Pub Date : 2026-01-12DOI: 10.1016/j.jss.2025.12.005
Ilse Torres Ruiz MD, Cuneyt Koksoy MD, Zachary S. Pallister MD, Ramyar S. Gilani MD, Joseph L. Mills MD, Jayer Chung MD, MSc
<div><h3>Introduction</h3><div>Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease) and can cause profound psychosocial distress, including depression. Depression in CLTI patients is often underdiagnosed and its impact on clinical outcomes remains unclear. This study aims to quantify the prevalence of depression in CLTI patients and quantify its impact on outcomes.</div></div><div><h3>Methods</h3><div>A single-center, retrospective analysis was conducted from December 2010 to January 2024. Demographics, comorbidities, ischemia metrics, limb-salvage, and survival were collected and analyzed.</div></div><div><h3>Results</h3><div>Over 14 y, 801 CLTI patients (median age, 66.7; interquartile range, 59.3-74.3 y; 62.5% male) underwent 1882 revascularizations. The first episode of revascularization procedures included 697 endovascular, 241 open surgical, and 56 hybrid procedures, while 73 extremities were managed without revascularization. During the follow-up, 288 (36.0%) patients underwent minor amputations and 156 (19.5%) underwent major amputations. A total of 255 (31.8%) patients had a history of depression. Binary logistic regression modeling revealed that age (odds ratio [OR], 0.96, 95% confidence interval [CI], 0.95-0.97), female sex (OR, 2.1; 95% CI, 1.5-2.9), congestive heart failure (OR, 1.6: 95% CI, 1.2-2.2), hypothyroidism (OR, 1.6; 95% CI, 1.2-2.8), and active smoking (OR, 1.6; 95% CI, 1.2-2.2) were independently associated with depression. At a 20-mo follow-up, depressed patients had higher rates of major amputation (25.5% <em>versus</em> 16.7%; <em>P</em> = 0.003), lower Kaplan–Meier-estimated amputation-free survival (OR, 49.3; 95% CI, 42.7-55.9 mo <em>versus</em> 70.2, 95% CI, 64.1-76.6 mo; <em>P</em> < 0.001), and lower overall Kaplan–Meier-estimated survival compared to nondepressed patients (OR, 76.9; 95% CI, 65.5-88.5 <em>versus</em> OR, 87.9; 95% CI, 81.9-93.9 mo, <em>P</em> = 0.03). There were no significant differences between depressed and nondepressed patients in baseline symptoms, tissue loss, osteomyelitis, total number of procedures, reintervention rates, and bypass patency. However, depressed patients had higher percentages in Wound, Ischemia, and foot Infection (WIfI) classification ischemia grade I-0 (2.4% <em>versus</em> 4.9%, <em>P</em> < 0.05) and I-2 (11.8% <em>versus</em> 17.9%, <em>P</em> < 0.01), but a lower percentage in grade I-3 (69.7% <em>versus</em> 59.8%, <em>P</em> = 0.001). Depressed patients also had higher percentages in WIfI clinical stage 1 (5.1% <em>versus</em> 9.8%, <em>P</em> < 0.01) and lower in stage 3 (23.2% <em>versus</em> 16.5%, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Depression is prevalent in almost one-third of CLTI patients and is associated with an increased risk of limb-loss. These findings underscore the opportunity for regimented depression screening and integrated psychosocial care in managing CLTI patients
{"title":"Association of Depression With Inferior Amputation-free Survival in Chronic Limb-threatening Ischemia","authors":"Ilse Torres Ruiz MD, Cuneyt Koksoy MD, Zachary S. Pallister MD, Ramyar S. Gilani MD, Joseph L. Mills MD, Jayer Chung MD, MSc","doi":"10.1016/j.jss.2025.12.005","DOIUrl":"10.1016/j.jss.2025.12.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease) and can cause profound psychosocial distress, including depression. Depression in CLTI patients is often underdiagnosed and its impact on clinical outcomes remains unclear. This study aims to quantify the prevalence of depression in CLTI patients and quantify its impact on outcomes.</div></div><div><h3>Methods</h3><div>A single-center, retrospective analysis was conducted from December 2010 to January 2024. Demographics, comorbidities, ischemia metrics, limb-salvage, and survival were collected and analyzed.</div></div><div><h3>Results</h3><div>Over 14 y, 801 CLTI patients (median age, 66.7; interquartile range, 59.3-74.3 y; 62.5% male) underwent 1882 revascularizations. The first episode of revascularization procedures included 697 endovascular, 241 open surgical, and 56 hybrid procedures, while 73 extremities were managed without revascularization. During the follow-up, 288 (36.0%) patients underwent minor amputations and 156 (19.5%) underwent major amputations. A total of 255 (31.8%) patients had a history of depression. Binary logistic regression modeling revealed that age (odds ratio [OR], 0.96, 95% confidence interval [CI], 0.95-0.97), female sex (OR, 2.1; 95% CI, 1.5-2.9), congestive heart failure (OR, 1.6: 95% CI, 1.2-2.2), hypothyroidism (OR, 1.6; 95% CI, 1.2-2.8), and active smoking (OR, 1.6; 95% CI, 1.2-2.2) were independently associated with depression. At a 20-mo follow-up, depressed patients had higher rates of major amputation (25.5% <em>versus</em> 16.7%; <em>P</em> = 0.003), lower Kaplan–Meier-estimated amputation-free survival (OR, 49.3; 95% CI, 42.7-55.9 mo <em>versus</em> 70.2, 95% CI, 64.1-76.6 mo; <em>P</em> < 0.001), and lower overall Kaplan–Meier-estimated survival compared to nondepressed patients (OR, 76.9; 95% CI, 65.5-88.5 <em>versus</em> OR, 87.9; 95% CI, 81.9-93.9 mo, <em>P</em> = 0.03). There were no significant differences between depressed and nondepressed patients in baseline symptoms, tissue loss, osteomyelitis, total number of procedures, reintervention rates, and bypass patency. However, depressed patients had higher percentages in Wound, Ischemia, and foot Infection (WIfI) classification ischemia grade I-0 (2.4% <em>versus</em> 4.9%, <em>P</em> < 0.05) and I-2 (11.8% <em>versus</em> 17.9%, <em>P</em> < 0.01), but a lower percentage in grade I-3 (69.7% <em>versus</em> 59.8%, <em>P</em> = 0.001). Depressed patients also had higher percentages in WIfI clinical stage 1 (5.1% <em>versus</em> 9.8%, <em>P</em> < 0.01) and lower in stage 3 (23.2% <em>versus</em> 16.5%, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Depression is prevalent in almost one-third of CLTI patients and is associated with an increased risk of limb-loss. These findings underscore the opportunity for regimented depression screening and integrated psychosocial care in managing CLTI patients","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 146-153"},"PeriodicalIF":1.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966330","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 : 2026-01-09DOI: 10.1016/j.jss.2025.12.018
James L. Galloway MD , Vivi W. Chen MD, MPH , Jennifer Kramer PhD, MPH , Tracey Rosen MSPH , Yongquan Dong MS , Peter A. Richardson PhD , Nader N. Massarweh MD, MPH
Introduction
Manually abstracted variables are considered the gold standard within national surgical quality improvement (QI) programs. However, because of the resources associated with manual data abstraction, opportunities to automate data collection could have numerous benefits for surgical QI. The goal of this study is to describe the accuracy and concordance of Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP) electronic health record (EHR) variable correlates (derived using EHR data) when compared to manually abstracted VASQIP variables.
Methods
This was a national, cross-sectional analysis of VASQIP and VA Corporate Data Warehouse (i.e., EHR) data (2016-2020). EHR-derived VASQIP variable correlates were created from Corporate Data Warehouse and compared to manually abstracted VASQIP variables for the same cases. The primary measure of agreement was Cohen's kappa. Sensitivity, specificity, positive predictive value, and negative predictive value were also calculated for each variable with addition of exact match proportion for lab variables. Strong agreement was considered kappa ≥80%.
Results
Among 533,164 cases across 113 hospitals for 429,163 unique patients, data were evaluated for five variable domains (race and ethnicity, preoperative risk factors, intraoperative factors, labs, and postoperative complications). Kappa for race and ethnicity ranged from 91.1 to 99.5%, with a median of 98.1% (IQR, 95.3-99.5%). Preoperative risk factors ranged from −0.1 to 83.0%, with a median of 28.6% (interquartile range [IQR], 12.7-53.9%). Preoperative labs ranged from 72.2 to 95.9% with a median of 91.9% (IQR, 89.9–93.3%). Intraoperative factors ranged from 0.0 to 99.5%, with a median of 93.9% (IQR, 9.9-97.3%). Postoperative complications ranged from 3.9 to 53.2%, with a median of 15.1% (IQR, 7.1-29.6%).
Conclusions:
Apart from postoperative complications, data collection for many VASQIP variables could potentially be automated using EHR-derived correlates with a high level of accuracy. This could minimize the resources associated with manual data collection and increase the timeliness and robustness of surgical QI programs.
{"title":"Manually Abstracted versus Electronic Health Record Data for Surgical Quality Improvement","authors":"James L. Galloway MD , Vivi W. Chen MD, MPH , Jennifer Kramer PhD, MPH , Tracey Rosen MSPH , Yongquan Dong MS , Peter A. Richardson PhD , Nader N. Massarweh MD, MPH","doi":"10.1016/j.jss.2025.12.018","DOIUrl":"10.1016/j.jss.2025.12.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Manually abstracted variables are considered the gold standard within national surgical quality improvement (QI) programs. However, because of the resources associated with manual data abstraction, opportunities to automate data collection could have numerous benefits for surgical QI. The goal of this study is to describe the accuracy and concordance of Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP) electronic health record (EHR) variable correlates (derived using EHR data) when compared to manually abstracted VASQIP variables.</div></div><div><h3>Methods</h3><div>This was a national, cross-sectional analysis of VASQIP and VA Corporate Data Warehouse (i.e., EHR) data (2016-2020). EHR-derived VASQIP variable correlates were created from Corporate Data Warehouse and compared to manually abstracted VASQIP variables for the same cases. The primary measure of agreement was Cohen's kappa. Sensitivity, specificity, positive predictive value, and negative predictive value were also calculated for each variable with addition of exact match proportion for lab variables. Strong agreement was considered kappa ≥80%.</div></div><div><h3>Results</h3><div>Among 533,164 cases across 113 hospitals for 429,163 unique patients, data were evaluated for five variable domains (race and ethnicity, preoperative risk factors, intraoperative factors, labs, and postoperative complications). Kappa for race and ethnicity ranged from 91.1 to 99.5%, with a median of 98.1% (IQR, 95.3-99.5%). Preoperative risk factors ranged from −0.1 to 83.0%, with a median of 28.6% (interquartile range [IQR], 12.7-53.9%). Preoperative labs ranged from 72.2 to 95.9% with a median of 91.9% (IQR, 89.9–93.3%). Intraoperative factors ranged from 0.0 to 99.5%, with a median of 93.9% (IQR, 9.9-97.3%). Postoperative complications ranged from 3.9 to 53.2%, with a median of 15.1% (IQR, 7.1-29.6%).</div></div><div><h3>Conclusions:</h3><div>Apart from postoperative complications, data collection for many VASQIP variables could potentially be automated using EHR-derived correlates with a high level of accuracy. This could minimize the resources associated with manual data collection and increase the timeliness and robustness of surgical QI programs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 136-145"},"PeriodicalIF":1.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927330","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 : 2026-01-09DOI: 10.1016/j.jss.2025.12.020
Ebbe Juul Kragbak BScMed , Andreas Weise Mucha MD , Pieter de Heer MD, PhD , Paul Morten Mau-Sørensen MD, PhD , Nikolaj Nerup MD, PhD , Michael Patrick Achiam MD, PhD, DMSc
Introduction
Curative treatment of gastric cancer requires surgery combined with perioperative chemotherapy. Textbook outcome (TO) and textbook oncological outcome (TOO) have gained increasing attention as composite measures representing an ideal surgical and oncological course. We aimed to evaluate the rates of TO and TOO after gastrectomy and their association with long-term outcomes.
Materials and Methods
A single-center retrospective observational study was conducted. TO was defined as achieving all of the following: macroscopic radical resection, R0 resection, removal of ≥15 lymph nodes, absence of severe complications (Clavien–Dindo grade >II), no intraoperative complications, hospital stay <21 days, no 30-day mortality, and no unplanned intensive care unit admission, reintervention, or readmission within 30 days after surgery. TOO was defined as TO plus adherence to guideline-compliant chemotherapy. Univariate analyses and multivariable logistic regression were used to identify predictors for TO and TOO. Associations between TO, TOO, and long-term outcomes were analyzed using Kaplan–Meier and Cox regression.
Results
We included 141 patients. TO was achieved in 56.7% and TOO in 25.9% of patients. TO was significantly associated with improved overall survival (hazard ratio: 0.31, P < 0.001) and recurrence-free survival (hazard ratio: 0.31, P < 0.001). TOO was not significantly associated with improved survival outcomes. The most common reasons for failing to achieve TO were severe complications (24.8%), reintervention (22.0%), and readmission (17.7%).
Conclusions
This study found TO and TOO rates of 56.7% and 25.9%, suggesting quality of care on an international level. TO was significantly associated with long-term survival, supporting its future use as an important quality metric.
{"title":"Textbook Outcome After Gastrectomy is Associated With Improved Survival: An Observational Study","authors":"Ebbe Juul Kragbak BScMed , Andreas Weise Mucha MD , Pieter de Heer MD, PhD , Paul Morten Mau-Sørensen MD, PhD , Nikolaj Nerup MD, PhD , Michael Patrick Achiam MD, PhD, DMSc","doi":"10.1016/j.jss.2025.12.020","DOIUrl":"10.1016/j.jss.2025.12.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Curative treatment of gastric cancer requires surgery combined with perioperative chemotherapy. Textbook outcome (TO) and textbook oncological outcome (TOO) have gained increasing attention as composite measures representing an ideal surgical and oncological course. We aimed to evaluate the rates of TO and TOO after gastrectomy and their association with long-term outcomes.</div></div><div><h3>Materials and Methods</h3><div>A single-center retrospective observational study was conducted. TO was defined as achieving all of the following: macroscopic radical resection, R0 resection, removal of ≥15 lymph nodes, absence of severe complications (Clavien–Dindo grade >II), no intraoperative complications, hospital stay <21 days, no 30-day mortality, and no unplanned intensive care unit admission, reintervention, or readmission within 30 days after surgery. TOO was defined as TO plus adherence to guideline-compliant chemotherapy. Univariate analyses and multivariable logistic regression were used to identify predictors for TO and TOO. Associations between TO, TOO, and long-term outcomes were analyzed using Kaplan–Meier and Cox regression.</div></div><div><h3>Results</h3><div>We included 141 patients. TO was achieved in 56.7% and TOO in 25.9% of patients. TO was significantly associated with improved overall survival (hazard ratio: 0.31, <em>P</em> < 0.001) and recurrence-free survival (hazard ratio: 0.31, <em>P</em> < 0.001). TOO was not significantly associated with improved survival outcomes. The most common reasons for failing to achieve TO were severe complications (24.8%), reintervention (22.0%), and readmission (17.7%).</div></div><div><h3>Conclusions</h3><div>This study found TO and TOO rates of 56.7% and 25.9%, suggesting quality of care on an international level. TO was significantly associated with long-term survival, supporting its future use as an important quality metric.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 126-135"},"PeriodicalIF":1.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927796","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}
Musculoskeletal disorders (MSDs) are common among minimally invasive surgeons, with increased rates of pain primarily in the upper body. This study aims to evaluate the impact of online ergonomic education modules on the rate of MSDs among minimally invasive surgeons.
Materials and Methods
Minimally invasive surgeons from nine surgical subspecialties at a single institution were recruited to participate in February 2024. The initial survey identified demographics and MSD prevalence. One month later, in March 2024, participants received online ergonomic modules, followed by a secondary survey in April 2024.
Results
A total of 23 out of 75 minimally invasive focused surgeons (30.7%) from seven surgical subspecialties participated in the initial survey: 12 males (52.2%), mean age 45 y, 11.4 mean years in practice, and practice breakdowns of 45.6% robotic, 37% laparoscopic, 31.1% open, and 29.5% natural orifice surgery. 65.2% of surgeons reported MSDs most commonly in the shoulder (65.1%) and upper back (59.1%). Among participants, 47.8% of surgeons had not received prior ergonomic education or implemented ergonomic change in the operating room. Six surgeons (26.1%) participated in the secondary survey, representing five subspecialties. There was no significant change in MSD rates for these surgeons (66.7% premodules versus 66.7% postmodules). In total, 66.7% surgeons made immediate ergonomic changes after the modules, and 100% reported they would endorse the modules to colleagues.
Conclusions
Minimally invasive surgeons experience high prevalence of MSDs. Although the online modules did not significantly reduce MSD rates immediately, surgeons did implement ergonomic modifications and unanimously recommended the modules. This emphasizes the need for broad and recurrent ergonomic initiatives for long-term benefit.
{"title":"Impact of Online Ergonomic Education on Musculoskeletal Disorders Among Minimally Invasive Surgeons","authors":"Lauren Hilt BS, Brianne Sherman BS, Madelyn Erdman BS, Rana M. Higgins MD","doi":"10.1016/j.jss.2025.12.007","DOIUrl":"10.1016/j.jss.2025.12.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Musculoskeletal disorders (MSDs) are common among minimally invasive surgeons, with increased rates of pain primarily in the upper body. This study aims to evaluate the impact of online ergonomic education modules on the rate of MSDs among minimally invasive surgeons.</div></div><div><h3>Materials and Methods</h3><div>Minimally invasive surgeons from nine surgical subspecialties at a single institution were recruited to participate in February 2024. The initial survey identified demographics and MSD prevalence. One month later, in March 2024, participants received online ergonomic modules, followed by a secondary survey in April 2024.</div></div><div><h3>Results</h3><div>A total of 23 out of 75 minimally invasive focused surgeons (30.7%) from seven surgical subspecialties participated in the initial survey: 12 males (52.2%), mean age 45 y, 11.4 mean years in practice, and practice breakdowns of 45.6% robotic, 37% laparoscopic, 31.1% open, and 29.5% natural orifice surgery. 65.2% of surgeons reported MSDs most commonly in the shoulder (65.1%) and upper back (59.1%). Among participants, 47.8% of surgeons had not received prior ergonomic education or implemented ergonomic change in the operating room. Six surgeons (26.1%) participated in the secondary survey, representing five subspecialties. There was no significant change in MSD rates for these surgeons (66.7% premodules <em>versus</em> 66.7% postmodules). In total, 66.7% surgeons made immediate ergonomic changes after the modules, and 100% reported they would endorse the modules to colleagues.</div></div><div><h3>Conclusions</h3><div>Minimally invasive surgeons experience high prevalence of MSDs. Although the online modules did not significantly reduce MSD rates immediately, surgeons did implement ergonomic modifications and unanimously recommended the modules. This emphasizes the need for broad and recurrent ergonomic initiatives for long-term benefit.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 110-119"},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927868","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 : 2026-01-08DOI: 10.1016/j.jss.2025.12.013
Tori Hester MPH , Selena J. An MD, MSPH, MA , Jotham Gondwe , Anthony Charles MD, MPH , Jared Gallaher MD, MPH
Introduction
Mass casualty incidents (MCIs) easily overwhelm hospitals in resource-limited settings. Unfortunately, limited data exists on this problem, and few hospitals are prepared to deal with these events. We hypothesized that excessive patient volume would be associated with worse outcomes at a tertiary hospital in Lilongwe, Malawi, and that these data would provide a foundation for targeted interventions and improvement.
Materials and methods
We retrospectively analyzed the Kamuzu Central Hospital Trauma Registry from 2010 to 2021. Using arrival data, we characterized patient co-arrival volume trends. We a priori set the mass casualty threshold at 2 standard deviations above the mean number of patient co-arrivals in 1 h. We performed bivariate and multivariable logistic regression analyses to investigate the relationship between mortality and the number of co-arrivals above the threshold.
Results
A total of 161,383 patients were analyzed. The median age was 24 y, and 73.8% were male. Crude mortality was 2.4%. A total of 3007 patients (1.9%) presented above the mass casualty threshold of 11 patients. Mortality for this group was 4.2% compared to 2.4% for those below the threshold. Those who have an arrival status above the MCI threshold of 11 patient arrivals in 1 h have 1.70 (95% confidence interval: 1.36, 2.12, P value < 0.001) times the odds of mortality than patients below the MCI threshold when adjusting for sex, age, primary injury type, and arrival time.
Conclusions
Overwhelming and sudden patient volume is associated with higher odds of mortality in a resource-limited setting. Our results will inform a mass casualty protocol to maximize efficient resource use in similar settings.
{"title":"Establishing a Mass Casualty Threshold in a Resource-Limited Hospital Setting: A Retrospective Analysis of a Trauma Registry From Malawi","authors":"Tori Hester MPH , Selena J. An MD, MSPH, MA , Jotham Gondwe , Anthony Charles MD, MPH , Jared Gallaher MD, MPH","doi":"10.1016/j.jss.2025.12.013","DOIUrl":"10.1016/j.jss.2025.12.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Mass casualty incidents (MCIs) easily overwhelm hospitals in resource-limited settings. Unfortunately, limited data exists on this problem, and few hospitals are prepared to deal with these events. We hypothesized that excessive patient volume would be associated with worse outcomes at a tertiary hospital in Lilongwe, Malawi, and that these data would provide a foundation for targeted interventions and improvement.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed the Kamuzu Central Hospital Trauma Registry from 2010 to 2021. Using arrival data, we characterized patient co-arrival volume trends. We <em>a priori</em> set the mass casualty threshold at 2 standard deviations above the mean number of patient co-arrivals in 1 h. We performed bivariate and multivariable logistic regression analyses to investigate the relationship between mortality and the number of co-arrivals above the threshold.</div></div><div><h3>Results</h3><div>A total of 161,383 patients were analyzed. The median age was 24 y, and 73.8% were male. Crude mortality was 2.4%. A total of 3007 patients (1.9%) presented above the mass casualty threshold of 11 patients. Mortality for this group was 4.2% compared to 2.4% for those below the threshold. Those who have an arrival status above the MCI threshold of 11 patient arrivals in 1 h have 1.70 (95% confidence interval: 1.36, 2.12, <em>P</em> value < 0.001) times the odds of mortality than patients below the MCI threshold when adjusting for sex, age, primary injury type, and arrival time.</div></div><div><h3>Conclusions</h3><div>Overwhelming and sudden patient volume is associated with higher odds of mortality in a resource-limited setting. Our results will inform a mass casualty protocol to maximize efficient resource use in similar settings.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 89-97"},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927797","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 : 2026-01-08DOI: 10.1016/j.jss.2025.12.014
Juan Sanjuan MD , Alberto Federico García MD, MSc , María Isabel Gutiérrez-Martínez MD, MSc, PhD , Gustavo Adolfo Villegas-Gomez MD
Introduction
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.
Methods
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.
Results
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; P = 0.011) and Glasgow Coma Scale score of 3 (HR, 29.7, 95% CI, 8.1–108.6; P < 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; P = 0.017) and abdominal trauma (AIS 5; HR, 11.5, 95% CI, 2.1–64.3; P = 0.005) increased risk, while thoracic trauma (AIS 3; HR, 0.25; 95% CI, 0.07–0.91; P = 0.035) was protective. Treatment at high-complexity hospitals reduced mortality (HR, 0.09; 95% CI, 0.02–0.46; P = 0.004). Patients with no or subsidized insurance had lower mortality than those in the contributory regime, suggesting structural determinants shape survival.
Conclusions
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.
人际伤害是影响年轻男子的主要公共卫生问题。本研究通过应用Krieger的生态社会模型来整合生物学和结构决定因素，评估了人际伤害患者的生存和风险因素。方法采用来自哥伦比亚卡利四个转诊中心的创伤患者观察队列数据进行二次分析。人际伤害按机制分类。采用Cox回归分析宏观因素（社会人口统计学、保险和制度复杂性）和微观因素（生理和解剖严重性）。结果856例外伤患者中有539例（61.5%）存在人际关系损伤。粗死亡率为12.8%，其中一半在72小时内死亡。在多变量模型中，无法检测到的收缩压（风险比[HR]， 106.3； 95%置信区间[CI]， 2.97-3799.9; P = 0.011）和格拉斯哥昏迷量表评分3 （HR, 29.7, 95% CI, 8.1-108.6; P < 0.001）与死亡率密切相关。严重创伤性脑损伤（AIS）；人力资源,7.6;95% ci, 1.4-39.8；P = 0.017)和腹部创伤（AIS 5； HR, 11.5, 95% CI, 2.1-64.3; P = 0.005）增加了风险，而胸部创伤（AIS 3； HR, 0.25; 95% CI, 0.07-0.91; P = 0.035）具有保护作用。高复杂性医院的治疗降低了死亡率（HR, 0.09; 95% CI, 0.02-0.46; P = 0.004）。没有保险或补贴保险的患者死亡率低于有缴费制度的患者，这表明结构决定因素影响了患者的生存。结论创伤存活取决于生理严重程度和结构因素。加强创伤系统和减少不公平现象至关重要，生态社会框架为创伤流行病学和政策提供了宝贵的视角。
{"title":"Survival and Risk Factors in Interpersonal Injuries: A Secondary Ecosocial Study","authors":"Juan Sanjuan MD , Alberto Federico García MD, MSc , María Isabel Gutiérrez-Martínez MD, MSc, PhD , 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> < 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":"2026-01-08","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}
Surgical randomized controlled trials (RCTs) are increasingly conducted in complex, multicenter contexts. Despite growing emphasis on research transparency and rigor, concerns remain regarding the methodological and ethical standards of such trials. Cooperative groups (CGs), well-established in oncology research, may play a role in improving trial quality in surgery—a domain where their influence remains underexplored. This scoping review aims to map the methodological and ethical quality of phase III surgical RCTs published between 2016 and 2020 in international surgical journals, with a focus on the potential impact of CG involvement.
Material and methods
We systematically searched ten major surgical journals for RCTs published between January 2016 and December 2020. Eligible trials were assessed using the Jadad scale (methodological quality) and the Berdeu score (ethical quality). We recorded study characteristics including sample size, funding source, multicenter design, and presence of a CG.
Results
A total of 520 surgical RCTs were included. The mean Jadad score was 10.0 (±1.54) and the mean Berdeu score was 0.8 (±0.11). Only 50 trials (10%) involved a CG. These trials showed a trend toward higher methodological quality (mean Jadad 10.4 versus 9.97; P = 0.0593) and more frequent inclusion of quality-of-life assessments (28% versus 13%; P = 0.0056). Public funding was significantly more common in CG-led trials (56% versus 33%; P < 0.001).
Conclusions
This scoping review highlights that CG involvement in surgical RCTs is still limited but may be associated with improved methodological practices and broader outcome measures, such as quality of life. These findings suggest that greater involvement of CGs could strengthen research infrastructure and make surgical trials more patient-centered.
{"title":"A Scoping Review Focused on Cooperative Group Involvement in Surgical Randomized Controlled Trials","authors":"Eloise Papet MD , Grégoire Moutel MD, PhD , Jean Pinson MD , Edouard Roussel MD , Valérie Bridoux MD, PhD , Jean-Jacques Tuech MD, PhD","doi":"10.1016/j.jss.2025.12.008","DOIUrl":"10.1016/j.jss.2025.12.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical randomized controlled trials (RCTs) are increasingly conducted in complex, multicenter contexts. Despite growing emphasis on research transparency and rigor, concerns remain regarding the methodological and ethical standards of such trials. Cooperative groups (CGs), well-established in oncology research, may play a role in improving trial quality in surgery—a domain where their influence remains underexplored. This scoping review aims to map the methodological and ethical quality of phase III surgical RCTs published between 2016 and 2020 in international surgical journals, with a focus on the potential impact of CG involvement.</div></div><div><h3>Material and methods</h3><div>We systematically searched ten major surgical journals for RCTs published between January 2016 and December 2020. Eligible trials were assessed using the Jadad scale (methodological quality) and the Berdeu score (ethical quality). We recorded study characteristics including sample size, funding source, multicenter design, and presence of a CG.</div></div><div><h3>Results</h3><div>A total of 520 surgical RCTs were included. The mean Jadad score was 10.0 (±1.54) and the mean Berdeu score was 0.8 (±0.11). Only 50 trials (10%) involved a CG. These trials showed a trend toward higher methodological quality (mean Jadad 10.4 <em>versus</em> 9.97; <em>P</em> = 0.0593) and more frequent inclusion of quality-of-life assessments (28% <em>versus</em> 13%; <em>P</em> = 0.0056). Public funding was significantly more common in CG-led trials (56% <em>versus</em> 33%; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>This scoping review highlights that CG involvement in surgical RCTs is still limited but may be associated with improved methodological practices and broader outcome measures, such as quality of life. These findings suggest that greater involvement of CGs could strengthen research infrastructure and make surgical trials more patient-centered.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 120-125"},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927798","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 : 2026-01-08DOI: 10.1016/j.jss.2025.12.021
Yang Yang MS , Jun-Chao Liu BS , Zhen-Kui Liu MS , Yu-Ping Zhang PhD , Min Xi BS , Hai-Ning Zheng MS , Jing Wang PhD , Zhen-Ao Zhao PhD , Chun-Yu Niu PhD , Zi-Gang Zhao PhD
Introduction
Vascular hyporeactivity contributes to a high mortality rate in sepsis. Resveratrol (Res) exhibits anti-inflammatory properties and improves vascular reactivity in septic animals. However, the mechanism of action of Res in sepsis-induced vascular hyporeactivity is not fully understood.
Methods
A rat model of sepsis was established by intraperitoneal injection of fecal filtrate. Rats were divided into sham, sham + Res, sepsis, and sepsis + Res groups. Hemodynamic parameters, intestinal microcirculation (assessed by laser speckle contrast imaging and in vivo microcirculation imaging), and histopathological changes in intestinal and pulmonary tissues were evaluated. Vascular reactivity of isolated mesenteric micro-arteries was measured using a wire myograph system. The effects of serum from septic rats (SS) and Res-treated septic rats (SS-Res) on vascular smooth muscle cell viability and contractility were assessed in vitro. Protein expression of phosphorylated Ras-related C3 botulinum toxin substrate 1 and myosin light-chain kinase (p-MLCK) in vascular tissues were analyzed by western blotting. The roles of Ras-related C3 botulinum toxin substrate (Rac1) and MLCK were further verified using specific pharmacological activators and inhibitors.
Results
Res improved the general health status, alleviated lung and intestinal injuries, and restored intestinal hemoperfusion and vessel distribution in SS. In addition, Res suppressed sepsis-induced intestinal microvascular hyporeactivity to norepinephrine in vitro, whereas treatment with Res-treated septic rats increased the cellular viability and contractility of vascular smooth muscle cells compared to SS. Furthermore, Res reversed the upregulated Ras-related C3 botulinum toxin substrate 1 and downregulated p-MLCK expressions in the mesenteric artery tissue of SS. The Rac1 activator platelet-derived growth factor and inhibitor NSC 27366 partially inhibited vascular reactivity in SS, whereas the effect of NSC 27366 was blocked by the MLCK inhibitor ML-7.
Conclusions
Res suppressed sepsis-induced microvascular hyporeactivity through the Rac1-MLCK pathway, providing insights into the treatment of vascular hyporeactivity during sepsis.
{"title":"Resveratrol Suppresses Sepsis-Induced Micro-vascular Hypo-Reactivity Through Rac1-MLCK Pathway","authors":"Yang Yang MS , Jun-Chao Liu BS , Zhen-Kui Liu MS , Yu-Ping Zhang PhD , Min Xi BS , Hai-Ning Zheng MS , Jing Wang PhD , Zhen-Ao Zhao PhD , Chun-Yu Niu PhD , Zi-Gang Zhao PhD","doi":"10.1016/j.jss.2025.12.021","DOIUrl":"10.1016/j.jss.2025.12.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Vascular hyporeactivity contributes to a high mortality rate in sepsis. Resveratrol (Res) exhibits anti-inflammatory properties and improves vascular reactivity in septic animals. However, the mechanism of action of Res in sepsis-induced vascular hyporeactivity is not fully understood.</div></div><div><h3>Methods</h3><div>A rat model of sepsis was established by intraperitoneal injection of fecal filtrate. Rats were divided into sham, sham + Res, sepsis, and sepsis + Res groups. Hemodynamic parameters, intestinal microcirculation (assessed by laser speckle contrast imaging and <em>in vivo</em> microcirculation imaging), and histopathological changes in intestinal and pulmonary tissues were evaluated. Vascular reactivity of isolated mesenteric micro-arteries was measured using a wire myograph system. The effects of serum from septic rats (SS) and Res-treated septic rats (SS-Res) on vascular smooth muscle cell viability and contractility were assessed <em>in vitro</em>. Protein expression of phosphorylated Ras-related C3 botulinum toxin substrate 1 and myosin light-chain kinase (p-MLCK) in vascular tissues were analyzed by western blotting. The roles of Ras-related C3 botulinum toxin substrate (Rac1) and MLCK were further verified using specific pharmacological activators and inhibitors.</div></div><div><h3>Results</h3><div>Res improved the general health status, alleviated lung and intestinal injuries, and restored intestinal hemoperfusion and vessel distribution in SS. In addition, Res suppressed sepsis-induced intestinal microvascular hyporeactivity to norepinephrine <em>in vitro</em>, whereas treatment with Res-treated septic rats increased the cellular viability and contractility of vascular smooth muscle cells compared to SS. Furthermore, Res reversed the upregulated Ras-related C3 botulinum toxin substrate 1 and downregulated p-MLCK expressions in the mesenteric artery tissue of SS. The Rac1 activator platelet-derived growth factor and inhibitor NSC 27366 partially inhibited vascular reactivity in SS, whereas the effect of NSC 27366 was blocked by the MLCK inhibitor ML-7.</div></div><div><h3>Conclusions</h3><div>Res suppressed sepsis-induced microvascular hyporeactivity through the Rac1-MLCK pathway, providing insights into the treatment of vascular hyporeactivity during sepsis.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 98-109"},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927867","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 : 2026-01-07DOI: 10.1016/j.jss.2025.12.010
Robert Tchounzou MD , Obi Cyril Egbe MD , Mark T. Yost MD, MPH , Brandon Carl Monica Pouekoua MD , Pascal Nwandum MD , Mefire Alain Chichom MD
Introduction
The process of informed consent before surgery has not been evaluated in Cameroon. We hypothesized that the process of informed consent for patients operated on in the Southwest Region of Cameroon is not appropriate.
Materials and methods
We conducted a prospective, cross-sectional study in three health institutions in the Southwest region of Cameroon. A pretested questionnaire was administered to patients in the postoperative period to assess the basic components of the informed consent process. Patient's satisfaction and the overall validity of the process were measured.
Results
We included 468 consenting patients in this study. Their mean age was 31.41 ± 8.6 y. The majority of patients (58.5%) underwent an elective procedure. The informed consent process was administered on the day of surgery, sometimes on the operative table for 53.4% of patients. Over half of the patients did not receive specific information on the surgical procedure. Though most of them (64.5%) received information about anesthesia, none were ever given the opportunity to choose the type of anesthesia. A total of 268 (57.3%) patients were informed about the potential risks of the surgical and anesthetic procedures. The majority (86.54%) were never informed that the surgery could possibly not yield the expected results. Over 70% of patients never read the consent form, and the overall process was considered fully valid in 1.1% of patients.
Conclusions
Though the process of informed consent is now widespread, it is still inadequate as some basic components are not fulfilled and patients’ participation in the final decision is poor.
{"title":"Effectiveness and Validity of Informed Consent in Patients Undergoing Surgery in Cameroon: A Prospective Survey","authors":"Robert Tchounzou MD , Obi Cyril Egbe MD , Mark T. Yost MD, MPH , Brandon Carl Monica Pouekoua MD , Pascal Nwandum MD , Mefire Alain Chichom MD","doi":"10.1016/j.jss.2025.12.010","DOIUrl":"10.1016/j.jss.2025.12.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The process of informed consent before surgery has not been evaluated in Cameroon. We hypothesized that the process of informed consent for patients operated on in the Southwest Region of Cameroon is not appropriate.</div></div><div><h3>Materials and methods</h3><div>We conducted a prospective, cross-sectional study in three health institutions in the Southwest region of Cameroon. A pretested questionnaire was administered to patients in the postoperative period to assess the basic components of the informed consent process. Patient's satisfaction and the overall validity of the process were measured.</div></div><div><h3>Results</h3><div>We included 468 consenting patients in this study. Their mean age was 31.41 ± 8.6 y. The majority of patients (58.5%) underwent an elective procedure. The informed consent process was administered on the day of surgery, sometimes on the operative table for 53.4% of patients. Over half of the patients did not receive specific information on the surgical procedure. Though most of them (64.5%) received information about anesthesia, none were ever given the opportunity to choose the type of anesthesia. A total of 268 (57.3%) patients were informed about the potential risks of the surgical and anesthetic procedures. The majority (86.54%) were never informed that the surgery could possibly not yield the expected results. Over 70% of patients never read the consent form, and the overall process was considered fully valid in 1.1% of patients.</div></div><div><h3>Conclusions</h3><div>Though the process of informed consent is now widespread, it is still inadequate as some basic components are not fulfilled and patients’ participation in the final decision is poor.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 25-31"},"PeriodicalIF":1.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927884","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 : 2026-01-07DOI: 10.1016/j.jss.2025.12.004
Jack H. Bowdle BS , Justin Pritchett BS , Andrew Hungerford BS , Sarah A. King MEng , Amanda McKinney PharmD , Robert E. Heidel PhD , Lou M. Smith MD , Catherine L. McKnight MD
Introduction
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.
Methods
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.
Results
N = 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 (r = 0.889, P < 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 > 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.
Conclusions
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.
{"title":"Associations Between Snakebite Severity Scores and Antivenin Administration","authors":"Jack H. Bowdle BS , Justin Pritchett BS , Andrew Hungerford BS , Sarah A. King MEng , Amanda McKinney PharmD , Robert E. Heidel PhD , Lou M. Smith MD , 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> < 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 > 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":"2026-01-07","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}
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