Journal of Surgical Research最新文献

Introduction: Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population.

Methods: A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate.

Results: Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10 ys of experience, 26 (27.1%) had 10-20 ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P < 0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference.

Conclusions: The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.

Introduction: Falls account for nearly ¾ of all trauma in the geriatric population. We hypothesized that history and physical could reliably identify elderly patients with ground-level falls (GLF) who require head and cervical spine imaging.

Materials and methods: Patients of age >65 y with GLF from January, 2018 to December, 2021 at a level 1 trauma center were retrospectively reviewed. Falls from height, transfers, and presentation >48 h post injury were excluded. Primary outcome was head or cervical spine injury defined by (+) computed axial tomography (CT). Data were compared with univariate and multivariate analyses at P < 0.05.

Results: In 825 patients, 275 (33%) were on home anticoagulation or antiplatelet agents, half (51%) were considered frail, and most had at least one comorbidity prior to arrival. In 645 (79%) with a head CT, 174 (27%) were (+) and 20 (11%) required surgical intervention. Head CT changes were associated with male gender, Glasgow Coma Scale (GCS) score < 15, external signs of head injury, and headache, but not pre-existing anticoagulation. In 536 (65%) with cervical spine CT, 32 (6%) were (+) and 5 (17%) required surgery. Only neck symptoms were associated with (+) cervical spine injury.

Conclusions: In geriatric GLF, normal GCS score with no external signs of head trauma or headache indicates a low likelihood of head injury regardless of pre-existing anticoagulation. Similarly, the absence of neck symptoms suggests a low likelihood of cervical spine injury. Thus, history and physical are reliable in the workup of head and cervical spine injuries after geriatric GLF.

Introduction: As family dynamics evolve, an increasing number of male residents are embracing parenthood during their training. Consequently, paternity leave has emerged as a crucial consideration. The aim of this study was to determine the gap in public availability of paternity leave policies in surgical residency programs across the United States.

Methods: We evaluated publicly available information regarding paternity leave policies across both program-specific and Graduate Medical Education (GME) websites of 1242 surgical residency programs across eight surgical specialties. This information was further evaluated in relation to program size, program director gender, specialty type, and geographic location using logistic regression models.

Results: Paternity leave policies were found on only 4.3% of program-specific websites and 18.8% of GME websites. Neurosurgery had the greatest number of programs that publicly advertised their policies-11.7% on program-specific websites and 82.5% on GME websites. Vascular surgery and ear, nose, and throat surgery had no policies available on program-specific websites, and general surgery had the least paternity leave policies publicly available as per the GME websites (7.9%). Programs in the northeast were significantly less likely to have paternal leave policies publicly available (odds ratio: 0.55; 95% confidence interval: 0.31-0.96; P = 0.034), whereas programs in the west were significantly more likely (odds ratio: 2.1; 95% confidence interval: 1.2-3.67; P = 0.009) compared to the midwest.

Conclusions: This study highlights the pressing need for standardization and transparency across all surgical specialties regarding paternity leave policies. Addressing this gap is crucial for empowering applicants in family planning decisions and fostering a culture supportive of parental leave uptake.

Introduction: Malnutrition among older adults continues to be a prevalent health concern. While literature has highlighted an increased risk of malnutrition mortality for adults older than 65 y, the age threshold at which malnutrition effects survival and mortality remains unexplored.

Methods: Annual crude and age-adjusted malnutrition-related mortality data from 2009 to 2018 was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. We compared crude rates by year, 10-y age groups (15 to 85+ y), and disposition among age groups 65+ y using analysis of variance. We examined crude rates, year, and 10-y age groups (15 to 85+ y) using multiple linear regression. A Welch two sample t-test was used to compare the 10-y age groups 55-64 and 65-74 by crude rate.

Results: From 2009 to 2018, there were 275,282 older adult malnutrition-related mortalities. The differences in crude rates by year from 2009 to 2018 (P < 0.001) and all 10-y age groups were significant (P = 0.028). Differences in crude rates by disposition among age groups 65+ were not significant (P = 0.062). A multiple linear regression between crude rates between years 2009 and 2018 by all 10-y age groups showed a significant association (β = 0.06, 95% CI: 0.03, 0.09, P < 0.001). The difference between the annual crude rate for 10-y age groups 55-64 y and 65-74 y was significant (95% CI = 7.49, 13.41, P value <0.001).

Conclusions: Increasing age correlates with higher rates of malnutrition mortality. While nourishment should be a priority for all patients, preventing malnutrition must be a priority for all care with the goal of survival and future research.

Introduction: A simple risk stratification model to predict aneurysm sac shrinkagein patients undergoing endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA) was developed using machine learning-based decision tree analysis.

Methods: One hundred nineteen patients with AAA who underwent elective EVAR at Tokyo Medical University Hospital between November 2013 and July 2019 were included in the study. Predictors of aneurysm sac shrinkage identified in univariable analysis (P < 0.05) were entered into the decision tree analysis.

Results: Univariable analysis revealed significant differences between patients with and without aneurysm sac shrinkage in the variables of age (<75 y or ≥75 y), current smoking, operative type II endoleak, and preoperative pulse wave velocity (PWV) (<1800 cm/s or ≥1800 cm/s). The decision tree showed that preoperative PWV was the most relevant predictor, followed by operative type II endoleak and current smoking, and identified 6 terminal nodes with likelihoods of aneurysm sac shrinkage ranging from 5.6% to 63.6%.

Conclusions: We established a decision tree model with 3 variables (preoperative PWV, operative type II endoleak, and current smoking) to predict aneurysm sac shrinkage in patients undergoing EVAR for AAA. This classification model may help identify patients with a high or low likelihood of aneurysm sac shrinkage.

Introduction: We sought to understand the impact of locum tenens surgeons on pediatric surgical care delivery.

Methods: We conducted a cross-sectional survey of Children's Hospital Association pediatric surgical practices. Anonymous electronic surveys were used to investigate locum tenens utilization, primary reason for use, limitations on clinical activities, and variations in practice standards or quality. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between practice characteristics and locum tenens use.

Results: Of 172 practices, 71% (n = 122) completed the survey. Median hospital size was 203 beds (interquartile range = 130-350). Median number of surgeons per practice was 5 (interquartile range = 3-8). Thirty-seven practices (30%) employed locum tenens at primary (n = 27) or satellite (n = 12) sites. Locum tenens utilization was higher in suburban (odds ratio [OR] = 3.78, P = 0.006) and rural (OR = 4.96, P = 0.041) locations and lower at sites with a level 4 neonatal intensive care unit (OR = 0.35, P = 0.035). Most (51%) used locum tenens ≥ 1 time monthly but < 1 time weekly and for ongoing or interim coverage (87%). In total, 14% of practices reported clinical restrictions for locum tenens surgeons, including limitations on extracorporeal membrane oxygenation, neonatal index cases, and operative trauma. Most (76%) practices using locum tenens reported variations in practice standards or quality; all were perceived as negative (57%) or neutral (43%).

Conclusions: Locum tenens providers are utilized most commonly in suburban and rural sites and hospitals without the highest level of neonatal intensive care. While locum tenens surgeons may help maintain access to pediatric surgical care where gaps exist, there may be a need to improve the quality and reliability of care rendered.

Introduction: Laparoscopic intestinal anastomosis requires specific technical skills and should be trained in a safe simulation environment before performing surgery in daily practice. However, anastomosis simulation training with objective feedback is not widely available. This study aimed to analyze a laparoscopic intestinal anastomosis training task that utilizes objective force, motion, and time measurements.

Methods: With the feedback of laparoscopic experts, an artificial tissue reproducible intestinal anastomosis training task was designed and developed. Novices and experts performed the training task four times using two running suture techniques, with a multifilament braided suture and a barbed suture. The laparoscopic box trainer (Lapron box trainer, Amsterdam Skills Centre, Amsterdam, the Netherlands) provided objective force, motion, and time feedback. The mean values of the parameters were calculated and analyzed using the Mann-Whitney U test.

Results: A total of 212 intestinal anastomosis repetitions were performed by 35 novices and 18 experts from 14 European teaching hospitals. For the multifilament braided sutures, experts showed significant lower maximal impulses (19.80 versus 12.90 Ns, P = 0.004), shorter total path length (23,545 mm versus 15,266 mm, P ≤ 0.001) and required less time to finish the task compared to novices (448 s versus 297 s, P ≤ 0.001). Using the barbed sutures, experts used significantly lower maximal forces (2.93 N versus 2.31 N, P = 0.032), had a shorter total path length (13,608 mm versus 8551 mm, P ≤ 0.001), and needed less time to execute the training task compared to novices (253 s versus 166 s, P ≤ 0.001).

Conclusions: The development of a modular and reproducible laparoscopic intestinal anastomosis training task with established construct validity for force, motion, and time-based assessment of technical skills allows for repetitive training of advanced skills. These outcomes can now be utilized to assess translation of these skills into the operating room.

Introduction: It has been previously shown that gender bias exists in standardized letters of recommendation for plastic surgery residency. However, similar analysis has not been conducted for narrative letters of recommendation (NLORs). Therefore, this study aims to determine if there exists linguistic bias in NLORs for plastic surgery residency based on applicants' and writers' gender and race.

Methods: The sample included applicants to a 6-y integrated plastic surgery residency program within application cycles from 2021 to 2023. The exclusion criteria included reapplicants and applicants without NLORs. Applicant demographics were self-identified. Faculty gender was identified through public online platforms and faculty race through Namsor, validated artificial intelligence software for name classification. The Linguistic Inquiry and Word Count program was used to calculate the amount of words in each NLOR that fell within predetermined linguistic categories, such as power and social behavior. Descriptive statistics and Wilcoxon rank-sum tests were used in the analysis were appropriate.

Results: Six hundred twenty-six unique applicants had at least one NLOR. Female writers used more descriptive evaluations of applicants compared to male writers with greater emphasis on applicants' social and emotional qualities. White writers used more words conveying negative tone to describe non-White applicants. Non-White writers used more word describing accomplishment, drive, and social qualities of non-White applicants compared to White Applicants.

Conclusions: Analysis of NLORs revealed differences related to gender and race. Female writers produced more favorable recommendations than male writers. Racial discordance between writer and applicant resulted in differences in the letter quality. Faculty education to improve the objectivity of NLORs is necessary.

Introduction: Prehabilitation (preoperative rehabilitation) encompasses a range of patient health driven interventions with the potential to enhance surgical outcomes. This systematic review aims to assess the efficacy of prehabilitation on postoperative outcomes across surgical specialties, focusing on physical functionality and postoperative length of stay (LOS).

Methods: Medline, Embase, CINAHL Plus, Cochrane Library, Scopus, and Clinicaltrials.gov databases were queried using the search terms prehabilitation, surgery, and related synonyms. Included publications were original, English-language, full-text studies conducted in the US with a cohort of ≥5 patients undergoing prehabilitation. After title (n = 1817), abstract (n = 1059), and full-text (n = 411) screens, 26 articles met inclusion criteria.

Results: Of 26 included articles, 30.8% (n = 8) assessed oncologic surgeries, 34.6% (n = 9) assessed orthopedic surgeries, 19.2% (n = 5) assessed general surgery procedures, and 15.4% (n = 4) assessed cardiac, colorectal, urologic, and transplant surgeries. Physical function was the most common assessed primary outcome, with 46.2% (n = 12) of studies measuring physical activity, functional status, range of motion, or muscle strength. The outcomes of six-meter walk test, sit-to-stand test, and LOS were reported in 26.9% (n = 7), 23.1% (n = 6), and 19.2% (n = 5) of studies, respectively. Three studies found a significant improvement in the six-meter walk test, and four studies demonstrated a significant improvement in sit-to-stand test after prehabilitation. LOS outcomes had varied results across studies.

Conclusions: Prehabilitation interventions have the potential to improve postoperative outcomes, including physical function and LOS in surgical patients. Further research is necessary to identify the most efficacious prehabilitation protocols and determine their optimal impact within diverse surgical subpopulations.

Introduction: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly performed in young patients with peritoneal surface malignancies. Important quality of life (QoL) questions arise; however, there is limited research on fertility experiences in young women with carcinomatosis or following CRS/HIPEC.

Methods: Retrospective review of a prospective database evaluating women less than 45 ys who underwent CRS/HIPEC at the University of Pittsburgh Medical Center from January 1998 to 2020. Eligible patients were contacted for a telephone-based interview. Themes regarding fertility counseling, childbearing, and patient-identified issues were investigated.

Results: A total of 28 of 29 women who met inclusion criteria participated. The majority had appendiceal primary (16/28). Most received Mitomycin C intraperitoneal chemotherapy (26/28) with an average Peritoneal Cancer Index of 8 (0-39). Almost half of the women (43%) desired fertility discussion. Although this conversation happened more often in younger patients, 75% were over the age of 35 ys at time of initial HIPEC. Less than half were offered fertility counseling. When fertility conversations occurred, many felt that they were insufficient. In addition to fertility, women cited lack of support on postprocedure hormonal and associated QoL changes.

Conclusions: As we treat younger females with CRS/HIPEC, we must provide support for age-appropriate QoL issues including fertility and surgical menopause.