Journal of Surgical Research最新文献

{"title":"Increased Prophylactic Enoxaparin Dosing is Associated With Improved Achievement of Target anti-Xa Levels; Implementation of the Western Trauma Association Venous-Thromboembolism Guidelines","authors":"Brian P. McKinzie PharmD, BCCCP ,&nbsp;Natassha Ebert RN, BSN, PharmD, BCCCP ,&nbsp;Felicia N. Williams MD, FACS, FABA ,&nbsp;Ian Kratzke MD, MHPE ,&nbsp;Jared Gallaher MD, MPH, FACS ,&nbsp;Lauren Raff MD, FACS","doi":"10.1016/j.jss.2025.12.032","DOIUrl":"10.1016/j.jss.2025.12.032","url":null,"abstract":"<div><h3>Background</h3><div>Evidence suggests that standard enoxaparin dosing for burn and trauma patients results in sub-optimal target thromboprophylactic plasma anti-Xa levels in up to 84% of the patients, potentially leading to increased incidence of venous thromboembolism (VTE). More intensive dosing regimens have been suggested; however, few studies have evaluated these protocols in trauma/burn patient populations.</div></div><div><h3>Methods</h3><div>A retrospective chart review of an American Burn Association–verified burn and American College of Surgeons–verified level 1 trauma center from June 2022 until July 2023 identified patients initiated on a higher dosing enoxaparin protocol for VTE prophylaxis in accordance with recent Western Trauma Association guidelines. Patients were included if they were at least 18 years of age, dosed according to protocol criteria, and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy.</div></div><div><h3>Results</h3><div>Two hundred forty five patients were screened with 196 patients included for analysis. 24.5% of the patients dosed according to the protocol did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/mL). Burn patients were more likely to achieve target anti-Xa levels than trauma patients (81.1% <em>versus</em> 65.2%, <em>P</em> = 0.016). An association between severe burns and inability to meet anti-Xa goals was also noted.</div></div><div><h3>Conclusions</h3><div>Utilization of a higher dose enoxaparin protocol for VTE prophylaxis has an improved likelihood of achieving plasma anti-Xa targets compared to standard dosing strategies, however, almost 23% of the patients were still underdosed. Increased enoxaparin dosing targeted to peak plasma anti-Xa levels and the impact on VTE reduction in severe burn and trauma patients should be further evaluated.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 300-305"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035154","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":"Critical Review of International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision System-Based Postoperative Surgical Complication Codes","authors":"Radhe Shantha Kumar MPhil ,&nbsp;Tarsicio Uribe-Leitz MD, MPH ,&nbsp;George Molina MD, MPH ,&nbsp;Rachel Adler ScD, RD ,&nbsp;Clancy J. Clark MD","doi":"10.1016/j.jss.2025.12.030","DOIUrl":"10.1016/j.jss.2025.12.030","url":null,"abstract":"<div><h3>Introduction</h3><div>The 2015 transition from International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision (ICD-9 to ICD-10) in the U.S. aimed to improve diagnostic and procedural precision. However, no validated methodology exists for translating complication codes, posing a barrier to longitudinal surgical outcomes research. This study evaluates a structured approach to map ICD-9 to ICD-10 complication codes for high-risk operations, including esophagectomy, pancreaticoduodenectomy, and hepatectomy.</div></div><div><h3>Methods</h3><div>We developed an 8-step process using the Center for Medicare and Medicaid Services General Equivalence Mappings, incorporating manual review and clinical adjudication. ICD-9 codes representing complications, including cardiovascular, gastrointestinal, pulmonary, renal, infectious, systemic, intraoperative, wound-related, blood transfusion, and postoperative interventions, were mapped to ICD-10 and classified as exact, approximate, or mismatch. This framework was then applied to the National Inpatient Sample to evaluate postoperative complications before and after implementation of ICD-10.</div></div><div><h3>Results</h3><div>A total of 148 ICD-9 codes mapped to 774 ICD-10 codes. Clinical review identified 63.3% as exact, 33.9% as approximate, and 2.8% as mismatched. The recorded postoperative complication rates appeared lower for esophagectomy (50.6%-44.5%, <em>P</em> &lt; 0.0001), higher for pancreatectomy (44.3%-46.4%, <em>P</em> &lt; 0.01), and similar for hepatectomy (33.4%-32.8%, <em>P</em> = 0.53) with ICD-10 compared to ICD-9. The recorded length of stay and in-hospital mortality were also lower in the ICD-10 era (all <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>ICD-10 implementation may improve the capture of specific complications and reflect evolving perioperative care. However, significant discrepancies in code translation underscore the need for validated methods. The mapping framework developed in this study enables reliable complication tracking across coding eras and supports higher-quality surgical outcomes research.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 306-317"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035155","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":"In-Person and Virtual Interview Format for General Surgery Residency From an Applicant Perspective","authors":"Maya Hammoud MD,&nbsp;Adam Ayoub BS,&nbsp;Robert Sawyer MD,&nbsp;Saad Shebrain MD","doi":"10.1016/j.jss.2025.12.034","DOIUrl":"10.1016/j.jss.2025.12.034","url":null,"abstract":"<div><h3>Introduction</h3><div>While residency interviews have historically been in person, the majority of residency interviews transitioned to virtual interviews (VTIs) due to the COVID-19 pandemic. Since that time, in-person interviews (IPIs) have slowly been reintroduced. This study assesses applicant perceptions of VTI <em>versus</em> IPI formats.</div></div><div><h3>Methods</h3><div>Applicants to a single general surgery residency program were surveyed regarding factors that were important for ranking the programs, experience with IPI and VTI platforms, experience at our institution, and decision-making in choosing the program for interview and ranking. Primary outcomes evaluated were the differences between IPI and VTI from an applicant perspective.</div></div><div><h3>Results</h3><div>Of the 229 applicants interviewed at our institution and ranked for 18 y-1 positions in the 2022-23, 2023-24, and 2024-2025 match cycles, 61 applicants (27%) responded with complete data to our survey (23 IPI, 30 VTI). Applicants in both groups (IPI <em>versus</em> VTI) reported fellowship prospects after graduation and geographic location to be important or extremely important in ranking programs (87.1%. <em>versus</em> 80.0%, <em>P</em> = 0.347). Applicants reported similar overall experiences at our institution. Candidates were more satisfied with in-person preinterview meeting with residents (93.5% IPI <em>versus</em> 63.3% VTI, <em>P</em> = 0.0043) and in-person hospital tours (80.6% IPI <em>versus</em> 53.3% VTI, <em>P</em> = 0.0244). More than half of applicants who interviewed virtually agreed or strongly agreed that financial considerations impacted their format selection, compared to one-third in the IPI (<em>P</em> = 0.221). Finally, more virtual interviewees agreed/strongly agreed that they would not have interviewed if not offered that format compared to IPI (30% VTI, 9% IPI, <em>P</em> = 0.11).</div></div><div><h3>Conclusions</h3><div>Overall, from the applicant perspective, there are few statistically significant differences between IPI and VTI. IPI is associated with better experiences at preinterview social events and during the hospital tours, but there was no difference in applicants’ abilities to rank the program based on interview format. Both IPI and VTI should continue to be offered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 359-365"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046770","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":"Changes in Vascular Cell Adhesion Molecule-1 in Conventional Versus Robotic Bypass Graft Surgery","authors":"Shiyi Li MD ,&nbsp;Katherine V. Nordick MD ,&nbsp;Iván Murrieta-Álvarez MD ,&nbsp;Randall P. Kirby MS ,&nbsp;Rishav Bhattacharya BS ,&nbsp;Ismael Garcia MD ,&nbsp;Zachary Gray MPAS, PA-C ,&nbsp;Camila Hochman-Mendez PhD ,&nbsp;Kenneth K. Liao MD, PhD ,&nbsp;Nandan K. Mondal MSc, MPhil, PhD","doi":"10.1016/j.jss.2025.12.022","DOIUrl":"10.1016/j.jss.2025.12.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Elevated plasma levels of vascular cell adhesion molecule-1 (VCAM-1) are implicated in cardiovascular complications after cardiac surgery. This study investigated changes in circulating VCAM-1 levels during robotic-assisted coronary artery bypass graft (R-CABG) compared to conventional coronary artery bypass graft (C-CABG).</div></div><div><h3>Methods</h3><div>Fifty-seven patients were divided into C-CABG (<em>n</em> = 27) and R-CABG (<em>n</em> = 30) groups. The R-CABG group was further stratified into those with extracorporeal membrane oxygenation (ECMO) (<em>n</em> = 14) and those without ECMO (<em>n</em> = 16). Plasma VCAM-1 levels were measured preoperatively (Pre-OP), intraoperatively (Intra-OP), and postoperatively (Post-OP). Surgical risk was assessed using the EuroSCORE II.</div></div><div><h3>Results</h3><div>Post-OP plasma VCAM-1 levels were significantly higher in the C-CABG group when compared to R-CABG group (1807.84 ± 710.74 <em>versus</em> 1320.56 ± 481.28 ng/mL, <em>P</em> = 0.007). Subgroup analysis indicated no significant differences in VCAM-1 levels between R-CABG patients with and without ECMO. Pre-OP VCAM-1 levels correlated positively with EuroSCORE II (<em>r</em> = 0.503, <em>P</em> &lt; 0.001). R-CABG was associated with significantly lower Post-OP atrial fibrillation (AFib) rates. Patients who developed AFib showed persistently higher VCAM-1 levels, and Pre-OP VCAM-1 was a predictor of Post-OP AFib, with an area under the curve (AUC) of 0.741 (95% confidence interval [CI]: 0.608-0.848, <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>R-CABG results in significantly lower postoperative VCAM-1 levels than C-CABG; however, this finding should be interpreted with caution, as most C-CABG patients had three-vessel coronary artery disease, whereas most R-CABG patients had single-vessel coronary artery disease. This robotic approach may reduce cardiovascular complications linked to elevated VCAM-1. Preoperative VCAM-1 may be a useful biomarker for assessing mortality risk and predicting postoperative AFib in CABG patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 40-51"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927866","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":"Associations Between Snakebite Severity Scores and Antivenin Administration","authors":"Jack H. Bowdle BS ,&nbsp;Justin Pritchett BS ,&nbsp;Andrew Hungerford BS ,&nbsp;Sarah A. King MEng ,&nbsp;Amanda McKinney PharmD ,&nbsp;Robert E. Heidel PhD ,&nbsp;Lou M. Smith MD ,&nbsp;Catherine L. McKnight MD","doi":"10.1016/j.jss.2025.12.004","DOIUrl":"10.1016/j.jss.2025.12.004","url":null,"abstract":"<div><h3>Introduction</h3><div>In the United States, thousands of crotalid envenomations are reported annually, with incidence varying significantly by region. Crotalid envenomation in North America lacks a standardized treatment protocol. We evaluated Snakebite Severity Scores (SSSs) calculated by health care providers and their association with aspects of care.</div></div><div><h3>Methods</h3><div>Retrospective review of venomous snakebites (VSB) at a level I trauma center, March 2017-September 2023. Data included SSS documented by clinicians (CSSS), retrospectively calculated SSS from clinical documentation (RSSS), injury details, antivenin administration, patient response, and SSS classification (mild, moderate, and severe). Discrepant scores were further analyzed. Statistical analysis was performed using SPSS v28.</div></div><div><h3>Results</h3><div><em>N</em> = 134 patients (age 46.5 ± 17.6 y; 64.9% male; 67.9% referral hospital transfer). Copperhead bites predominated (76.9%). The mean CSSS was 3.09 ± 1.64, while RSSS was 3.59 ± 2.42 (<em>r</em> = 0.889, <em>P</em> &lt; 0.001). Categorically, 70 patients (60.3%) were classified as mild, 25 (21.6%) moderate, and 3 (2.6%) severe. CSSS/RSSS differed in 47 patients (40.5%), with 40 RSSS &gt; CSSS. Eighteen discrepancies (13.4%) suggested potential variation in treatment classification. CSSS aligned with the eventual clinical course in 10 patients: eight required no antivenin and two received antivenin consistent with their CSSS category. RSSS aligned more closely in seven patients: three improved with antivenin despite CSSS suggesting otherwise; two required additional antivenin; one received antivenin that may not have been clinically necessary; one had delayed intensive care unit admission. One patient's antivenin requirement appeared underestimated by both CSSS and RSSS.</div></div><div><h3>Conclusions</h3><div>Inconsistent use of institutional protocol for VSBs highlights educational needs. Miscalculated SSS values were associated with potential delays in treatment. Patients with an SSS of four did not receive antivenin, indicating variability in decision-making. Computer-based electronic medical record checklists may aid calculations and improve protocol adherence.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 32-39"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927870","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":"The Association of Blood Transfusion With Free Flap Survival and Thrombosis: A Review and Meta-Analysis","authors":"Karolina Anuszkiewicz MD ,&nbsp;Artur Furga MD ,&nbsp;Piotr Stogowski MD, PhD ,&nbsp;Magdalena Graczyk MD ,&nbsp;Jerzy Jankau MD, PhD","doi":"10.1016/j.jss.2025.12.012","DOIUrl":"10.1016/j.jss.2025.12.012","url":null,"abstract":"<div><h3>Introduction</h3><div>As risk factors of free flap loss related to the patient are unmodifiable, proper perioperative protocol is crucial. Perioperative blood transfusion (PBT) may be associated with an increased risk of medical complications, prolonged length of stay, and an increased risk of surgical site infection. The question of this study is whether PBT in free flap reconstructions may be associated with flap failure and anastomosis thrombosis.</div></div><div><h3>Methods</h3><div>Preferred Reporting Items Systematic Review and Meta-Analysis protocol was used, and the literature search was performed on Pubmed, Embase, and Scopus. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. Meta-analysis was performed.</div></div><div><h3>Results</h3><div>Fifteen articles were enrolled in the study, representing 7871 patients. Statistically significant risk ratios (RRs) were observed, indicating PBT was associated with an increased risk of both anastomosis thrombosis (RR 1.71, 95% confidence interval [CI] 1.12-2.59) and flap failure (RR 2.02, 95% CI 1.25-3.26). Further analysis led to the division of three subgroups due to the operation site. For breast reconstruction, the RR was 7.96 (95% CI 4.00-15.81) for flap failure and 2.94 (95% CI 1.88-4.61) for anastomosis thrombosis. For head and neck reconstruction, the RR were 1.22 (95% CI 0.86-1.73) and 1.02 (95% CI 0.59-1.75), respectively. In the mixed group, RR was 2.23 (95% CI 1.06-4.58) for flap failure and 1.23 (95% CI 0.59-2.56) for anastomosis thrombosis.</div></div><div><h3>Conclusions</h3><div>Although overall PBT is associated with a higher incidence of flap necrosis and anastomosis thrombosis, this association is statistically significant only in breast reconstruction. Further prospective studies focusing on specific flap surgery types are warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 14-24"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911837","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":"Reimaging High-grade Blunt Hepatic Injuries: Revisiting the Role of Routine Surveillance in Modern Nonoperative Management","authors":"Caitlyn Braschi MD ,&nbsp;Paul Brosnihan MD ,&nbsp;Lara Senekjian MD ,&nbsp;Philip Brennan MD ,&nbsp;Janelle Cyprich MD ,&nbsp;Jessica A. Keeley MD","doi":"10.1016/j.jss.2025.12.016","DOIUrl":"10.1016/j.jss.2025.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic liver injuries are associated with significant morbidity and mortality. The value of routine postinjury imaging surveillance is uncertain, as is whether this value increases with higher grade injuries.</div></div><div><h3>Methods</h3><div>A multicenter retrospective review was performed at two level I trauma centers from 2015 to 2020. Adults with American Association for the Surgery of Trauma grades II-V liver lacerations following blunt trauma were included. Reimaging patterns, need for reintervention, and 30-d outcomes of grades II/III injuries (“lower grade liver injuries,” LGLI) were compared to grades IV/V (“higher grade liver injuries,” HGLI).</div></div><div><h3>Results</h3><div>A total of 229 patients were included, 69.9% with LGLI and 30.1% with HGLI. Overall mortality was 15.3%. HGLI were more likely to be reimaged (69.2% <em>versus</em> 32.7%, <em>P</em> &lt; 0.001). Comparing lower grade to higher grade injuries, there was no difference in time to reimaging (4 <em>versus</em> 4 d, <em>P</em> = 0.523). Patients with HGLI had more liver-specific complications (23.1% <em>versus</em> 2.0%, <em>P</em> &lt; 0.001) and required more reinterventions (19.2% <em>versus</em> 2.6%, <em>P</em> &lt; 0.001). Length of stay was longer (median 6 (interquartile range 4-13) <em>versus</em> median 10 (interquartile range 5-21), <em>P</em> = 0.044), and 30-d mortality was higher (27.5% <em>versus</em> 10.0%, <em>P</em> &lt; 0.001) for HGLI. In multivariate analysis controlling for extrahepatic injuries, HGLI (odds ratio 3.10, 95% confidence interval 1.38-6.94, <em>P</em> = 0.006) and initial operative or Interventional Radiology management (odds ratio, 4.66; 95% confidence interval, 2.18-9.99, <em>P</em> &lt; 0.001) were independently associated with reimaging.</div></div><div><h3>Conclusions</h3><div>A majority of patients with higher grade liver injuries undergo repeat imaging in the first several days postinjury and 19% require reintervention. Given the high rate of reintervention, routine imaging surveillance should be considered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 318-322"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035045","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":"Survival and Risk Factors in Interpersonal Injuries: A Secondary Ecosocial Study","authors":"Juan Sanjuan MD ,&nbsp;Alberto Federico García MD, MSc ,&nbsp;María Isabel Gutiérrez-Martínez MD, MSc, PhD ,&nbsp;Gustavo Adolfo Villegas-Gomez MD","doi":"10.1016/j.jss.2025.12.014","DOIUrl":"10.1016/j.jss.2025.12.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Interpersonal injuries are a major public health concern disproportionately affecting young men. This study evaluated survival and risk factors in patients with interpersonal injuries, by applying Krieger's ecosocial model to integrate biological and structural determinants.</div></div><div><h3>Methods</h3><div>A secondary analysis was conducted using data from an observational cohort of trauma patients at four referral centers in Cali, Colombia. Patients with interpersonal injuries were classified by mechanism. Macro-level factors (sociodemographics, insurance, and institutional complexity) and microlevel factors (physiology and anatomical severity) were analyzed with Cox regression.</div></div><div><h3>Results</h3><div>Of 856 trauma patients, 539 (61.5%) sustained interpersonal injuries. Crude mortality was 12.8%, with half of the deaths within 72 h. In multivariate models, undetectable systolic blood pressure (hazard ratio [HR], 106.3; 95% confidence interval [CI], 2.97–3799.9; <em>P</em> = 0.011) and Glasgow Coma Scale score of 3 (HR, 29.7, 95% CI, 8.1–108.6; <em>P</em> &lt; 0.001) were strongly linked to mortality. Severe traumatic brain injury (Abbreviated Injury Scale (AIS) 5; HR, 7.6; 95% CI, 1.4–39.8; <em>P</em> = 0.017) and abdominal trauma (AIS 5; HR, 11.5, 95% CI, 2.1–64.3; <em>P</em> = 0.005) increased risk, while thoracic trauma (AIS 3; HR, 0.25; 95% CI, 0.07–0.91; <em>P</em> = 0.035) was protective. Treatment at high-complexity hospitals reduced mortality (HR, 0.09; 95% CI, 0.02–0.46; <em>P</em> = 0.004). Patients with no or subsidized insurance had lower mortality than those in the contributory regime, suggesting structural determinants shape survival.</div></div><div><h3>Conclusions</h3><div>Trauma survival depends on both physiological severity and structural factors. Strengthening trauma systems and reducing inequities are essential, with the ecosocial framework offering a valuable lens for trauma epidemiology and policy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 75-88"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927869","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":"Effects of Local and Systematic Administration of Adipose Tissue–Derived Stem Cells to Intestinal Anastomosis in Intestinal Ishemic Rerfusion Injury: Ani̇mal Experi̇ment Model","authors":"İbrahim Doğan MD ,&nbsp;Bahar Kartal PhD ,&nbsp;Bülent Cavit Yüksel MD ,&nbsp;Umut Fırat Turan MD ,&nbsp;Metin Bozkaya MD ,&nbsp;Gökçe Yağmur Summak ,&nbsp;Ömür Besbinar PhD ,&nbsp;Açelya Yilmazer PhD ,&nbsp;Sadettin Er MD","doi":"10.1016/j.jss.2025.12.023","DOIUrl":"10.1016/j.jss.2025.12.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Intestinal ischemia-reperfusion (IR) injury compromises anastomotic healing and may weaken anastomotic integrity. Adipose tissue–derived stem cells (AD-SCs) have been shown to enhance tissue regeneration through angiogenic and anti-ischemic effects. This study aimed to evaluate the impact of local and systemic AD-SC administration on anastomotic healing and strength following intestinal IR injury using histopathological parameters and bursting pressure measurements.</div></div><div><h3>Methods</h3><div>Thirty male Wistar Albino rats were randomly assigned to three groups (<em>n</em> = 10 each): control, local AD-SC, and systemic AD-SC. IR injury was induced by clamping the superior mesenteric artery, followed by intestinal resection and anastomosis. Local or systemic AD-SCs (1 × 10⁶ cells in 1.5 mL phosphate-buffered saline) were administered according to group allocation. On postoperative day 7, serum hydroxyproline levels, bursting pressures, and semiquantitative histological scores (ischemic necrosis, vascular proliferation, re-epithelialization, and collagen density) were assessed. Ordinal histological outcomes were analyzed using Kruskal–Wallis tests with Dunn's post hoc comparisons.</div></div><div><h3>Results</h3><div>Six animals died before the end point, leaving 24 rats for analysis. Bursting pressures and serum hydroxyproline levels did not differ significantly among groups. However, systemic AD-SC administration significantly improved all histological parameters compared with the control group, exhibiting lower ischemic necrosis and higher vascular proliferation, re-epithelialization, and collagen density (<em>P</em> &lt; 0.05 for each). Local AD-SCs produced intermediate improvements but did not differ significantly from controls in some parameters. Effect sizes indicated moderate to very large differences favoring systemic administration.</div></div><div><h3>Conclusions</h3><div>Systemic AD-SC administration enhanced multiple histological markers of anastomotic healing following intestinal IR injury, whereas local administration produced more modest effects. Although bursting pressures and serum hydroxyproline levels did not significantly differ, the histopathological findings suggest that systemic AD-SCs may provide a broader therapeutic benefit in promoting anastomotic integrity in ischemic bowel conditions. Further experimental studies incorporating direct leak outcomes are warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 290-299"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal of Surgical Research","authors":"","doi":"10.1016/S0022-4804(26)00039-9","DOIUrl":"10.1016/S0022-4804(26)00039-9","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Page iii"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188647","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}