Journal of Surgical Research最新文献

{"title":"Intentions Matter: Long-Term Patient Outcomes After Intentional, Interpersonal Injury","authors":"Colby Wilson,&nbsp;Joseph Kern MD,&nbsp;Kathleen O'Neill MD, PhD,&nbsp;Mark Seamon MD,&nbsp;Elinore Kaufman MD, MSHP","doi":"10.1016/j.jss.2025.11.063","DOIUrl":"10.1016/j.jss.2025.11.063","url":null,"abstract":"<div><h3>Introduction</h3><div>Any traumatic injury can lead to long-term challenges with physical health, mental health, and social well-being. Intentional injury due to interpersonal violence can further impair patients’ sense of safety and may hinder recovery. We compared long-term patient-reported outcomes according to injury intent with the hypothesis that mental health outcomes would be worse in those injured by interpersonal violence compared to unintentional injury.</div></div><div><h3>Methods</h3><div>Beginning in 10/2019, we prospectively collected data on patient demographics, post traumatic stress disorder (PTSD), and patient-reported outcomes using patient reported outcomes measurement information system-29 (PROMIS-29) domains (depression, anxiety, physical function, sleep disturbance, ability to participate in social roles, and pain interference in daily activity) for adult trauma patients admitted to an urban, academic, level 1 trauma center. Participants were screened at the time of injury and at least one follow-up at 6 or 12 mo by January 7, 2024. Injury and treatment characteristics were collected from the institutional trauma registry. We compared patients injured unintentionally to those injured by interpersonal violence using descriptive statistics. Multivariable logistic regression was used to evaluate the contribution of injury intent to those outcomes for which univariate analysis showed a difference at 6 or 12 mo. We screened for PTSD with the PC-PTSD-5, considering a score of ≥3 to be positive. PROMIS-29 outcomes are expressed as the proportion of respondents whose scores were ≥1 standard deviation worse than population norms.</div></div><div><h3>Results</h3><div>Of 315 participants, 105 were injured by interpersonal violence (gunshot wounds, stabbings, and blunt assaults). Intentionally injured patients were younger (median age 32 <em>versus</em> 50 for unintentional injuries) and more severely injured. Patients with unintentional injury were more often male (85% <em>versus</em> 60% of unintentionally injured patients) and were more often Black (87% <em>versus</em> 53%). At follow-up, 44 (43.6%) of intentionally inured patients screened positive for PTSD, compared to 47 (22.6%) of unintentionally injured patients, <em>P</em> &lt; 0.001. In multivariable analysis accounting for age, gender, and injury severity, intentional injury was associated with a 2.1-fold increase in odds of PTSD (95% confidence interval: 1.1, 3.8). There was no significant association of intent with anxiety or depression.</div></div><div><h3>Conclusions</h3><div>Intentional injury is associated with higher rates of positive screens for PTSD after trauma. Screening and treatment protocols should attend to the mental health needs of all injured patients, with particular attention to post traumatic stress in survivors of interpersonal violence.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 453-460"},"PeriodicalIF":1.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provisional Treatment of Volumetric Muscle Loss With Insulin-like Growth Factor 1 Releasing Muscle Void Fillers","authors":"Andrew R. Clark PhD ,&nbsp;Alex T. Adams BS ,&nbsp;Todd O. McKinley MD ,&nbsp;Roman M. Natoli MD, PhD ,&nbsp;Christopher L. Dearth PhD ,&nbsp;Stephen M. Goldman PhD","doi":"10.1016/j.jss.2025.11.043","DOIUrl":"10.1016/j.jss.2025.11.043","url":null,"abstract":"<div><h3>Introduction</h3><div>Volumetric muscle loss (VML) resulting from severe extremity injuries in combat remains a significant clinical challenge, particularly in austere environments. Current research emphasizes the development and evaluation of definitive treatments, largely neglecting acute stabilization strategies. To address this unmet need, this study investigated the efficacy of delivering insulin-like growth factor 1 long arginine 3 (IGF1-LR3) via a synthetic <em>in situ</em> forming hydrogel muscle void filler (MVF) to enhance muscle recovery after VML.</div></div><div><h3>Methods</h3><div>Adult male Lewis rats underwent VML surgery, followed by implantation of a polyethylene glycol-acrylate MVF containing either soluble or poly(lactic-co-glycolic acid) (PLGA)-encapsulated IGF1-LR3 at a low (28 μg) or high (280 μg) dose, or no IGF1-LR3 (control). Neuromuscular function was assessed via isometric torque measurements. Muscle tissue was analyzed using wheat germ agglutinin and picrosirius red staining for fiber size, count, and fibrosis. Statistical analysis was performed using ANOVA with Holm-Šídák post hoc testing.</div></div><div><h3>Results</h3><div>High-dose PLGA-encapsulated IGF1-LR3 resulted in increased muscle weight compared to the control group at 28 d post implantation. However, no differences were observed in specific torque or maximum torque production between any experimental groups. Histological analysis revealed no changes in muscle fibrosis or fiber size or count of IGF1-LR3 compared to controls.</div></div><div><h3>Conclusions</h3><div>The addition of IGF1-LR3 in an MVF did not enhance neuromuscular function or muscle fiber hypertrophy. Further studies are needed to optimize IGF1-LR3 delivery or alternative hypertrophy-inducing soluble factors.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 461-466"},"PeriodicalIF":1.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the Lactate-to-Albumin Ratio With All-Cause Mortality in Trauma and Surgical Intensive Care Patients: A Retrospective Study","authors":"Dexiang Liao BS ,&nbsp;Shuai Zhang BS ,&nbsp;Jiajie Zhang BS ,&nbsp;Zuohong Shang MM ,&nbsp;Dandan Ma MM ,&nbsp;Weidong Jin MD ,&nbsp;Tao Fu MD","doi":"10.1016/j.jss.2025.11.035","DOIUrl":"10.1016/j.jss.2025.11.035","url":null,"abstract":"<div><h3>Introduction</h3><div>The lactate-to-albumin ratio (LAR) has emerged as a novel prognostic biomarker in acute pancreatitis, septic shock, acute respiratory distress syndrome, and cardiac arrest. However, the prognostic utility of the LAR for all-cause mortality (ACM) in critically ill surgical/trauma patients remains unevaluated.</div></div><div><h3>Materials and methods</h3><div>Patients in surgical/trauma surgical intensive care unit (SICU/TSICU) were identified through the Medical Information Mart for Intensive Care–IV database. The Boruta feature selection algorithm was implemented to identify predictors significantly associated with ACM, Cox proportional hazards regression models and Restricted cubic splines were employed to evaluate the nonlinear association between the LAR and ACM, while Kaplan–Meier survival curves were generated to visualize temporal survival differences.</div></div><div><h3>Results</h3><div>This study enrolled 2838 patients in TSICU and SICU. Multivariable Cox proportional hazards regression demonstrated the LAR was associated with 90-d and 1-y ACM in patients admitted to the SICU/TSICU. Restricted cubic splines regression revealed a dose-dependent increase in ACM risk with escalating LAR levels. A nonlinear relationship between LAR and 90-d and 1-y ACM was identified, with an inflection point of 0.79 (<em>P</em> &lt; 0.001). Consistently, LAR ≥ 0.79 was associated with increased risks of 90-d (hazard ratio 1.52, 95% confidence interval 1.28 ∼ 1.80) and 1-y (hazard ratio 1.37, 95% confidence interval 1.18 ∼ 1.59) ACM.</div></div><div><h3>Conclusions</h3><div>In summary, a correlation was observed between the LAR and ACM in SICU and TSICU patients. Future validation in prospective, multicenter cohorts is essential before any consideration can be given to its application in clinical practice.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 416-430"},"PeriodicalIF":1.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Three-step Algorithm for Axial Pattern Flap Selection in Repairing Deep Soft Tissue Defects of the Lower Extremity","authors":"Qian Wang MMed ,&nbsp;Hai-Yan Zhong MMed ,&nbsp;Rui Yang MMed ,&nbsp;Yong Chen MD ,&nbsp;Min Wang MMed ,&nbsp;Ming-Li Zou MMed ,&nbsp;Si-Ming Yuan MD","doi":"10.1016/j.jss.2025.11.028","DOIUrl":"10.1016/j.jss.2025.11.028","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to summarize an algorithm for flap selection in the repair of deep lower extremity defects with bone, tendon, or joint cavity exposure.</div></div><div><h3>Methods</h3><div>The medical records of patients with deep lower extremity defects repaired using axial pattern flaps between January 2007 and December 2023 in our department were retrospectively reviewed. A three-step algorithm for axial pattern flap selection was formulated. Outcomes were evaluated based on flap survival rate, functional recovery of the affected limb, complications, and patient satisfaction.</div></div><div><h3>Results</h3><div>Ninety-six patients with a mean age of 51.2 y (range: 11-77 y) were included. The three-step algorithm involved sequential evaluation of the defect location, vascular condition of potential flaps and the size of the defect. Patients were followed up for 6 mo to 2 y. The flap survival rate was 100%, with no severe complications observed. The mean Lower Extremity Functional Scale score was 65.6 (range: 46-75). Overall, 85.4% of patients were satisfied with the outcomes.</div></div><div><h3>Conclusions</h3><div>The three-step algorithm for axial pattern flap selection—based on defect location and size, and vascular condition of potential flaps—can achieve satisfactory long-term outcomes and serves as a practical and straightforward method in clinical practice.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 431-438"},"PeriodicalIF":1.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter Regarding: Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends.","authors":"Zafer Turkyilmaz, Ramazan Karabulut, Cem Kaya, Kaan Sonmez","doi":"10.1016/j.jss.2025.11.059","DOIUrl":"https://doi.org/10.1016/j.jss.2025.11.059","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma During Pregnancy: Predictors of Readmission and Maternal–Fetal Outcomes","authors":"Yasmin Arda MD ,&nbsp;May Abiad MD ,&nbsp;Wardah Rafaqat MBBS ,&nbsp;Emanuele Lagazzi MD ,&nbsp;Dias Argandykov MD ,&nbsp;Anne H. Hoekman BS ,&nbsp;Casey M. Luckhurst MD ,&nbsp;George C. Velmahos MD, PhD ,&nbsp;John O. Hwabejire MD, MPH ,&nbsp;Michael P. DeWane MD","doi":"10.1016/j.jss.2025.11.032","DOIUrl":"10.1016/j.jss.2025.11.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma is the leading nonobstetrical cause of mortality in pregnant women and a major cause of fetal demise. Among pregnant trauma patients, there is a paucity of data on factors associated with unplanned readmissions. We examined the predictors of 90-day readmission in pregnant women admitted for traumatic injuries and evaluated the associated maternal–fetal complications.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database (2016-2019) was reviewed for all adult trauma admissions. Pregnant state at index admission was determined by International Classification of Diseases-10 codes for gestational age. The primary outcome was 90-d readmission rate. A multivariable logistic regression model was used to identify predictors of readmissions in this patient population.</div></div><div><h3>Results</h3><div>Of the 5653 pregnant trauma admissions, 254 (4.5%) had at least one unplanned readmission within 90 d of discharge. Readmitted patients were younger, in their first or second trimester, on Medicaid, belonged to a lower-income quartile, suffered more severe injuries, and had a greater number of comorbid conditions, including substance use disorder and pregestational diabetes. The most common nonobstetric cause of 90-d readmission was psychiatric conditions. Readmitted patients were less likely to have experienced fetal death at index admission (0.1% <em>versus</em> 2.6%, <em>P</em> = 0.029) but more likely to have developed genitourinary complications during index admission (15.4% <em>versus</em> 5.9%, <em>P</em> &lt; 0.001). Preterm delivery, chorioamnionitis, and intrauterine growth restriction were significantly increased in readmitted patients. Uninsured status, multiple comorbidities, and history of a cesarean section were independent predictors of readmission.</div></div><div><h3>Conclusions</h3><div>In pregnant patients admitted for traumatic injuries, readmission was associated with poor maternal–fetal outcomes. The risk of readmission was significantly higher in younger patients, those with multiple comorbidities, and those who were uninsured. Interventions targeting these risk factors should be implemented to alleviate the burden of the initial trauma.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 400-408"},"PeriodicalIF":1.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Earlier Index Endoscopic Retrograde Cholangiopancreatography is Associated With Biliary Stricture Resolution After Orthotopic Liver Transplant","authors":"Bishal Paudel MD ,&nbsp;Jennifer Fieber MD ,&nbsp;Abdillahi Ahmed MD ,&nbsp;Christy Shao ,&nbsp;Rushi Shah MD ,&nbsp;Apara Agarwal MD ,&nbsp;Matthew Giansiracusa DO ,&nbsp;Bashar Qumseya MD, MPH ,&nbsp;Andreas G. Zori MD ,&nbsp;Christopher Forsmark MD ,&nbsp;Aleksey A. Novikov MD","doi":"10.1016/j.jss.2025.11.056","DOIUrl":"10.1016/j.jss.2025.11.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Biliary strictures are the most common biliary complication following orthotopic liver transplantation (OLT). While factors associated with stricture formation are relatively well-studied, variables related to their resolution remain poorly understood. The goal of this study was to identify factors associated with the resolution of post-OLT anastomotic biliary strictures.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients who underwent OLT and developed an anastomotic biliary stricture in a single health system from 2019 to 2022. The primary outcome was defined as endoscopic evidence of biliary stricture resolution (BSR), leading to stent removal. Secondary outcomes included the time to first endoscopic retrograde cholangiopancreatography (ERCP), the number of ERCPs performed, the type of stent used during ERCP, and complications associated with ERCP.</div></div><div><h3>Results</h3><div>Of the 357 patients that underwent OLT, 96 (26.9%) patients developed a biliary stricture. ERCP was performed on 84 patients, and 12 patients underwent percutaneous transhepatic biliary drainage due to anatomical variations. BSR was achieved in 71 (84.5%) patients who underwent ERCP. The median time to the index ERCP was 57 d in patients with BSR, compared to 230 d in patients with persistent strictures (<em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>In patients with anastomotic biliary strictures following OLT who underwent ERCP, shorter time to first ERCP was independently associated with BSR. Further investigation into the development of post-OLT biliary strictures, the ERCP technique, and the behavior of biliary strictures is needed to fully understand this relationship.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 446-452"},"PeriodicalIF":1.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calculating Carbon Reduction Via Pediatric Outreach Clinics From a Surgical Patient Cohort","authors":"Brittany Walker MD ,&nbsp;Abner Barbosa MD ,&nbsp;Michael Stellon MD ,&nbsp;Peter F. Nichol MD, PhD","doi":"10.1016/j.jss.2025.11.044","DOIUrl":"10.1016/j.jss.2025.11.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Transportation is a major contributor to carbon emissions. This study evaluates the carbon footprint reduction associated with surgical outreach clinics as an alternative to patients traveling long distances to a tertiary medical center.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed pediatric pectus excavatum (PE) patients seen in two outreach clinics between 2012 and 2024. Distances from patients' homes to both the children's hospital and outreach clinics were calculated. Using the average distance traveled per PE patient and Environmental Protection Agency's emission factor of 400 g of CO₂ per mile, we estimated the carbon footprint reduction for all pediatric patients seen at our outreach clinics over the last three calendar years.</div></div><div><h3>Results</h3><div>There were 33 PE patients who had 142 total outpatient visits that met inclusion for this study. There were 10,470 total pediatric patient outreach visits from January 2022 through September 2024. The use of outreach clinics was associated with an estimated reduction in carbon emissions of 695.3 metric tons for all pediatric patients between 2022 and 2024 (67% reduction) and with an estimated savings of $273,065 in travel expenses over this 33-mo period.</div></div><div><h3>Conclusions</h3><div>The use of outreach clinics was associated with an estimated reduction in carbon emissions for all pediatric patients while offering some economic benefits. Outreach clinics present a practical strategy for enhancing health care delivery, lowering costs, and reducing environmental impact.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 409-415"},"PeriodicalIF":1.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response Regarding: Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends.","authors":"Nina D Kosciuszek, Kenneth W Gow","doi":"10.1016/j.jss.2025.11.060","DOIUrl":"https://doi.org/10.1016/j.jss.2025.11.060","url":null,"abstract":"","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":"145774806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NLR and PLR in Differentiating Appendicitis Severity: A Meta-Analysis","authors":"Kaijun Li MMed ,&nbsp;Junjie Xiang MMed ,&nbsp;Yuqian Li MMed ,&nbsp;Xuedong Sun MD","doi":"10.1016/j.jss.2025.11.040","DOIUrl":"10.1016/j.jss.2025.11.040","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute appendicitis is a frequent cause of abdominal pain, and accurate distinction between simple and complex forms is crucial for guiding treatment. Traditional diagnostic approaches, such as imaging and clinical scoring systems, often provide suboptimal accuracy. Recently, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have drawn attention as convenient, inexpensive indicators of systemic inflammation. However, their reported diagnostic value varies across studies. This study aimed to assess the effectiveness of NLR and PLR in differentiating simple from complex appendicitis, with additional analysis by age group to improve clinical relevance.</div></div><div><h3>Methods</h3><div>We searched for relevant studies published before May 2025. We assessed the diagnostic accuracy of NLR and PLR for complex appendicitis using receiver operating characteristic (ROC) curve analysis and forest plots.</div></div><div><h3>Results</h3><div>A total of 60 studies (54 evaluating NLR, 23 assessing PLR) were included. The pooled area under the curve (AUC) of NLR for diagnosis was 0.76 in the overall population. Age-stratified analysis showed that NLR achieved a sensitivity of 0.72, specificity of 0.64, and AUC of 0.74 in pediatric patients, while in adults, sensitivity was 0.70, specificity was 0.67, and AUC was 0.74. For PLR, pooled sensitivity and specificity were 0.58 and 0.69, respectively (AUC = 0.67).</div></div><div><h3>Conclusions</h3><div>NLR is a more reliable biomarker than PLR for identifying complex appendicitis, aiding early clinical decision-making.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 365-379"},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774834","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}