Pub Date : 2024-10-20DOI: 10.1016/j.jss.2024.09.070
Ryan Chae MD, Nicholas D'Ambrosio BS, Kevin Kulshrestha MD, Adam Price MD, Stephen Hartman MD, Matthew Baucom MD, Jenna Whitrock MD, MS, Lane Frasier MD, MS
Introduction
Pericardiotomy is performed in the setting of trauma to diagnose and treat cardiac injury. The frequency of cardiac arrhythmia after pericardiotomy for trauma is poorly described in the literature. We sought to identify the frequency of and risk factors for the development of postpericardiotomy arrhythmia in trauma patients.
Materials and Methods
We performed a retrospective single-center cohort study of patients >16 y of age, querying our institutional trauma database (Jan 2011-Dec 2020) for International Classification of Diseases-9 and -10 codes involving pericardiotomy (i.e., pericardial window, sternotomy). Operative details and postoperative course were collected for patients surviving >24 h. Sinus bradycardia and tachycardia were not included as arrhythmias.
Results
We identified 252 trauma patients who underwent pericardiotomy. One hundred fifty-four patients survived >24 h. Of these, 12.3% experienced arrhythmia. Patients developing arrhythmia were older, had higher injury severity score, were more likely to have a blunt mechanism of injury, and had higher in-hospital mortality. On multiple logistic regressions, increasing age, blunt mechanism, and concomitant laparotomy were associated with arrhythmia development, while operative characteristics were not.
Conclusions
At our institution, trauma patients undergoing pericardiotomy have a risk of arrhythmia of 12.3%, which is associated with multiple nonmodifiable risk factors. Further study is warranted to identify potential mechanisms to reduce arrhythmias in this population.
{"title":"Cardiac Arrhythmias in Trauma Patients Undergoing Pericardiotomy: A Retrospective Analysis","authors":"Ryan Chae MD, Nicholas D'Ambrosio BS, Kevin Kulshrestha MD, Adam Price MD, Stephen Hartman MD, Matthew Baucom MD, Jenna Whitrock MD, MS, Lane Frasier MD, MS","doi":"10.1016/j.jss.2024.09.070","DOIUrl":"10.1016/j.jss.2024.09.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Pericardiotomy is performed in the setting of trauma to diagnose and treat cardiac injury. The frequency of cardiac arrhythmia after pericardiotomy for trauma is poorly described in the literature. We sought to identify the frequency of and risk factors for the development of postpericardiotomy arrhythmia in trauma patients.</div></div><div><h3>Materials and Methods</h3><div>We performed a retrospective single-center cohort study of patients >16 y of age, querying our institutional trauma database (Jan 2011-Dec 2020) for International Classification of Diseases-9 and -10 codes involving pericardiotomy (i.e., pericardial window, sternotomy). Operative details and postoperative course were collected for patients surviving >24 h. Sinus bradycardia and tachycardia were not included as arrhythmias.</div></div><div><h3>Results</h3><div>We identified 252 trauma patients who underwent pericardiotomy. One hundred fifty-four patients survived >24 h. Of these, 12.3% experienced arrhythmia. Patients developing arrhythmia were older, had higher injury severity score, were more likely to have a blunt mechanism of injury, and had higher in-hospital mortality. On multiple logistic regressions, increasing age, blunt mechanism, and concomitant laparotomy were associated with arrhythmia development, while operative characteristics were not.</div></div><div><h3>Conclusions</h3><div>At our institution, trauma patients undergoing pericardiotomy have a risk of arrhythmia of 12.3%, which is associated with multiple nonmodifiable risk factors. Further study is warranted to identify potential mechanisms to reduce arrhythmias in this population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 554-560"},"PeriodicalIF":1.8,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468424","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 : 2024-10-19DOI: 10.1016/j.jss.2024.09.071
Britney K. He BS , Crystal D. Chu PhD, RN , Caleigh E. Smith MD , Lucie Lefbom BS, BA , Anneke Schroen MD, MPH
Introduction
In 2016, an American Society of Breast Surgeons (ASBrS) statement discouraged contralateral prophylactic mastectomy (CPM) in average-risk women with unilateral breast cancer. Despite evidence of no oncologic benefit and related attempts to discourage the practice, CPM remains prevalent. This study aims to assess CPM trends post-ASBrS statement and factors associated with these trends.
Methods
A retrospective cohort study of patients with primary unilateral breast cancer undergoing complete mastectomy at a single-tertiary center between January 2014 and December 2020 was performed. We assessed the proportion opting for CPM, compared pre- and post-ASBrS statement CPM rates, and examined associated patient and tumor factors. Pearson's Chi-square test, Fisher's exact test, and equal variance t-tests were used to compare subsets who underwent CPM versus those who did not.
Results
Of 605 patients, 161 (27%) underwent CPM during our study period, with the median follow-up time for all patients being 58 mo (IQR: 38 to 81). Among all patients, CPM rates ranged from 30% to 14% before the ASBrS statement and then declined from 36% to 19% after the statement. For average-risk patients (no genetic mutation), these rates ranged from 20.2% to 10.2% from 2014 to 2016 and had a steady decline from 23.2% in 2017 to 13.2% in 2020. Only two cases (1.2%) had incidental contralateral breast cancer. Patients undergoing CPM tended to be younger, more likely to have a breast cancer gene mutation, pursue reconstruction, and elect for nipple- or skin-sparing mastectomy. Recurrence and mortality events did not differ significantly. Genetic testing and pathogenic variant rates were greater among CPM patients.
Conclusions
After an initial time lag, CPM rates appear to be decreasing post-ASBrS statement, with ongoing data needed to confirm this trend. CPM rates among breast cancer gene patients align appropriately with guidelines catering to this higher risk population. Better educational tools and decision aids may impact CPM trends and facilitate shared decision-making.
{"title":"Trends in Contralateral Prophylactic Mastectomies Before and After the American Society of Breast Surgeons Consensus Statement","authors":"Britney K. He BS , Crystal D. Chu PhD, RN , Caleigh E. Smith MD , Lucie Lefbom BS, BA , Anneke Schroen MD, MPH","doi":"10.1016/j.jss.2024.09.071","DOIUrl":"10.1016/j.jss.2024.09.071","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2016, an American Society of Breast Surgeons (ASBrS) statement discouraged contralateral prophylactic mastectomy (CPM) in average-risk women with unilateral breast cancer. Despite evidence of no oncologic benefit and related attempts to discourage the practice, CPM remains prevalent. This study aims to assess CPM trends post-ASBrS statement and factors associated with these trends.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of patients with primary unilateral breast cancer undergoing complete mastectomy at a single-tertiary center between January 2014 and December 2020 was performed. We assessed the proportion opting for CPM, compared pre- and post-ASBrS statement CPM rates, and examined associated patient and tumor factors. Pearson's Chi-square test, Fisher's exact test, and equal variance t-tests were used to compare subsets who underwent CPM <em>versus</em> those who did not.</div></div><div><h3>Results</h3><div>Of 605 patients, 161 (27%) underwent CPM during our study period, with the median follow-up time for all patients being 58 mo (IQR: 38 to 81). Among all patients, CPM rates ranged from 30% to 14% before the ASBrS statement and then declined from 36% to 19% after the statement. For average-risk patients (no genetic mutation), these rates ranged from 20.2% to 10.2% from 2014 to 2016 and had a steady decline from 23.2% in 2017 to 13.2% in 2020. Only two cases (1.2%) had incidental contralateral breast cancer. Patients undergoing CPM tended to be younger, more likely to have a breast cancer gene mutation, pursue reconstruction, and elect for nipple- or skin-sparing mastectomy. Recurrence and mortality events did not differ significantly. Genetic testing and pathogenic variant rates were greater among CPM patients.</div></div><div><h3>Conclusions</h3><div>After an initial time lag, CPM rates appear to be decreasing post-ASBrS statement, with ongoing data needed to confirm this trend. CPM rates among breast cancer gene patients align appropriately with guidelines catering to this higher risk population. Better educational tools and decision aids may impact CPM trends and facilitate shared decision-making.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 545-553"},"PeriodicalIF":1.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468447","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 : 2024-10-19DOI: 10.1016/j.jss.2024.09.060
Justine S. Broecker MD , Christopher Gross MA , Robert Winchell MD , Marie Crandall MD, MPH
Introduction
There has been a substantial increase in the number of trauma centers (TCs) opened in the US over the past decade which coincided with population increases and policy changes. Our hypotheses were that new TC locations would likely be related to the socioeconomic profile of the surrounding locale—likely favoring higher-income areas—and that hospital ownership status may play a role in the distribution of new centers. Our aim was to use geographic information systems (GIS) analysis to evaluate the growth of an established regional TC and to delineate factors associated with the site chosen for new centers.
Methods
ARC-GIS mapping software was utilized to generate a map of all TCs within two Florida metropolitan areas—Jacksonville and Miami. Hospital ownership was classified as for-profit (FP) or government, and opening dates were obtained from publicly available data. US census data (2020) was utilized to add sociodemographic data (race, income, insurance status) by zip code.
Results
The majority of newer TCs opened in Duval/Clay and Dade/Broward counties were FP. GIS mapping demonstrated that 100% of new TCs demonstrated higher mean charges compared to established TC and were located in higher-income neighborhoods where residents were more likely to have health insurance with fewer African-American residents.
Conclusions
Most TCs added to two of the largest metropolitan areas within Florida over the past decade were FP. These TCs demonstrated higher mean charges and tended to be located in areas of higher-income neighborhoods with better insured residents and fewer African-Americans. Such data suggest that more oversight is potentially needed to regulate and organize trauma system development to address trauma need rather than financial incentive alone.
{"title":"Geographic Information Systems Mapping of Trauma Center Development in Florida","authors":"Justine S. Broecker MD , Christopher Gross MA , Robert Winchell MD , Marie Crandall MD, MPH","doi":"10.1016/j.jss.2024.09.060","DOIUrl":"10.1016/j.jss.2024.09.060","url":null,"abstract":"<div><h3>Introduction</h3><div>There has been a substantial increase in the number of trauma centers (TCs) opened in the US over the past decade which coincided with population increases and policy changes. Our hypotheses were that new TC locations would likely be related to the socioeconomic profile of the surrounding locale—likely favoring higher-income areas—and that hospital ownership status may play a role in the distribution of new centers. Our aim was to use geographic information systems (GIS) analysis to evaluate the growth of an established regional TC and to delineate factors associated with the site chosen for new centers.</div></div><div><h3>Methods</h3><div>ARC-GIS mapping software was utilized to generate a map of all TCs within two Florida metropolitan areas—Jacksonville and Miami. Hospital ownership was classified as for-profit (FP) or government, and opening dates were obtained from publicly available data. US census data (2020) was utilized to add sociodemographic data (race, income, insurance status) by zip code.</div></div><div><h3>Results</h3><div>The majority of newer TCs opened in Duval/Clay and Dade/Broward counties were FP. GIS mapping demonstrated that 100% of new TCs demonstrated higher mean charges compared to established TC and were located in higher-income neighborhoods where residents were more likely to have health insurance with fewer African-American residents.</div></div><div><h3>Conclusions</h3><div>Most TCs added to two of the largest metropolitan areas within Florida over the past decade were FP. These TCs demonstrated higher mean charges and tended to be located in areas of higher-income neighborhoods with better insured residents and fewer African-Americans. Such data suggest that more oversight is potentially needed to regulate and organize trauma system development to address trauma need rather than financial incentive alone.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 561-567"},"PeriodicalIF":1.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468429","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}
Skewed immune response plays a pivotal role in tumor progression. Systemic inflammatory responses represented by combined peripheral leukocyte fractions are prognostic predictors of multiple cancers, including thyroid cancer. We previously reported the prognostic significance of lymphocyte–to–monocyte ratio (LMR) in curatively resected papillary thyroid cancer (PTC). Therefore, this study aimed to analyze immune cell profiles in the tumor microenvironment and their association with LMR in curatively resected PTC.
Materials and methods
The immune cell profiles of primary tumors in 162 patients with curatively resected PTC were analyzed clinicopathologically. Immunohistochemistry of tumor-associated macrophages (TAMs), myeloid-derived suppressor cells, and lymphocytes was performed using CD163, CD33, and CD3 antibodies, respectively. Prognostic analysis and correlation assays were performed using the immunocyte profiles. The gene expression of tumor-derived chemokines was assessed using a The Cancer Genome Atlas database.
Results
Patients with a higher density of CD163+ TAMs exhibited a significantly worse prognosis than their counterparts (10-y recurrence-free survival: 80.9% versus 91.2%, P = 0.011). Multivariate prognostic analyses revealed that high CD163+ cell density (P = 0.011), low preoperative LMR (P = 0.003), pN1b (P = 0.005), and high thyroglobulin level (P = 0.038) were independent predictors of recurrence. High CD163+ cell density had a prognostic impact on stage II and III PTC. Interestingly, high CD163+ cell density correlated with low LMR and high monocyte fraction in peripheral blood. Indeed, the expression of TAM-inducible, tumor-derived chemokines is increased in the The Cancer Genome Atlas database.
Conclusions
A high density of infiltrated CD163+ TAMs predicts recurrence in correlation with low LMR and circulating monocyte accumulation. Thus, TAMs should be considered when assessing advanced PTC.
{"title":"CD163+ Tumor-Associated Macrophage Recruitment Predicts Papillary Thyroid Cancer Recurrence","authors":"Hiroshi Katoh MD, PhD, FACS , Riku Okamoto MD , Mitsuo Yokota MD, PhD , Kanako Naito MD , Mariko Kikuchi MD, PhD , Takaaki Tokito MD , Takafumi Sangai MD, PhD , Keishi Yamashita MD, PhD, FACS","doi":"10.1016/j.jss.2024.09.035","DOIUrl":"10.1016/j.jss.2024.09.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Skewed immune response plays a pivotal role in tumor progression. Systemic inflammatory responses represented by combined peripheral leukocyte fractions are prognostic predictors of multiple cancers, including thyroid cancer. We previously reported the prognostic significance of lymphocyte–to–monocyte ratio (LMR) in curatively resected papillary thyroid cancer (PTC). Therefore, this study aimed to analyze immune cell profiles in the tumor microenvironment and their association with LMR in curatively resected PTC.</div></div><div><h3>Materials and methods</h3><div>The immune cell profiles of primary tumors in 162 patients with curatively resected PTC were analyzed clinicopathologically. Immunohistochemistry of tumor-associated macrophages (TAMs), myeloid-derived suppressor cells, and lymphocytes was performed using CD163, CD33, and CD3 antibodies, respectively. Prognostic analysis and correlation assays were performed using the immunocyte profiles. The gene expression of tumor-derived chemokines was assessed using a The Cancer Genome Atlas database.</div></div><div><h3>Results</h3><div>Patients with a higher density of CD163<sup>+</sup> TAMs exhibited a significantly worse prognosis than their counterparts (10-y recurrence-free survival: 80.9% <em>versus</em> 91.2%, <em>P</em> = 0.011). Multivariate prognostic analyses revealed that high CD163<sup>+</sup> cell density (<em>P</em> = 0.011), low preoperative LMR (<em>P</em> = 0.003), pN1b (<em>P</em> = 0.005), and high thyroglobulin level (<em>P</em> = 0.038) were independent predictors of recurrence. High CD163<sup>+</sup> cell density had a prognostic impact on stage II and III PTC. Interestingly, high CD163<sup>+</sup> cell density correlated with low LMR and high monocyte fraction in peripheral blood. Indeed, the expression of TAM-inducible, tumor-derived chemokines is increased in the The Cancer Genome Atlas database.</div></div><div><h3>Conclusions</h3><div>A high density of infiltrated CD163<sup>+</sup> TAMs predicts recurrence in correlation with low LMR and circulating monocyte accumulation. Thus, TAMs should be considered when assessing advanced PTC.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 532-544"},"PeriodicalIF":1.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.jss.2024.09.066
Matthew D. Price MD, MPH , Katherine M. McDermott MD , Rahul Gorijavolu BS , Charbel Chidiac MD , Yao Li PhD , Katherine Hoops MD, MPH , Mark B. Slidell MD, MPH , Isam W. Nasr MD
Introduction
Pediatric firearm injuries are a significant public health concern in the United States. This study examines risk factors for firearm reinjury in Maryland’s pediatric population.
Methods
Pediatric patients (age 0-19 y) who presented to any hospital in Maryland with a firearm injury between October 1, 2015, and December 31, 2019, were identified in the Maryland Health Services Cost Review Commission database and were followed for repeat firearm injuries through March 31, 2020. Logistic regression was used to analyze risk factors for reinjury. Geospatial analysis was used to identify communities with the highest prevalence of reinjury.
Results
Of 1351 index presentations for firearm injuries, 102 (7.3%) were fatal. Among children with nonfatal injuries, 40 (3.1%) re-presented with a second firearm injury, 25% of which were fatal. The median interval to reinjury was 149 d [interquartile range: 73-617]. Reinjury was more common in children aged ≥15 y (90% versus 76%), males (100% versus 87%), of Black race (90% versus 69%) or publicly insured (90% versus 68%) (all P < 0.05). Most lived in highly deprived neighborhoods of Baltimore City. No single factor was significant in multivariable models.
Conclusions
Pediatric firearm reinjury is rare but highly morbid in Maryland. While prior studies have shown Black race to be independently associated with firearm reinjury, we found the effect of race was entirely attenuated after controlling for neighborhood deprivation. These findings underscore the urgent need for targeted interventions in areas identified as high risk in addition to policies to reduce youth firearm access.
{"title":"Pediatric Firearm Reinjury: A Retrospective Statewide Risk Factor Analysis","authors":"Matthew D. Price MD, MPH , Katherine M. McDermott MD , Rahul Gorijavolu BS , Charbel Chidiac MD , Yao Li PhD , Katherine Hoops MD, MPH , Mark B. Slidell MD, MPH , Isam W. Nasr MD","doi":"10.1016/j.jss.2024.09.066","DOIUrl":"10.1016/j.jss.2024.09.066","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric firearm injuries are a significant public health concern in the United States. This study examines risk factors for firearm reinjury in Maryland’s pediatric population.</div></div><div><h3>Methods</h3><div>Pediatric patients (age 0-19 y) who presented to any hospital in Maryland with a firearm injury between October 1, 2015, and December 31, 2019, were identified in the Maryland Health Services Cost Review Commission database and were followed for repeat firearm injuries through March 31, 2020. Logistic regression was used to analyze risk factors for reinjury. Geospatial analysis was used to identify communities with the highest prevalence of reinjury.</div></div><div><h3>Results</h3><div>Of 1351 index presentations for firearm injuries, 102 (7.3%) were fatal. Among children with nonfatal injuries, 40 (3.1%) re-presented with a second firearm injury, 25% of which were fatal. The median interval to reinjury was 149 d [interquartile range: 73-617]. Reinjury was more common in children aged ≥15 y (90% <em>versus</em> 76%), males (100% <em>versus</em> 87%), of Black race (90% <em>versus</em> 69%) or publicly insured (90% <em>versus</em> 68%) (all <em>P</em> < 0.05). Most lived in highly deprived neighborhoods of Baltimore City. No single factor was significant in multivariable models.</div></div><div><h3>Conclusions</h3><div>Pediatric firearm reinjury is rare but highly morbid in Maryland. While prior studies have shown Black race to be independently associated with firearm reinjury, we found the effect of race was entirely attenuated after controlling for neighborhood deprivation. These findings underscore the urgent need for targeted interventions in areas identified as high risk in addition to policies to reduce youth firearm access.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 568-578"},"PeriodicalIF":1.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468432","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 : 2024-10-18DOI: 10.1016/j.jss.2024.09.058
Sai S. Kurapati MS , Camille Moeckel BA , Molly M. Stegman BS , Antonio Yaghy MD , Inginia Genao MD , Aakriti G. Shukla MD
Introduction
Women comprise over half of enrolled United States medical students. Yet, they continue to be under-represented in the active physician workforce, particularly among surgical specialties. This study investigates recent trends in the representation of women across surgical specialties in comparison to nonsurgical specialties within the US physician and resident workforce.
Methods
Data on active physicians and residents across 48 specialties were extracted from the Association of American Medical College's biennial (2010-2021) and annual reports (2018-2022), respectively. Descriptive statistics were performed on the proportion of physicians who were women in surgical and nonsurgical specialties. Poisson regressions were utilized with proportion of women as the outcome and specialty and year as the predictors.
Results
In 2021, 37.1% of all active physicians (946,790) were women, with a higher proportion of women in nonsurgical (38.4%) compared to surgical specialties (29.1%). In the resident workforce, women constituted 47.3% of the total workforce (149,296) in 2022, with a relatively comparable proportion of women in nonsurgical (47.4%) and surgical specialties (47.0%). The rate of yearly change decreased significantly (P < 0.01) for women in all surgical specialties except obstetrics and gynecology (1 of 10), with nonsurgical specialties as reference.
Conclusions
Although the proportion of women in surgery has increased over the last decade, this is the first study to identify that the rate of yearly change in women in the active physician and resident workforce is decreasing significantly in almost all (9 of 10) surgical specialties relative to nonsurgical specialties. This emphasizes the urgent need for systemic interventions that address the major barriers in recruitment and retention of women surgeons.
{"title":"A Flattened Curve: National Trends of Women Physicians and Residents in Surgery Over the Last Decade","authors":"Sai S. Kurapati MS , Camille Moeckel BA , Molly M. Stegman BS , Antonio Yaghy MD , Inginia Genao MD , Aakriti G. Shukla MD","doi":"10.1016/j.jss.2024.09.058","DOIUrl":"10.1016/j.jss.2024.09.058","url":null,"abstract":"<div><h3>Introduction</h3><div>Women comprise over half of enrolled United States medical students. Yet, they continue to be under-represented in the active physician workforce, particularly among surgical specialties. This study investigates recent trends in the representation of women across surgical specialties in comparison to nonsurgical specialties within the US physician and resident workforce.</div></div><div><h3>Methods</h3><div>Data on active physicians and residents across 48 specialties were extracted from the Association of American Medical College's biennial (2010-2021) and annual reports (2018-2022), respectively. Descriptive statistics were performed on the proportion of physicians who were women in surgical and nonsurgical specialties. Poisson regressions were utilized with proportion of women as the outcome and specialty and year as the predictors.</div></div><div><h3>Results</h3><div>In 2021, 37.1% of all active physicians (946,790) were women, with a higher proportion of women in nonsurgical (38.4%) compared to surgical specialties (29.1%). In the resident workforce, women constituted 47.3% of the total workforce (149,296) in 2022, with a relatively comparable proportion of women in nonsurgical (47.4%) and surgical specialties (47.0%). The rate of yearly change decreased significantly (<em>P</em> < 0.01) for women in all surgical specialties except obstetrics and gynecology (1 of 10), with nonsurgical specialties as reference.</div></div><div><h3>Conclusions</h3><div>Although the proportion of women in surgery has increased over the last decade, this is the first study to identify that the rate of yearly change in women in the active physician and resident workforce is decreasing significantly in almost all (9 of 10) surgical specialties relative to nonsurgical specialties. This emphasizes the urgent need for systemic interventions that address the major barriers in recruitment and retention of women surgeons.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 506-512"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468421","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 : 2024-10-18DOI: 10.1016/j.jss.2024.09.032
Jordan M. Winter MD , Jonathan R. Brody PhD
{"title":"A Surgeon–Scientist’s Pursuit of the Elusive R01","authors":"Jordan M. Winter MD , Jonathan R. Brody PhD","doi":"10.1016/j.jss.2024.09.032","DOIUrl":"10.1016/j.jss.2024.09.032","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 461-467"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468422","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 : 2024-10-18DOI: 10.1016/j.jss.2024.09.069
Aleezay Haider MD , Hamza Hanif MD , Terryn M. Dyche MOT , Noah V. Monagle MOT , Andrea Patterson MOT , Lauren Eberle MOT , Patricia C. Siegel OTD , Jasmeet Paul MD, FACS , Alissa Greenbaum MD
Introduction
Work-related musculoskeletal injuries are common in general surgeons, causing chronic pain and lost work. However, formal ergonomic curriculums in residency programs are rare. We aimed to assess the feasibility of an interprofessional educational approach to ergonomics in general surgery residents, in collaboration with occupational therapy (OT) students.
Methods
General surgery residents completed a survey regarding musculoskeletal pain and ergonomics. OT students captured photos of trainees performing open and laparoscopic abdominal surgery over a 4-wk period. Rapid entire body assessment (REBA) and the rapid upper limb assessment were used to assess ergonomic efficiency and postural risk. Higher scores represent unfavorable posture and correlate with the need for ergonomic change.
Results
There were 37/44 (84%) responses. Everyone reported some degree of pain related to surgery, most commonly neck pain (75%), shoulder (61%), and foot pain (53%). Most residents (66%) felt the pressure to perform surgery regardless of the pain. Ergonomic breaks directed by faculty were reported by less than 11% of residents. A total of 11 intraoperative observations were made by OT students of surgical trainees, with a mean rapid upper limb assessment score of 6.1 and a mean rapid entire body assessment score of 7.3. These scores demonstrated suboptimal posture with recommendations for prompt change.
Conclusions
This study conveys a successful interprofessional educational approach to assessing surgical ergonomics in general surgery residents. Musculoskeletal symptoms and intraoperative ergonomic dysfunctions are prevalent among general surgery residents, without workplace measures for management or prevention. This needs assessment will be used to create an ergonomics initiative for the surgery residency.
{"title":"An Interprofessional Approach to Assessing Musculoskeletal Pain and Ergonomics in Surgery Residents","authors":"Aleezay Haider MD , Hamza Hanif MD , Terryn M. Dyche MOT , Noah V. Monagle MOT , Andrea Patterson MOT , Lauren Eberle MOT , Patricia C. Siegel OTD , Jasmeet Paul MD, FACS , Alissa Greenbaum MD","doi":"10.1016/j.jss.2024.09.069","DOIUrl":"10.1016/j.jss.2024.09.069","url":null,"abstract":"<div><h3>Introduction</h3><div>Work-related musculoskeletal injuries are common in general surgeons, causing chronic pain and lost work. However, formal ergonomic curriculums in residency programs are rare. We aimed to assess the feasibility of an interprofessional educational approach to ergonomics in general surgery residents, in collaboration with occupational therapy (OT) students.</div></div><div><h3>Methods</h3><div>General surgery residents completed a survey regarding musculoskeletal pain and ergonomics. OT students captured photos of trainees performing open and laparoscopic abdominal surgery over a 4-wk period. Rapid entire body assessment (REBA) and the rapid upper limb assessment were used to assess ergonomic efficiency and postural risk. Higher scores represent unfavorable posture and correlate with the need for ergonomic change.</div></div><div><h3>Results</h3><div>There were 37/44 (84%) responses. Everyone reported some degree of pain related to surgery, most commonly neck pain (75%), shoulder (61%), and foot pain (53%). Most residents (66%) felt the pressure to perform surgery regardless of the pain. Ergonomic breaks directed by faculty were reported by less than 11% of residents. A total of 11 intraoperative observations were made by OT students of surgical trainees, with a mean rapid upper limb assessment score of 6.1 and a mean rapid entire body assessment score of 7.3. These scores demonstrated suboptimal posture with recommendations for prompt change.</div></div><div><h3>Conclusions</h3><div>This study conveys a successful interprofessional educational approach to assessing surgical ergonomics in general surgery residents. Musculoskeletal symptoms and intraoperative ergonomic dysfunctions are prevalent among general surgery residents, without workplace measures for management or prevention. This needs assessment will be used to create an ergonomics initiative for the surgery residency.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 513-518"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468423","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 : 2024-10-18DOI: 10.1016/j.jss.2024.09.053
Samuel Sharp MD , Lincoln Tracy PhD , Yvonne Singer RN, MPH , Marc Schnekenburger MBBS , Aidan Burrell MBBS , Andrew Paton MBChB , Stephen Salerno MBBS , Dane Holden MBBS
Introduction
Acute kidney injury (AKI) following burns is associated with increased mortality and morbidity. Some patients require renal replacement therapy. There is limited large-scale data to sufficiently validate risk factors influencing the incidence and severity of early AKI, defined as AKI within the first 72 h since admission to a burn center following burn injury. The aims of this study were to compare the profile of adult patients admitted to Australian and New Zealand burn centers, with burns ≥10% total body surface area (TBSA) who developed early AKI with patients who did not develop AKI and to quantify the association between early AKI and in-hospital outcomes.
Methods
Data were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 y), with burns ≥10% TBSA admitted to Australian or New Zealand burn centers between July 2016 and June 2021. All patients with two valid serum creatinine blood tests within the first 72 h were included. Differences in patient profiles and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between early AKI and outcomes of interest.
Results
There were 1297 patients who met the inclusion criteria for this study. Eighty-three patients (6.4%) developed early AKI. Compared to patients without AKI, patients with an AKI were older (P = 0.006), had a greater median %TBSA burned (P < 0.001), and had an inhalation injury (P < 0.001). In adjusted models, the development of early AKI was significantly associated with in-hospital mortality (adjusted odds ratio (aOR) [95% CI] 2.73 [1.33, 5.62], P < 0.001) and the need for mechanical ventilation (aOR [95% CI] 3.44 [1.77, 6.68], P = 0.001), but there was no significant increase in the hospital length of stay or intensive care unit length of stay.
Conclusions
This is the first large-scale study looking at early AKI in adult burns ≥10% TBSA. The incidence of AKI was lower than previously reported and AKI was associated with higher in-hospital mortality and increased need for mechanical ventilation. These findings support the notion that development of AKI in the immediate phase post burns injury can potentially have consequences and the appropriate care should be given to prevent its development.
简介：烧伤后的急性肾损伤（AKI）与死亡率和发病率的增加有关。一些患者需要进行肾脏替代治疗。早期 AKI 是指烧伤后入住烧伤中心后 72 小时内发生的 AKI，目前只有有限的大规模数据可以充分验证影响早期 AKI 发生率和严重程度的风险因素。本研究旨在比较澳大利亚和新西兰烧伤中心收治的烧伤面积≥10%、发生早期AKI的成年患者与未发生AKI的患者的情况，并量化早期AKI与院内预后之间的关系：从澳大利亚和新西兰烧伤登记处提取了2016年7月至2021年6月期间澳大利亚或新西兰烧伤中心收治的烧伤面积≥10% TBSA的成人（≥18岁）的数据。所有在最初 72 小时内进行过两次有效血清肌酐血液检测的患者均被纳入研究范围。研究了患者概况和院内预后的差异。采用单变量和多变量逻辑及线性回归模型来量化早期 AKI 与相关结果之间的关联：共有 1297 名患者符合本研究的纳入标准。83名患者（6.4%）出现了早期 AKI。与没有发生 AKI 的患者相比，发生 AKI 的患者年龄更大（P = 0.006），烧伤的中位 TBSA 百分比更高（P 结论：这是一项首次对早期 AKI 和相关结果进行研究的大规模研究：这是首次对TBSA≥10%的成人烧伤患者的早期AKI进行大规模研究。AKI 的发生率低于之前的报道，AKI 与较高的院内死亡率和机械通气需求增加有关。这些研究结果支持这样一种观点，即在烧伤后的初期阶段发生 AKI 可能会产生潜在的后果，因此应给予适当的护理以防止其发生。
{"title":"Early Acute Kidney Injury in Adult Patients With Burns in Australia & New Zealand","authors":"Samuel Sharp MD , Lincoln Tracy PhD , Yvonne Singer RN, MPH , Marc Schnekenburger MBBS , Aidan Burrell MBBS , Andrew Paton MBChB , Stephen Salerno MBBS , Dane Holden MBBS","doi":"10.1016/j.jss.2024.09.053","DOIUrl":"10.1016/j.jss.2024.09.053","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute kidney injury (AKI) following burns is associated with increased mortality and morbidity. Some patients require renal replacement therapy. There is limited large-scale data to sufficiently validate risk factors influencing the incidence and severity of early AKI, defined as AKI within the first 72 h since admission to a burn center following burn injury. The aims of this study were to compare the profile of adult patients admitted to Australian and New Zealand burn centers, with burns ≥10% total body surface area (TBSA) who developed early AKI with patients who did not develop AKI and to quantify the association between early AKI and in-hospital outcomes.</div></div><div><h3>Methods</h3><div>Data were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 y), with burns ≥10% TBSA admitted to Australian or New Zealand burn centers between July 2016 and June 2021. All patients with two valid serum creatinine blood tests within the first 72 h were included. Differences in patient profiles and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between early AKI and outcomes of interest.</div></div><div><h3>Results</h3><div>There were 1297 patients who met the inclusion criteria for this study. Eighty-three patients (6.4%) developed early AKI. Compared to patients without AKI, patients with an AKI were older (<em>P</em> = 0.006), had a greater median %TBSA burned (<em>P</em> < 0.001), and had an inhalation injury (<em>P</em> < 0.001). In adjusted models, the development of early AKI was significantly associated with in-hospital mortality (adjusted odds ratio (aOR) [95% CI] 2.73 [1.33, 5.62], <em>P</em> < 0.001) and the need for mechanical ventilation (aOR [95% CI] 3.44 [1.77, 6.68], <em>P</em> = 0.001), but there was no significant increase in the hospital length of stay or intensive care unit length of stay.</div></div><div><h3>Conclusions</h3><div>This is the first large-scale study looking at early AKI in adult burns ≥10% TBSA. The incidence of AKI was lower than previously reported and AKI was associated with higher in-hospital mortality and increased need for mechanical ventilation. These findings support the notion that development of AKI in the immediate phase post burns injury can potentially have consequences and the appropriate care should be given to prevent its development.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 482-488"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468428","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 : 2024-10-18DOI: 10.1016/j.jss.2024.09.036
Sarah A. Hatfield MD, MPH , Samuel Medina BS , Elizabeth Gorman MD , Philip S. Barie MD , Robert J. Winchell MD , Cassandra V. Villegas MD, MPH
Introduction
Operative volume is associated with improved outcomes across many surgical specialties, but this relationship has not been illustrated clearly in trauma. This study sought to evaluate the relationship between operative trauma volume and mortality, hypothesizing that increased volume would be associated with improved survival.
Materials and Methods
The National Trauma Data Bank was queried for patients ≥18 y undergoing hemorrhage control surgery at level I or II trauma centers from 2017 to 2020. Hierarchical logistic regression was performed to evaluate the association between operative volume and in-hospital mortality, controlling for demographic and clinical characteristics.
Results
55,469 patients were included and treated at 516 centers. After adjustment, the operative volume was significantly associated with reduced mortality (OR 0.999, 95% CI 0.997-0.999, P = 0.018). However, there was considerable variability in volumes, with the busiest 5% of centers performing 90-294 operations per year, compared to 7-35 in the middle 50% of centers. To evaluate whether volume exhibited a uniform effect, the top 5% of trauma centers were excluded on subset analysis, with operative volume becoming nonsignificant in the remaining 491 centers (OR 0.999, 95% CI 0.996-1.001, P = 0.274).
Conclusions
Higher operative trauma volume is associated with reduced mortality for patients undergoing hemorrhage control surgery, but this mortality benefit appears to arise solely from very high-volume centers. The time-sensitive nature of hemorrhage control surgery makes centralization at this level impractical. Future efforts should focus on investigating the relationship between patient proximity to trauma centers and center volume as well as identifying modifiable factors common to high-volume centers that may be widely implemented.
导言：在许多外科专科中，手术量都与预后的改善有关，但在创伤外科中，这种关系尚未得到明确说明。本研究试图评估创伤手术量与死亡率之间的关系，假设手术量的增加与生存率的提高有关：在国家创伤数据库中查询了 2017 年至 2020 年期间在一级或二级创伤中心接受出血控制手术的年龄≥18 岁的患者。在控制人口统计学和临床特征的前提下，进行了层次逻辑回归，以评估手术量与院内死亡率之间的关系：共纳入 55,469 名患者，他们在 516 个中心接受治疗。经调整后，手术量与死亡率的降低显著相关（OR 0.999，95% CI 0.997-0.999，P = 0.018）。然而，手术量存在很大差异，最繁忙的5%的中心每年进行90-294例手术，而中间50%的中心每年进行7-35例手术。为了评估手术量是否会产生一致的影响，在子集分析中排除了前5%的创伤中心，手术量在剩余的491个中心中变得不显著（OR 0.999，95% CI 0.996-1.001，P = 0.274）：结论：创伤手术量越大，接受出血控制手术的患者死亡率就越低，但这种死亡率的益处似乎只来自于手术量非常大的中心。由于出血控制手术具有时间敏感性，因此在这一层面进行集中管理是不切实际的。未来的工作重点应该是研究患者距离创伤中心的远近与中心规模之间的关系，以及确定可广泛实施的高规模中心的共同可调节因素。
{"title":"Operative Trauma and Mortality: The Role of Volume","authors":"Sarah A. Hatfield MD, MPH , Samuel Medina BS , Elizabeth Gorman MD , Philip S. Barie MD , Robert J. Winchell MD , Cassandra V. Villegas MD, MPH","doi":"10.1016/j.jss.2024.09.036","DOIUrl":"10.1016/j.jss.2024.09.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Operative volume is associated with improved outcomes across many surgical specialties, but this relationship has not been illustrated clearly in trauma. This study sought to evaluate the relationship between operative trauma volume and mortality, hypothesizing that increased volume would be associated with improved survival.</div></div><div><h3>Materials and Methods</h3><div>The National Trauma Data Bank was queried for patients ≥18 y undergoing hemorrhage control surgery at level I or II trauma centers from 2017 to 2020. Hierarchical logistic regression was performed to evaluate the association between operative volume and in-hospital mortality, controlling for demographic and clinical characteristics.</div></div><div><h3>Results</h3><div>55,469 patients were included and treated at 516 centers. After adjustment, the operative volume was significantly associated with reduced mortality (OR 0.999, 95% CI 0.997-0.999, <em>P</em> = 0.018). However, there was considerable variability in volumes, with the busiest 5% of centers performing 90-294 operations per year, compared to 7-35 in the middle 50% of centers. To evaluate whether volume exhibited a uniform effect, the top 5% of trauma centers were excluded on subset analysis, with operative volume becoming nonsignificant in the remaining 491 centers (OR 0.999, 95% CI 0.996-1.001, <em>P</em> = 0.274).</div></div><div><h3>Conclusions</h3><div>Higher operative trauma volume is associated with reduced mortality for patients undergoing hemorrhage control surgery, but this mortality benefit appears to arise solely from very high-volume centers. The time-sensitive nature of hemorrhage control surgery makes centralization at this level impractical. Future efforts should focus on investigating the relationship between patient proximity to trauma centers and center volume as well as identifying modifiable factors common to high-volume centers that may be widely implemented.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"303 ","pages":"Pages 499-505"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468430","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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