j.jss.2025.11.048","DOIUrl":"10.1016/j.jss.2025.11.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Lobectomy (LT) is not generally recommended for papillary thyroid cancer (PTC) patients with intermediate-risk features, although there is no high-level evidence showing that this approach is inferior. This study aimed to examine the association between the extent of thyroidectomy and the outcomes of intermediate-risk PTC patients.</div></div><div><h3>Methods</h3><div>Using the Surveillance, Epidemiology, and End Results database data (2004–2020), 8543 intermediate-risk PTC patients were stratified into LT and total thyroidectomy (TT) groups. Propensity score matching generated 1557 matched pairs. Cancer-specific survival (CSS) was analyzed via Kaplan–Meier and Cox regression.</div></div><div><h3>Results</h3><div>No significant CSS difference emerged between LT and TT in original (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.82–3.74, <em>P</em> = 0.144) or propensity score matching cohorts. Subgroup analyses confirmed comparable CSS for patients aged ≥55 y (HR = 1.55, 95% CI = 0.64-3.78, <em>P</em> = 0.327), tumors >40 mm (HR = 5.24, 95% CI = 0.69-39.87, <em>P</em> = 0.074), and lymph node metastasis (HR = 1.15, 95% CI = 0.42-3.09, <em>P</em> = 0.788).</div></div><div><h3>Conclusions</h3><div>TT was not associated with a CSS advantage for PTC patients with intermediate-risk features.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 340-346"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774778","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}
Pub Date : 2025-12-16DOI: 10.1016/j.jss.2025.11.052
Muhammad Haris Khurshid MD, Francisco Castillo-Diaz MD, Mohammad Al Ma'ani MD, Omar Hejazi MD, Banan W. Otaibi MD, Louis J. Magnotti MD, MS, FACS, Bellal Joseph MD, FACS
Introduction
Frailty is prevalent among geriatric patients and is a risk factor for worse outcomes in this population. The aim of this study is to provide setting-specific evidence by comparing outcomes of emergent laparotomy between frail and nonfrail geriatric blunt trauma patients.
Methods
A 5-y (2017-2021) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program was performed. Older adult (age ≥65 y) blunt trauma patients who underwent emergent laparotomy were included and stratified using the 11-factor modified frailty index into frail (F) and nonfrail (NF) groups. Primary outcome was in-hospital mortality. Secondary outcomes were hospital and intensive care unit length of stay (LOS), and major complications (cardiac arrest, myocardial infarction, acute respiratory distress syndrome, acute kidney injury, deep venous thrombosis, pulmonary embolism, stroke, sepsis, surgical site infection, and catheter-associated urinary tract infection). Univariate and multivariable regression analyses, adjusting for potential confounding factors, were performed.
Results
We identified a total of 1655 geriatric blunt trauma patients who underwent laparotomy (F: 273, NF: 1382). The mean age was 74 (7) y and 66% were male. The median injury severity score was 14 [9-25] and the median time to laparotomy was 112 [52-223] min. There was no significant difference in terms of injury characteristics and time to laparotomy between F and NF groups. On univariate analysis, there was no difference in terms of mortality (P = 0.161), intensive care unit LOS (P = 0.204), and major complications (P = 0.969); however, F group had significantly longer median hospital LOS (F: 10 [5-15] versus NF: 8 [2-14], P = 0.001). On multivariable regression analysis, F group was independently associated with higher odds of mortality (adjusted odds ratio: 1.665, 95% confidence interval [1.194-2.321], P = 0.003) and longer hospital LOS (β: +2.131, 95% confidence interval [+0.492 to +3.771], P = 0.011).
Conclusions
In older adults undergoing emergent laparotomy after blunt trauma, frailty identifies patients at increased risk of in-hospital mortality and prolonged length of stay; incorporating frailty assessment at presentation can guide perioperative counseling and resource planning.
{"title":"Emergent Laparotomy for Blunt Trauma: Operating on Frail Older Adults Goes Beyond the Operating Room","authors":"Muhammad Haris Khurshid MD, Francisco Castillo-Diaz MD, Mohammad Al Ma'ani MD, Omar Hejazi MD, Banan W. Otaibi MD, Louis J. Magnotti MD, MS, FACS, Bellal Joseph MD, FACS","doi":"10.1016/j.jss.2025.11.052","DOIUrl":"10.1016/j.jss.2025.11.052","url":null,"abstract":"<div><h3>Introduction</h3><div>Frailty is prevalent among geriatric patients and is a risk factor for worse outcomes in this population. The aim of this study is to provide setting-specific evidence by comparing outcomes of emergent laparotomy between frail and nonfrail geriatric blunt trauma patients.</div></div><div><h3>Methods</h3><div>A 5-y (2017-2021) retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program was performed. Older adult (age ≥65 y) blunt trauma patients who underwent emergent laparotomy were included and stratified using the 11-factor modified frailty index into frail (F) and nonfrail (NF) groups. Primary outcome was in-hospital mortality. Secondary outcomes were hospital and intensive care unit length of stay (LOS), and major complications (cardiac arrest, myocardial infarction, acute respiratory distress syndrome, acute kidney injury, deep venous thrombosis, pulmonary embolism, stroke, sepsis, surgical site infection, and catheter-associated urinary tract infection). Univariate and multivariable regression analyses, adjusting for potential confounding factors, were performed.</div></div><div><h3>Results</h3><div>We identified a total of 1655 geriatric blunt trauma patients who underwent laparotomy (F: 273, NF: 1382). The mean age was 74 (7) y and 66% were male. The median injury severity score was 14 [9-25] and the median time to laparotomy was 112 [52-223] min. There was no significant difference in terms of injury characteristics and time to laparotomy between F and NF groups. On univariate analysis, there was no difference in terms of mortality (<em>P</em> = 0.161), intensive care unit LOS (<em>P</em> = 0.204), and major complications (<em>P</em> = 0.969); however, F group had significantly longer median hospital LOS (F: 10 [5-15] <em>versus</em> NF: 8 [2-14], <em>P</em> = 0.001). On multivariable regression analysis, F group was independently associated with higher odds of mortality (adjusted odds ratio: 1.665, 95% confidence interval [1.194-2.321], <em>P</em> = 0.003) and longer hospital LOS (β: +2.131, 95% confidence interval [+0.492 to +3.771], <em>P</em> = 0.011).</div></div><div><h3>Conclusions</h3><div>In older adults undergoing emergent laparotomy after blunt trauma, frailty identifies patients at increased risk of in-hospital mortality and prolonged length of stay; incorporating frailty assessment at presentation can guide perioperative counseling and resource planning.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 394-399"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774809","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}
Pub Date : 2025-12-16DOI: 10.1016/j.jss.2025.11.017
Christina S. Boutros DO, Omkar S. Pawar BDS MS, Aria Bassiri MD, John B. Ammori MD, Julie Freischlag MD, Philip A. Linden MD, Christopher W. Towe MD
{"title":"Response Regarding: “Gender Disparities in Career Longevity Among Surgeons and Physicians: A Decade-long Analysis”","authors":"Christina S. Boutros DO, Omkar S. Pawar BDS MS, Aria Bassiri MD, John B. Ammori MD, Julie Freischlag MD, Philip A. Linden MD, Christopher W. Towe MD","doi":"10.1016/j.jss.2025.11.017","DOIUrl":"10.1016/j.jss.2025.11.017","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 337-339"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774915","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}
Pub Date : 2025-12-16DOI: 10.1016/j.jss.2025.11.041
Lijie Chen MMed , Xiqian Wang MD , Yafei Liu MMed , Wei Zhang MMed , Rui Zhang MMed , Ranglamu Cai MMed , Jie Zhang MD
Introduction
Ultrasound-guided chemical ablation is a first-line treatment for benign cystic thyroid nodules. Although absolute ethanol is the most common sclerosing agent, it is associated with prolonged procedure time and potential complications. Polidocanol, a widely used sclerosing agent for varicose veins, liver, and kidney cysts, offers a potential alternative due to its favorable safety profile. This study aimed to compare the efficacy and safety of polidocanol retention versus absolute ethanol lavage and identify factors predicting treatment success.
Methods
This two-part investigation consisted of a prospective randomized exploratory study (part 1; n = 68) and a retrospective predictor analysis (part 2; n = 76). In part 1, patients were randomly assigned to undergo either absolute ethanol lavage (ethanol group, n = 34) or low-dose polidocanol retention (polidocanol group, n = 34). The primary endpoint was the volume reduction rate of the thyroid nodules at 3 mo. Secondary outcomes included rates of complications and operation procedure. Part two combined patients from the polidocanol group of the part 1 with additional retrospectively reviewed cases to identify predictors of treatment response, with a specific focus on baseline nodule volume and thyroglobulin (Tg) levels in the lavage fluid.
Results
In the first part, both groups achieved significant volume reduction at 3 mo (ethanol: 92.78% versus polidocanol: 83.51%, P > 0.05). The polidocanol group had a numerically lower complication rate (2.9% versus 8.2%, P = 0.64). In the second part, lavage fluid Tg ≤ 310 ng/mL was a strong predictor of treatment success at 3 mo (area under the curve = 0.885, sensitivity = 84.48%, specificity = 91.27%).
Conclusions
Polidocanol demonstrated noninferior efficacy to ethanol, achieving comparable volume reduction while offering a simplified treatment protocol and a more favorable safety profile. Baseline nodule volume and lavage fluid Tg are key predictors of short-term efficacy.
{"title":"Polidocanol Retention Therapy for Benign Predominantly Cystic Thyroid Nodules: Analysis of Efficacy, Safety, and Factors Influencing Short-Term Efficacy: A Single-Center Exploratory Study","authors":"Lijie Chen MMed , Xiqian Wang MD , Yafei Liu MMed , Wei Zhang MMed , Rui Zhang MMed , Ranglamu Cai MMed , Jie Zhang MD","doi":"10.1016/j.jss.2025.11.041","DOIUrl":"10.1016/j.jss.2025.11.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Ultrasound-guided chemical ablation is a first-line treatment for benign cystic thyroid nodules. Although absolute ethanol is the most common sclerosing agent, it is associated with prolonged procedure time and potential complications. Polidocanol, a widely used sclerosing agent for varicose veins, liver, and kidney cysts, offers a potential alternative due to its favorable safety profile. This study aimed to compare the efficacy and safety of polidocanol retention <em>versus</em> absolute ethanol lavage and identify factors predicting treatment success.</div></div><div><h3>Methods</h3><div>This two-part investigation consisted of a prospective randomized exploratory study (part 1; <em>n</em> = 68) and a retrospective predictor analysis (part 2; <em>n</em> = 76). In part 1, patients were randomly assigned to undergo either absolute ethanol lavage (ethanol group, <em>n</em> = 34) or low-dose polidocanol retention (polidocanol group, <em>n</em> = 34). The primary endpoint was the volume reduction rate of the thyroid nodules at 3 mo. Secondary outcomes included rates of complications and operation procedure. Part two combined patients from the polidocanol group of the part 1 with additional retrospectively reviewed cases to identify predictors of treatment response, with a specific focus on baseline nodule volume and thyroglobulin (Tg) levels in the lavage fluid.</div></div><div><h3>Results</h3><div>In the first part, both groups achieved significant volume reduction at 3 mo (ethanol: 92.78% <em>versus</em> polidocanol: 83.51%, <em>P</em> > 0.05). The polidocanol group had a numerically lower complication rate (2.9% <em>versus</em> 8.2%, <em>P</em> = 0.64). In the second part, lavage fluid Tg ≤ 310 ng/mL was a strong predictor of treatment success at 3 mo (area under the curve = 0.885, sensitivity = 84.48%, specificity = 91.27%).</div></div><div><h3>Conclusions</h3><div>Polidocanol demonstrated noninferior efficacy to ethanol, achieving comparable volume reduction while offering a simplified treatment protocol and a more favorable safety profile. Baseline nodule volume and lavage fluid Tg are key predictors of short-term efficacy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 380-388"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774838","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}
Introduction: Effective pain management is crucial to reduce complications and enhance recovery in patients with multiple rib fractures. Although intercostal cryoanalgesia is emerging as a promising strategy to optimize conventional multimodal analgesia in these patients, the literature remains sparse. Since 2019, we have been using cryoanalgesia in surgical stabilization of rib fractures (SSRF), and we hypothesize that it is associated with lower opioid requirements. Thus, we decided to perform a comparative study between patients undergoing SSRF with and without cryoanalgesia.
Methods: This retrospective study comprised patients with multiple traumatic rib fractures, who underwent SSRF with multimodal analgesia without cryo (group A) compared with a cohort of similar patients managed with multimodal analgesia with cryo (group B). Multimodal analgesia comprised epidural analgesia, opioids, and nonsteroidal anti-inflammatory drugs. Demographics, severity of pain using the visual analog scale, and median requirement of morphine equivalent dose (MED) were analyzed in both groups. Factors associated with postoperative opioid use were evaluated using descriptive and multivariable analyses.
Results: Thirty-six patients were studied, 9 in group A and 27 in group B. Both groups were similar in age, number of rib fracture fixations required, preoperative requirement of opioids, and length of stay. Regarding postoperative opioid consumption, group A required more than twice MED than group B [37.2 mg (interquartile range [IQR] 28.7-47) versus 14.7 mg (IQR 8.25-19.1); P < 0.001]. This difference increased in the outpatient setting [group A: 18.8 mg (IQR 15-27) versus group B: 0.0 mg (IQR 0-3.45); P < 0.001]. The comparison between visual analog scale at discharge also showed significant differences at 7, 14, and 30 d (P < 0.0001) in both groups. In multivariable analysis, only preoperative MED and cryoanalgesia was independently associated with postoperative opioid requirements (R2 = 0.58), with cryoanalgesia associated with a mean reduction of 19.9 MED units (95% confidence interval, -28.0 to -11.0).
Conclusions: Percutaneous intercostal cryoanalgesia was associated with reduced postoperative and outpatient opioid use and improved pain control in patients undergoing surgical stabilization of rib fractures, supporting its potential role as an adjunct to multimodal analgesia.
{"title":"Cryoanalgesia in Patients Undergoing Surgical Stabilization of Rib Fractures: A Comparative Study.","authors":"Alejandro Carmona, Matias Nicolas, Gerardo Tusman, Luzia Toselli, Alejandro García-Pérez, Gastón Bellia-Munzon","doi":"10.1016/j.jss.2025.11.061","DOIUrl":"https://doi.org/10.1016/j.jss.2025.11.061","url":null,"abstract":"<p><strong>Introduction: </strong>Effective pain management is crucial to reduce complications and enhance recovery in patients with multiple rib fractures. Although intercostal cryoanalgesia is emerging as a promising strategy to optimize conventional multimodal analgesia in these patients, the literature remains sparse. Since 2019, we have been using cryoanalgesia in surgical stabilization of rib fractures (SSRF), and we hypothesize that it is associated with lower opioid requirements. Thus, we decided to perform a comparative study between patients undergoing SSRF with and without cryoanalgesia.</p><p><strong>Methods: </strong>This retrospective study comprised patients with multiple traumatic rib fractures, who underwent SSRF with multimodal analgesia without cryo (group A) compared with a cohort of similar patients managed with multimodal analgesia with cryo (group B). Multimodal analgesia comprised epidural analgesia, opioids, and nonsteroidal anti-inflammatory drugs. Demographics, severity of pain using the visual analog scale, and median requirement of morphine equivalent dose (MED) were analyzed in both groups. Factors associated with postoperative opioid use were evaluated using descriptive and multivariable analyses.</p><p><strong>Results: </strong>Thirty-six patients were studied, 9 in group A and 27 in group B. Both groups were similar in age, number of rib fracture fixations required, preoperative requirement of opioids, and length of stay. Regarding postoperative opioid consumption, group A required more than twice MED than group B [37.2 mg (interquartile range [IQR] 28.7-47) versus 14.7 mg (IQR 8.25-19.1); P < 0.001]. This difference increased in the outpatient setting [group A: 18.8 mg (IQR 15-27) versus group B: 0.0 mg (IQR 0-3.45); P < 0.001]. The comparison between visual analog scale at discharge also showed significant differences at 7, 14, and 30 d (P < 0.0001) in both groups. In multivariable analysis, only preoperative MED and cryoanalgesia was independently associated with postoperative opioid requirements (R<sup>2</sup> = 0.58), with cryoanalgesia associated with a mean reduction of 19.9 MED units (95% confidence interval, -28.0 to -11.0).</p><p><strong>Conclusions: </strong>Percutaneous intercostal cryoanalgesia was associated with reduced postoperative and outpatient opioid use and improved pain control in patients undergoing surgical stabilization of rib fractures, supporting its potential role as an adjunct to multimodal analgesia.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774852","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}
Pub Date : 2025-12-16DOI: 10.1016/j.jss.2025.11.042
Marco J. Henriquez MD , Danyi Wang BA , Fabiana C. Sanchez MD , Ricardo A. Fonseca MD , Michael W. Alchaer MD , Leonardo J. Diaz MD , Amin Dehghan MD , Grant V. Bochicchio MD, MPH , Lindsay M. Kranker MD , Douglas J.E. Schuerer MD , Grace M. Niziolek MD
Introduction
Traumatic brain injury (TBI) is a significant public health problem with patients frequently suffering long-term neurologic, psychiatric, and cognitive symptoms. Systematic outpatient follow-up after hospital discharge is critical for identifying residual deficits and improving functional outcomes. We hypothesize that the majority of TBI patients do not engage in routine outpatient follow-up after their index admission and may not receive ancillary services necessary for long-term recovery.
Methods
We conducted a retrospective, single-center analysis of all admitted TBI patients between January 2022 and January 2024. Patients with radiographically confirmed TBI who were expected to survive to follow-up were included. Chart reviews determined post discharge appointments and referrals to ancillary services, including physical therapy, occupational therapy, speech-language pathology, and neurocognitive testing.
Results
Among 1142 TBI patients, 605 (53%) returned for outpatient follow-up. Of those, 543 (89.8%) patients were seen in neurosurgery clinic, primarily for repeat imaging and/or post surgical care. Clinic documentation rarely discussed quality of life, cognitive deficits, or behavioral changes, and ancillary referrals were infrequent (<2%). In multivariate analysis, discharge to a nonrehabilitative facility (odds ratio (OR): 0.541, P < 0.001) and uninsured status (OR 0.591, P = 0.016) were independently associated with decreased likelihood of follow-up. Higher Abbreviated Injury Scale Head scores (OR 1.446, P < 0.001) and decompressive craniectomy (OR 2.867, P = 0.003) were associated with increased likelihood of follow-up.
Conclusions
Nearly half of TBI patients did not receive outpatient follow-up after discharge, and utilization of ancillary services was low, revealing significant gaps in post acute care. Targeted strategies to improve post discharge follow-up are essential to support long-term recovery in this vulnerable population.
{"title":"Lost in Transition: Long-term Follow-up in Traumatic Brain Injury Patients","authors":"Marco J. Henriquez MD , Danyi Wang BA , Fabiana C. Sanchez MD , Ricardo A. Fonseca MD , Michael W. Alchaer MD , Leonardo J. Diaz MD , Amin Dehghan MD , Grant V. Bochicchio MD, MPH , Lindsay M. Kranker MD , Douglas J.E. Schuerer MD , Grace M. Niziolek MD","doi":"10.1016/j.jss.2025.11.042","DOIUrl":"10.1016/j.jss.2025.11.042","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury (TBI) is a significant public health problem with patients frequently suffering long-term neurologic, psychiatric, and cognitive symptoms. Systematic outpatient follow-up after hospital discharge is critical for identifying residual deficits and improving functional outcomes. We hypothesize that the majority of TBI patients do not engage in routine outpatient follow-up after their index admission and may not receive ancillary services necessary for long-term recovery.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center analysis of all admitted TBI patients between January 2022 and January 2024. Patients with radiographically confirmed TBI who were expected to survive to follow-up were included. Chart reviews determined post discharge appointments and referrals to ancillary services, including physical therapy, occupational therapy, speech-language pathology, and neurocognitive testing.</div></div><div><h3>Results</h3><div>Among 1142 TBI patients, 605 (53%) returned for outpatient follow-up. Of those, 543 (89.8%) patients were seen in neurosurgery clinic, primarily for repeat imaging and/or post surgical care. Clinic documentation rarely discussed quality of life, cognitive deficits, or behavioral changes, and ancillary referrals were infrequent (<2%). In multivariate analysis, discharge to a nonrehabilitative facility (odds ratio (OR): 0.541, <em>P</em> < 0.001) and uninsured status (OR 0.591, <em>P</em> = 0.016) were independently associated with decreased likelihood of follow-up. Higher Abbreviated Injury Scale Head scores (OR 1.446, <em>P</em> < 0.001) and decompressive craniectomy (OR 2.867, <em>P</em> = 0.003) were associated with increased likelihood of follow-up.</div></div><div><h3>Conclusions</h3><div>Nearly half of TBI patients did not receive outpatient follow-up after discharge, and utilization of ancillary services was low, revealing significant gaps in post acute care. Targeted strategies to improve post discharge follow-up are essential to support long-term recovery in this vulnerable population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 347-354"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774793","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}
Pub Date : 2025-12-16DOI: 10.1016/j.jss.2025.11.054
Seth Saylors MD, Cory Nonnemacher MD, Charles Snyder MD, Pablo Aguayo MD, Irene Isabel P. Lim MD, Rebecca Rentea MD, MS, MBA, Shawn St. Peter MD, Tolulope Oyetunji MD, MBA, MPH
<div><h3>Introduction</h3><div>Inguinal hernia repair is one of the most common pediatric surgical procedures performed with an estimated incidence of 1-5% in children. Patients can present with or without symptoms, with symptomatic hernias (incarcerated or strangulated) that may require emergent or urgent operative intervention. During the COVID-19 pandemic, restrictions, and shutdowns of elective surgeries at our institution resulted in delaying elective inguinal hernia repair unless presenting with more emergent symptoms, with no apparent increase in complication. In our institution, this practice was continued even after COVID restrictions were lifted, with elective repairs delayed until patients were older before completing elective inguinal hernia repair to also reduce early exposure to anesthesia. The aim of this study was to observe any changes in preoperative or postoperative complications after delaying repair of inguinal hernias in infants that initially present to the outpatient clinic.</div></div><div><h3>Methods</h3><div>We completed a retrospective cohort study reviewing children <1 y old who underwent inguinal hernia repairs from January 2018 to January 2024 treated at a single freestanding children's hospital. Patients admitted to the neonatal intensive care unit during surgical management or whose index presentation was in the emergency department (ED) were excluded. Procedures prior to March 1, 2020, were considered pre-COVID while subsequent operations were categorized as post-COVID. In the latter group, surgical repair was delayed until approximately 6 mo of age. Details of their hospitalization, including demographic, operative, and length of stay data, as well as postoperative complications including return to ED, readmission, and recurrence of hernia(s) were collected.</div></div><div><h3>Results</h3><div>A total of 179 patients were included, and majority were male (85%, <em>n</em> = 153). One-third of patients underwent surgical repair prior to COVID restrictions (32%, <em>n</em> = 58) while 68% of patients (<em>n</em> = 121) were repaired during or after COVID restrictions. The average time from diagnosis of hernia(s) to surgery in the pre-COVID group was 44 d compared to 74 d in the post-COVID group (<em>P</em> = 0.0001). The average age of patients at time of surgery was 125 d in the pre-COVID group compared to 152 d in the post-COVID group (<em>P</em> = 0.034). There was no increase in the rate of patient presentation to the ED/hernia incarceration rate in the post-COVID group (10% pre- versus 8% post-COVID). There were no observed differences in operative characteristics or postoperative complications between groups.</div></div><div><h3>Conclusions</h3><div>Delayed inguinal hernia repair beyond 4 wks from diagnosis in infants was not associated with any increased risk of hernia incarceration or complications in these patients. Potential benefits of delaying surgery include allowing patients to grow while also avo
腹股沟疝修补术是最常见的儿科外科手术之一，估计儿童发生率为1-5%。患者有或无症状，有症状性疝（嵌顿或绞窄），可能需要紧急或紧急手术干预。在COVID-19大流行期间，我院择期手术的限制和关闭导致择期腹股沟疝修补延迟，除非出现更紧急的症状，并发症没有明显增加。在我们的机构中，即使在COVID限制解除后，这种做法仍在继续，选择性修复推迟到患者年龄较大时才完成选择性腹股沟疝修复，以减少早期麻醉暴露。本研究的目的是观察首次到门诊就诊的婴儿腹股沟疝延迟修复后术前或术后并发症的变化。方法：我们完成了一项对儿童进行回顾性队列研究。结果：共纳入179例患者，其中大多数为男性（85%,n = 153）。三分之一的患者在COVID限制之前进行了手术修复（32%,n = 58）， 68%的患者（n = 121）在COVID限制期间或之后进行了修复。术前组从诊断疝气到手术的平均时间为44 d，而术后组为74 d （P = 0.0001）。术前患者手术时平均年龄为125 d，而术后患者手术时平均年龄为152 d （P = 0.034）。在covid后组中，患者出现ED/疝嵌顿率没有增加（前10% vs后8%）。两组手术特点及术后并发症无明显差异。结论：诊断后4周以上的婴儿腹股沟疝延迟修复与这些患者疝嵌顿或并发症的风险增加无关。延迟手术的潜在好处包括允许患者生长，同时避免在婴儿期早期接触麻醉剂。
{"title":"Impact of Delayed Inguinal Hernia Repair in Infants","authors":"Seth Saylors MD, Cory Nonnemacher MD, Charles Snyder MD, Pablo Aguayo MD, Irene Isabel P. Lim MD, Rebecca Rentea MD, MS, MBA, Shawn St. Peter MD, Tolulope Oyetunji MD, MBA, MPH","doi":"10.1016/j.jss.2025.11.054","DOIUrl":"10.1016/j.jss.2025.11.054","url":null,"abstract":"<div><h3>Introduction</h3><div>Inguinal hernia repair is one of the most common pediatric surgical procedures performed with an estimated incidence of 1-5% in children. Patients can present with or without symptoms, with symptomatic hernias (incarcerated or strangulated) that may require emergent or urgent operative intervention. During the COVID-19 pandemic, restrictions, and shutdowns of elective surgeries at our institution resulted in delaying elective inguinal hernia repair unless presenting with more emergent symptoms, with no apparent increase in complication. In our institution, this practice was continued even after COVID restrictions were lifted, with elective repairs delayed until patients were older before completing elective inguinal hernia repair to also reduce early exposure to anesthesia. The aim of this study was to observe any changes in preoperative or postoperative complications after delaying repair of inguinal hernias in infants that initially present to the outpatient clinic.</div></div><div><h3>Methods</h3><div>We completed a retrospective cohort study reviewing children <1 y old who underwent inguinal hernia repairs from January 2018 to January 2024 treated at a single freestanding children's hospital. Patients admitted to the neonatal intensive care unit during surgical management or whose index presentation was in the emergency department (ED) were excluded. Procedures prior to March 1, 2020, were considered pre-COVID while subsequent operations were categorized as post-COVID. In the latter group, surgical repair was delayed until approximately 6 mo of age. Details of their hospitalization, including demographic, operative, and length of stay data, as well as postoperative complications including return to ED, readmission, and recurrence of hernia(s) were collected.</div></div><div><h3>Results</h3><div>A total of 179 patients were included, and majority were male (85%, <em>n</em> = 153). One-third of patients underwent surgical repair prior to COVID restrictions (32%, <em>n</em> = 58) while 68% of patients (<em>n</em> = 121) were repaired during or after COVID restrictions. The average time from diagnosis of hernia(s) to surgery in the pre-COVID group was 44 d compared to 74 d in the post-COVID group (<em>P</em> = 0.0001). The average age of patients at time of surgery was 125 d in the pre-COVID group compared to 152 d in the post-COVID group (<em>P</em> = 0.034). There was no increase in the rate of patient presentation to the ED/hernia incarceration rate in the post-COVID group (10% pre- versus 8% post-COVID). There were no observed differences in operative characteristics or postoperative complications between groups.</div></div><div><h3>Conclusions</h3><div>Delayed inguinal hernia repair beyond 4 wks from diagnosis in infants was not associated with any increased risk of hernia incarceration or complications in these patients. Potential benefits of delaying surgery include allowing patients to grow while also avo","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 389-393"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774836","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}
Firearm-related injuries have become the leading cause of death for US children. Although a “volume-outcome” relationship is well-established in adults, it is less understood in pediatric penetrating trauma. This study aimed to evaluate the relationship between trauma center volume and patient outcomes in pediatric penetrating injuries.
Methods
Utilizing the National Trauma Data Bank (2017-2021), we conducted a retrospective database study of pediatric patients (1-18 y) with stab or gunshot wounds (GSWs), treated at level I or II trauma centers. Patients with GSW to the head, interfacility transfers, or emergency department deaths were excluded. Trauma centers were categorized into quartiles based on penetrating injury volume. Primary outcomes were in-hospital mortality, intensive care unit length of stay, and ventilator dependency duration.
Results
Of 666,111 patients, 34,064 with penetrating trauma were included, with 22,237 sustaining GSW. In-hospital mortality (4%-5%) did not significantly differ across volume quartiles. Patients at the highest-volume facilities (q4) experienced longer intensive care unit stays (4.33 d in q1 versus 5.45 d in q4, P < 0.001) and longer ventilator duration (3.22 d in q1 versus 4.90 d in q4, P < 0.001). After 3:1 matching to minimize confounding, prolonged ventilator dependency remained statistically significant in q4 facilities (relative risk = 1.256, P = 0.008), a trend also seen in the GSW subgroup (relative risk = 1.264, P = 0.016).
Conclusions
This study indicates that while trauma center volume may influence resource utilization for pediatric penetrating trauma, it does not significantly affect in-hospital mortality. Further research with more anatomically precise injury matching is warranted.
{"title":"Pediatric Penetrating Trauma Volume and Patient Outcome: A National Trauma Data Bank Study","authors":"Ayaka Tsutsumi MD , Ruizhi Huang MS , Paula Buchanan PhD, MPH , Morihiro Katsura MD, MPH , Kazuhide Matsushima MD , Grace Trello BS , Shin Miyata MD","doi":"10.1016/j.jss.2025.11.058","DOIUrl":"10.1016/j.jss.2025.11.058","url":null,"abstract":"<div><h3>Introduction</h3><div>Firearm-related injuries have become the leading cause of death for US children. Although a “volume-outcome” relationship is well-established in adults, it is less understood in pediatric penetrating trauma. This study aimed to evaluate the relationship between trauma center volume and patient outcomes in pediatric penetrating injuries.</div></div><div><h3>Methods</h3><div>Utilizing the National Trauma Data Bank (2017-2021), we conducted a retrospective database study of pediatric patients (1-18 y) with stab or gunshot wounds (GSWs), treated at level I or II trauma centers. Patients with GSW to the head, interfacility transfers, or emergency department deaths were excluded. Trauma centers were categorized into quartiles based on penetrating injury volume. Primary outcomes were in-hospital mortality, intensive care unit length of stay, and ventilator dependency duration.</div></div><div><h3>Results</h3><div>Of 666,111 patients, 34,064 with penetrating trauma were included, with 22,237 sustaining GSW. In-hospital mortality (4%-5%) did not significantly differ across volume quartiles. Patients at the highest-volume facilities (q4) experienced longer intensive care unit stays (4.33 d in q1 versus 5.45 d in q4, <em>P</em> < 0.001) and longer ventilator duration (3.22 d in q1 <em>versus</em> 4.90 d in q4, <em>P</em> < 0.001). After 3:1 matching to minimize confounding, prolonged ventilator dependency remained statistically significant in q4 facilities (relative risk = 1.256, <em>P</em> = 0.008), a trend also seen in the GSW subgroup (relative risk = 1.264, <em>P</em> = 0.016).</div></div><div><h3>Conclusions</h3><div>This study indicates that while trauma center volume may influence resource utilization for pediatric penetrating trauma, it does not significantly affect in-hospital mortality. Further research with more anatomically precise injury matching is warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 355-364"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774847","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}
Pub Date : 2025-12-15DOI: 10.1016/j.jss.2025.11.033
Patrick Morris BS , Gena V. Topper MD , Jacob Metheny BS , Jared Plumb BA , Asanthi Ratnasekera DO, FACS , Tanya Anand MD, MPH, MT (ASCP), FACS , Malia Voytik MD , T Hess MD , Rachel J. Nation MD, MPH , Hannah Sofield MD , Krystal Hunter PhD, MBA , Tanya Egodage MD, FACS
Introduction
Anticoagulation and antiplatelet (AC/AP) medications complicate hemorrhage control and are associated with increased mortality in trauma. Whole blood (WB) may be associated with different outcomes for hemorrhaging patients over component therapy (CT). We hypothesize that in hemorrhaging patients on AC/AP, WB is associated with improved outcomes over CT transfusion.
Methods
We retrospectively reviewed the National Trauma Data Bank (2020-2022) for AC/AP patients who received CT or WB+CT, excluding those who died within 1 h, were pregnant, were <18 y old, transferred from facilities, or with a head abbreviated injury score > 2. Univariable and multivariable analyses assessed mortality and secondary outcomes.
Results
A total of 5580 patients met inclusion. A total of 4802 received CT and 778 WB+CT. WB+CT patients presented with lower systolic blood pressure, higher heart rate, greater injury severity, and were more likely to undergo emergent operation. They received a higher total blood product volume (1000 versus 600 mL, P < 0.01). WB+CT patients received a lower packed red blood cell volume (0 versus 350 mL, P < 0.01). WB+CT patients had longer hospital (10 versus 8 d, P < 0.01) and intensive care unit (ICU) stays (5 versus 4 d, P < 0.01).
Conclusions
WB+CT patients presented with more severe injuries and hemodynamic instability. Although hospital and ICU length of stay were longer in the WB+CT group on univariable analysis, after risk adjustment, there were no significant differences in mortality, hospital or ICU length of stay, or ventilator days between groups. Further research is warranted to evaluate the role of WB resuscitation in patients on AC/AP.
抗凝和抗血小板（AC/AP）药物使出血控制复杂化，并与创伤患者死亡率增加相关。与成分治疗（CT）相比，全血（WB）可能与出血患者的不同结局有关。我们假设，在AC/AP出血患者中，WB与CT输血改善的预后有关。方法：我们回顾性地回顾了国家创伤数据库（2020-2022）中接受CT或WB+CT的AC/AP患者，不包括1小时内死亡的患者，怀孕的2例。单变量和多变量分析评估了死亡率和次要结局。结果：共有5580例患者符合纳入标准。CT 4802例，WB+CT 778例。WB+CT患者收缩压较低，心率较高，损伤严重程度较大，更容易进行紧急手术。总血制品体积（1000 mL）高于600 mL （P < 0.01）。WB+CT患者红细胞充血量较低（0 vs 350 mL, P < 0.01）。WB+CT患者住院时间较长（10天比8天，P < 0.01），重症监护病房（ICU）住院时间较长（5天比4天，P < 0.01）。结论：WB+CT患者表现为更严重的损伤和血流动力学不稳定。单变量分析显示，WB+CT组住院和ICU住院时间较长，但经风险调整后，两组患者的死亡率、住院和ICU住院时间、呼吸机天数均无显著差异。需要进一步的研究来评估WB复苏在AC/AP患者中的作用。
{"title":"Use of Whole Blood in Trauma Patients on Anticoagulation or Antiplatelet Therapy","authors":"Patrick Morris BS , Gena V. Topper MD , Jacob Metheny BS , Jared Plumb BA , Asanthi Ratnasekera DO, FACS , Tanya Anand MD, MPH, MT (ASCP), FACS , Malia Voytik MD , T Hess MD , Rachel J. Nation MD, MPH , Hannah Sofield MD , Krystal Hunter PhD, MBA , Tanya Egodage MD, FACS","doi":"10.1016/j.jss.2025.11.033","DOIUrl":"10.1016/j.jss.2025.11.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Anticoagulation and antiplatelet (AC/AP) medications complicate hemorrhage control and are associated with increased mortality in trauma. Whole blood (WB) may be associated with different outcomes for hemorrhaging patients over component therapy (CT). We hypothesize that in hemorrhaging patients on AC/AP, WB is associated with improved outcomes over CT transfusion.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the National Trauma Data Bank (2020-2022) for AC/AP patients who received CT or WB+CT, excluding those who died within 1 h, were pregnant, were <18 y old, transferred from facilities, or with a head abbreviated injury score > 2. Univariable and multivariable analyses assessed mortality and secondary outcomes.</div></div><div><h3>Results</h3><div>A total of 5580 patients met inclusion. A total of 4802 received CT and 778 WB+CT. WB+CT patients presented with lower systolic blood pressure, higher heart rate, greater injury severity, and were more likely to undergo emergent operation. They received a higher total blood product volume (1000 <em>v</em><em>er</em><em>s</em><em>us</em> 600 mL, <em>P</em> < 0.01). WB+CT patients received a lower packed red blood cell volume (0 <em>v</em><em>er</em><em>s</em><em>us</em> 350 mL, <em>P</em> < 0.01). WB+CT patients had longer hospital (10 <em>v</em><em>er</em><em>s</em><em>us</em> 8 d, <em>P</em> < 0.01) and intensive care unit (ICU) stays (5 <em>v</em><em>er</em><em>s</em><em>us</em> 4 d, <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>WB+CT patients presented with more severe injuries and hemodynamic instability. Although hospital and ICU length of stay were longer in the WB+CT group on univariable analysis, after risk adjustment, there were no significant differences in mortality, hospital or ICU length of stay, or ventilator days between groups. Further research is warranted to evaluate the role of WB resuscitation in patients on AC/AP.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 305-312"},"PeriodicalIF":1.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768469","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}
Pub Date : 2025-12-15DOI: 10.1016/j.jss.2025.11.046
İlyas Kudaş MD , Yahya Özel MD , Sinem Durmuş MD , Abdullah Şişik MD , Fatih Başak MD , Hafize Uzun MD , Ethem Ünal MD , Gürhan Baş MD
Introduction
Ischemic colitis (IC) results from reduced blood flow to the colon, causing inflammation and injury. Current diagnostic methods are limited, highlighting the need for reliable biomarkers. This experimental animal study investigates calprotectin, a protein linked to inflammation, as a diagnostic and prognostic marker for IC.
Methods
Eighteen male Wistar Albino rats were divided into a sham surgery group and an experimental ischemia group. Acute IC was induced by ligating the superior and inferior mesenteric vessels supplying the left colon. Serum and colonic tissue samples were collected at 6 and 24 h postsurgery. Calprotectin levels were measured using enzyme-linked immunosorbent assay, and histopathological examination was performed. Investigators performing histopathological scoring and data analysis were blinded to group assignments.
Results
No significant difference in serum calprotectin levels was observed at 6 h between groups (P > 0.05). At 24 h, the ischemia group showed significantly higher serum calprotectin levels compared to the sham group (P < 0.001). Tissue calprotectin levels were also significantly elevated in the ischemia group (P < 0.001). Histopathological analysis revealed severe mucosal damage in the ischemia group, correlating with increased calprotectin levels. The fold increase of calprotectin levels in the ischemia group at 24 h was approximately two-fold in serum and five-fold in tissue compared to the sham group.
Conclusions
Elevated calprotectin levels in serum and colonic tissue correlate with the severity of ischemic injury in this IC rat model. Calprotectin shows promise as a biomarker for diagnosing and monitoring IC, potentially improving diagnostic accuracy and patient outcomes. However, the small sample size and exclusive use of male rats represent limitations that necessitate further validation.
{"title":"Calprotectin as a Novel Biomarker for Ischemic Colitis: Experimental Insights in a Rat Model","authors":"İlyas Kudaş MD , Yahya Özel MD , Sinem Durmuş MD , Abdullah Şişik MD , Fatih Başak MD , Hafize Uzun MD , Ethem Ünal MD , Gürhan Baş MD","doi":"10.1016/j.jss.2025.11.046","DOIUrl":"10.1016/j.jss.2025.11.046","url":null,"abstract":"<div><h3>Introduction</h3><div>Ischemic colitis (IC) results from reduced blood flow to the colon, causing inflammation and injury. Current diagnostic methods are limited, highlighting the need for reliable biomarkers. This experimental animal study investigates calprotectin, a protein linked to inflammation, as a diagnostic and prognostic marker for IC.</div></div><div><h3>Methods</h3><div>Eighteen male Wistar Albino rats were divided into a sham surgery group and an experimental ischemia group. Acute IC was induced by ligating the superior and inferior mesenteric vessels supplying the left colon. Serum and colonic tissue samples were collected at 6 and 24 h postsurgery. Calprotectin levels were measured using enzyme-linked immunosorbent assay, and histopathological examination was performed. Investigators performing histopathological scoring and data analysis were blinded to group assignments.</div></div><div><h3>Results</h3><div>No significant difference in serum calprotectin levels was observed at 6 h between groups (<em>P</em> > 0.05). At 24 h, the ischemia group showed significantly higher serum calprotectin levels compared to the sham group (<em>P</em> < 0.001). Tissue calprotectin levels were also significantly elevated in the ischemia group (<em>P</em> < 0.001). Histopathological analysis revealed severe mucosal damage in the ischemia group, correlating with increased calprotectin levels. The fold increase of calprotectin levels in the ischemia group at 24 h was approximately two-fold in serum and five-fold in tissue compared to the sham group.</div></div><div><h3>Conclusions</h3><div>Elevated calprotectin levels in serum and colonic tissue correlate with the severity of ischemic injury in this IC rat model. Calprotectin shows promise as a biomarker for diagnosing and monitoring IC, potentially improving diagnostic accuracy and patient outcomes. However, the small sample size and exclusive use of male rats represent limitations that necessitate further validation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 297-304"},"PeriodicalIF":1.7,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768518","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}
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