Journal of Surgical Research最新文献

英文中文

Outpatient Laparoscopic Appendectomy PI 门诊腹腔镜阑尾切除术PI。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.039

Vera M. Funk MD , Mason H. Remondelli MD , Michael Morell BS , Natalia K. Barzanji MD , Megan C. Bartel MD , Patrick F. Walker MD , Matthew J. Bradley MD

Introduction

Acute appendicitis is one of the most common reasons for emergency general surgery, with more than 1 in 20 Americans expected to develop it during their lifetime. Despite its prevalence, there is significant variability in the treatment of acute appendicitis, particularly in the use of antibiotics, imaging modalities, and length of hospital stay. In 2016, our military medical institution established a novel Emergency General Surgery Performance Improvement program. As part of this initiative, we developed disease-specific protocols, including an outpatient laparoscopic appendectomy (OLA) protocol, to reduce treatment variability, improve efficiency, and optimize the quality of patient care. This is a 5-yreview of our appendectomy protocol.

Methods

Our institution implemented an OLA, which outlined specific imaging and antibiotic administration, and minimized the hospital length of stay to within 24 h. Data from patients undergoing OLA between 2017 and 2021 were retrospectively reviewed. Exclusion criteria included age < 18 y, advanced appendicitis, immunosuppression, pregnancy, or lack of postdischarge supervision. Categorical variables were compared using chi-square tests. Continuous variables (age, time to operating room [OR]) were tested for normality with the Shapiro–Wilk test and reported as median (Q1, Q3). Nonparametric comparisons across years used the Kruskal–Wallis test; 2020 (signage posted) was compared to other years using the Mann–Whitney U test. Significance was set at P < 0.05.

Results

A total of 104 patients met inclusion criteria (median age 35 y; 60% male). Antibiotic compliance ranged from 56% to 93%, and imaging compliance from 75% to 100%, both varying significantly over time (P = 0.014 and P = 0.039, respectively). Median time to OR remained stable at 7.0 h (interquartile range 6.0-10.0), with no significant yearly difference (P = 0.29). In 2020, signage was associated with higher antibiotic (P = 0.001) and imaging compliance (P = 0.001), but not shorter time to OR (P = 0.35). Complications were rare (2%).

Conclusions

Despite variations in antibiotic and imaging compliance, key surgical outcomes, including time to the OR and hospital length of stay, remained stable. Signage reinforced protocol adherence, highlighting the importance of ongoing education. The low complication rate supports the overall safety of laparoscopic appendectomy. Future efforts should focus on improving compliance and optimizing preoperative workflows to enhance patient care.

简介：急性阑尾炎是紧急普通外科手术最常见的原因之一，超过1 / 20的美国人预计在他们的一生中会患上这种疾病。尽管它很流行，但急性阑尾炎的治疗有很大的差异，特别是在抗生素的使用、成像方式和住院时间方面。2016年，我军医疗机构建立了全新的急诊普外科绩效提升项目。作为这一倡议的一部分，我们制定了针对特定疾病的方案，包括门诊腹腔镜阑尾切除术（OLA）方案，以减少治疗的可变性，提高效率，并优化患者护理的质量。这是我们阑尾切除术方案的5年回顾。方法：我们的机构实施了一项OLA，概述了特定的成像和抗生素给药，并将住院时间缩短到24小时以内。回顾性分析了2017年至2021年接受OLA的患者的数据。排除标准包括年龄< 18岁、晚期阑尾炎、免疫抑制、妊娠或出院后缺乏监护。分类变量比较采用卡方检验。连续变量（年龄，到手术室的时间[OR]）用Shapiro-Wilk检验检验正态性，并报告为中位数（Q1, Q3）。跨年的非参数比较使用了Kruskal-Wallis检验；使用曼-惠特尼U测试将2020年（标牌张贴）与其他年份进行比较。P < 0.05为显著性。结果：共有104例患者符合纳入标准（中位年龄35岁，60%为男性）。抗生素依从性从56%到93%不等，影像学依从性从75%到100%不等，两者随时间变化显著（P = 0.014和P = 0.039分别）。到OR的中位时间保持稳定在7.0 h（四分位数范围为6.0-10.0），没有显著的年度差异（P = 0.29）。在2020年，标识与更高的抗生素（P = 0.001）和影像学依从性（P = 0.001）相关，但与更短的手术时间（P = 0.35）无关。并发症罕见（2%）。结论：尽管抗生素和影像学依从性有所不同，但关键的手术结果，包括到手术室的时间和住院时间，保持稳定。标识加强了协议的遵守，强调了持续教育的重要性。低并发症率保证了腹腔镜阑尾切除术的整体安全性。未来的努力应集中在提高依从性和优化术前工作流程，以加强患者护理。

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引用次数: 0

Letter Regarding: Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends 关于：供应和需求：儿科外科专业奖学金匹配趋势。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.059

Zafer Turkyilmaz MD (Prof.), Ramazan Karabulut MD (Prof), Cem Kaya MD (Assoc.Prof.), Kaan Sonmez MD (Prof.)

引用次数: 0

Journal of Surgical Research 外科研究杂志

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/S0022-4804(26)00002-8

引用次数: 0

Pediatric Intussusception in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Surgical Outcomes 撒哈拉以南非洲儿童肠套叠：手术结果的系统回顾和荟萃分析

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.068

Yohannis Derbew Molla MD , Kidist Hunegn Setargew MD , Mekdes Tsegaye Alebel MD , Hirut Tesfahun Alemu MD

Introduction

Intussusception is a common cause of acute abdominal pain and intestinal obstruction in children worldwide. However, in areas with limited health-care resources, it is more frequently associated with severe complications and poor outcomes due to delays in diagnosis and treatment. Although nonsurgical treatments have improved outcomes worldwide, many children in Sub-Saharan Africa (SSA) still require surgery for this condition. This study reviews the available evidence on surgical outcomes for pediatric intussusception in SSA.

Methods

We conducted a systematic search across multiple databases including PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar—for studies published from 1991 to 2024 that reported on surgical treatment of pediatric intussusception in SSA. From these studies, we extracted key details such as patient demographics, symptoms, diagnostic approaches, surgical procedures, complications, and mortality rates. Using random-effects meta-analysis, we calculated pooled prevalence estimates with 95% confidence intervals (CIs). Finally, we evaluated study quality with the Newcastle–Ottawa Scale.

Results

Twenty-four studies involving 2078 children from 11 SSA countries were included. The pooled mean age at presentation was 13.2 mo, with 64% of cases occurring in males. The classic triad (intermittent abdominal pain, vomiting, and bloody stools) was present in 50.4% (95% CI: 37.3–63.4), and the mean duration of symptoms before presentation was 3.45 d. Ultrasound was used in 58.3% (95% CI: 49.2–66.9), whereas clinical diagnosis alone accounted for 34.7%. Manual reduction was the most common surgical procedure (55.2%; 95% CI: 49.9–60.6), followed by resection with anastomosis (38.2%; 95% CI: 31.0–45.3). Postoperative complications occurred in 24.5% (95% CI: 18.5–30.5), with surgical site infection being the most frequent. The pooled mortality rate was 12.4% (95% CI: 9.2–15.6), substantially higher than global averages.

Conclusions

Pediatric intussusception in SSA is characterized by delayed presentation, high reliance on surgical management, and unacceptably high mortality and complication rates. Strengthening early diagnosis, expanding access to nonoperative reduction, and improving surgical capacity are essential to reduce the burden of this condition in the region.

肠套叠是全世界儿童急性腹痛和肠梗阻的常见原因。然而，在保健资源有限的地区，由于诊断和治疗的延误，它往往与严重并发症和不良结果有关。尽管非手术治疗改善了世界范围内的预后，但撒哈拉以南非洲（SSA）的许多儿童仍然需要手术治疗。本研究回顾了SSA患儿肠套叠手术结果的现有证据。方法系统检索PubMed、Scopus、Web of Science、African Journals Online和谷歌scholar等多个数据库，检索1991年至2024年发表的关于SSA患儿肠套叠手术治疗的研究。从这些研究中，我们提取了关键细节，如患者人口统计学、症状、诊断方法、外科手术、并发症和死亡率。使用随机效应荟萃分析，我们计算了95%置信区间（ci）的合并患病率估计值。最后，我们用纽卡斯尔-渥太华量表评估研究质量。结果共纳入24项研究，涉及来自11个SSA国家的2078名儿童。合并平均发病年龄为13.2个月，64%的病例为男性。典型的三联征（间歇性腹痛、呕吐和带血便）出现在50.4% (95% CI: 37.3-63.4)，症状出现前的平均持续时间为3.45 d。58.3% （95% CI: 49.2-66.9）使用了超声波，而单独的临床诊断占34.7%。手工复位是最常见的手术方法（55.2%;95% CI: 49.9-60.6），其次是吻合切除（38.2%;95% CI: 31.0-45.3）。术后并发症发生率为24.5% (95% CI: 18.5-30.5)，以手术部位感染最为常见。合并死亡率为12.4% (95% CI: 9.2-15.6)，大大高于全球平均水平。结论小儿SSA肠套叠表现迟缓，对手术治疗的依赖程度高，死亡率和并发症发生率高得令人无法接受。加强早期诊断、扩大非手术复位的可及性和提高手术能力对于减轻该地区这种疾病的负担至关重要。

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引用次数: 0

Letter Regarding: Racial and Sex Disparities in US Kidney Transplant Clinical Trials: A Comparative Analysis With National Transplant Registry Data 关于“美国肾移植临床试验中的种族和性别差异：与国家移植登记数据的比较分析”的信。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.10.050

Annika Gompers MPhil, Jessica L. Harding PhD

引用次数: 0

Cover 1: Update 封面一：更新

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/S0022-4804(26)00005-3

引用次数: 0

On The Cover 封面上

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/S0022-4804(26)00004-1

引用次数: 0

Response Regarding: Predicting Acute Cholecystitis on Final Pathology to Prioritize Surgical Urgency: An Evaluation of the Tokyo Criteria and Development of a Novel Predictive Score 关于：预测急性胆囊炎的最终病理优先手术紧迫性：东京标准的评估和一种新的预测评分的发展。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.014

Lilly Groszman MD, Brent Hopkins MD, MSc, FRCSC, Nawaf AlShahwan MBBS, FRCSC, DABS, Shannon Fraser MD, MSc, FRCSC, Simon Bergman MD, MSc, FRCSC, Jean-Sebastien Pelletier MD, FRCSC, Tsafrir Vanounou MD, MBA, Evan G. Wong MD, MPH, FRCSC, FACS

引用次数: 0

Letter Regarding: Predicting Acute Cholecystitis on Final Pathology to Prioritize Surgical Urgency: An Evaluation of the Tokyo Criteria and Development of a Novel Predictive Score 关于：“预测急性胆囊炎的最终病理优先手术紧迫性：东京标准的评估和一种新的预测评分的发展”。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.10.049

Tirayut Veerasatian MD, Schawanya K. Rattanapitoon MD, Chutharat Thanchonnang PhD, Nathkapach K. Rattanapitoon PhD

引用次数: 0

Automating Injury Severity Score Calculation Using Large Language Models: A Feasibility Study With Large Language Model–Assisted Trauma Scoring 使用大型语言模型自动计算损伤严重程度评分：大型语言模型辅助创伤评分的可行性研究。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.11.064

Sheng-Yu Chan MD , Pang-Chun Liao , Albert Jow , Ying-Jia Lin PhD , Kuan-Yueh Fang , Chi-Tung Cheng MDPhD , Chien-Hung Liao MDFACSFICS , Chih-Chi Chen MD , David A. Spain MDFACS

Introduction

The injury severity score (ISS) is a crucial tool for trauma severity assessment, but its calculation relies on registrars manually assigning the scores, a process prone to human error and time constraints. This study evaluates the feasibility of using a large language model (LLM) to assist in ISS calculation based on trauma patients’ diagnoses.

Methods

A retrospective study was conducted at a level I trauma center. Training data from trauma patients hospitalized in 2022 were used, and we retrieved the final diagnoses, abbreviated injury scale scores, and ISS values assigned by experienced registrars. The LLM was trained with structured prompts detailing trauma scoring principles. The model was validated using 100 randomly selected trauma cases from 2022, comparing LLM-generated ISS (LLM ISS) with registrar-calculated ISS. The correlation was evaluated using Pearson correlation, and the agreement was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis.

Results

Among the 100 trauma patients, the ISS distribution showed 34 patients with ISS <9, 33 with ISS 9–16, and 33 with ISS >16. The intraclass correlation coefficient between LLM ISS and registrar-calculated ISS was 0.981 (95% confidence interval: 0.97, 0.99), with an accuracy of 0.91. Bland-Altman analysis showed a mean bias of −0.03 indicating strong consistency.

Conclusions

LLM ISS demonstrated high reliability and accuracy, offering a promising approach to automate trauma scoring. Future research should explore its integration into real-time clinical workflows and its expansion to other trauma severity scores.

简介：损伤严重程度评分（ISS）是创伤严重程度评估的重要工具，但其计算依赖于注册员手动分配分数，这一过程容易出现人为错误和时间限制。本研究评估了基于创伤患者诊断使用大语言模型（LLM）辅助ISS计算的可行性。方法：在某一级创伤中心进行回顾性研究。我们使用了2022年住院的创伤患者的训练数据，并检索了最终诊断、简略损伤量表评分和由经验丰富的登记员分配的ISS值。法学硕士接受结构化提示，详细说明创伤评分原则。该模型使用2022年随机选择的100例创伤病例进行验证，将LLM生成的ISS （LLM ISS）与注册者计算的ISS进行比较。使用Pearson相关评价相关性，使用类内相关系数（ICC）和Bland-Altman分析评价一致性。结果：100例外伤患者中，ISS分布为34例，ISS为16。LLM ISS与注册者计算ISS的类内相关系数为0.981(95%可信区间：0.97,0.99)，准确率为0.91。Bland-Altman分析显示，平均偏差为-0.03，表明一致性强。结论：LLM ISS具有较高的可靠性和准确性，为创伤自动评分提供了一种有前景的方法。未来的研究应探索将其整合到实时临床工作流程中，并将其扩展到其他创伤严重程度评分中。

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Journal of Surgical Research

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