Pub Date : 2026-01-05DOI: 10.1016/j.jss.2025.12.012
Karolina Anuszkiewicz MD , Artur Furga MD , Piotr Stogowski MD, PhD , Magdalena Graczyk MD , Jerzy Jankau MD, PhD
Introduction
As risk factors of free flap loss related to the patient are unmodifiable, proper perioperative protocol is crucial. Perioperative blood transfusion (PBT) may be associated with an increased risk of medical complications, prolonged length of stay, and an increased risk of surgical site infection. The question of this study is whether PBT in free flap reconstructions may be associated with flap failure and anastomosis thrombosis.
Methods
Preferred Reporting Items Systematic Review and Meta-Analysis protocol was used, and the literature search was performed on Pubmed, Embase, and Scopus. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. Meta-analysis was performed.
Results
Fifteen articles were enrolled in the study, representing 7871 patients. Statistically significant risk ratios (RRs) were observed, indicating PBT was associated with an increased risk of both anastomosis thrombosis (RR 1.71, 95% confidence interval [CI] 1.12-2.59) and flap failure (RR 2.02, 95% CI 1.25-3.26). Further analysis led to the division of three subgroups due to the operation site. For breast reconstruction, the RR was 7.96 (95% CI 4.00-15.81) for flap failure and 2.94 (95% CI 1.88-4.61) for anastomosis thrombosis. For head and neck reconstruction, the RR were 1.22 (95% CI 0.86-1.73) and 1.02 (95% CI 0.59-1.75), respectively. In the mixed group, RR was 2.23 (95% CI 1.06-4.58) for flap failure and 1.23 (95% CI 0.59-2.56) for anastomosis thrombosis.
Conclusions
Although overall PBT is associated with a higher incidence of flap necrosis and anastomosis thrombosis, this association is statistically significant only in breast reconstruction. Further prospective studies focusing on specific flap surgery types are warranted.
导言：游离皮瓣丢失的危险因素与患者的关系是不可改变的，因此正确的围手术期方案至关重要。围手术期输血（PBT）可能与并发症风险增加、住院时间延长和手术部位感染风险增加有关。本研究的问题是游离皮瓣重建中的PBT是否与皮瓣衰竭和吻合口血栓形成有关。方法：采用系统评价和荟萃分析方案，在Pubmed、Embase和Scopus上进行文献检索。个别研究的偏倚风险通过纽卡斯尔渥太华量表进行评估。进行meta分析。结果：15篇文章纳入研究，代表7871例患者。观察到具有统计学意义的风险比（RRs），表明PBT与吻合口血栓形成（RR 1.71, 95%可信区间[CI] 1.12-2.59）和皮瓣衰竭（RR 2.02, 95% CI 1.25-3.26）的风险增加相关。进一步分析，根据手术部位将其分为三个亚组。对于乳房重建，皮瓣失败的RR为7.96 (95% CI 4.00-15.81)，吻合口血栓形成的RR为2.94 （95% CI 1.88-4.61）。对于头颈部重建，RR分别为1.22 （95% CI 0.86-1.73）和1.02 （95% CI 0.59-1.75）。混合组皮瓣失败的RR为2.23 (95% CI 1.06-4.58)，吻合口血栓形成的RR为1.23 （95% CI 0.59-2.56）。结论：尽管整体PBT与较高的皮瓣坏死和吻合口血栓发生率相关，但这种关联仅在乳房重建中具有统计学意义。进一步的前瞻性研究侧重于特定的皮瓣手术类型是必要的。
{"title":"The Association of Blood Transfusion With Free Flap Survival and Thrombosis: A Review and Meta-Analysis","authors":"Karolina Anuszkiewicz MD , Artur Furga MD , Piotr Stogowski MD, PhD , Magdalena Graczyk MD , Jerzy Jankau MD, PhD","doi":"10.1016/j.jss.2025.12.012","DOIUrl":"10.1016/j.jss.2025.12.012","url":null,"abstract":"<div><h3>Introduction</h3><div>As risk factors of free flap loss related to the patient are unmodifiable, proper perioperative protocol is crucial. Perioperative blood transfusion (PBT) may be associated with an increased risk of medical complications, prolonged length of stay, and an increased risk of surgical site infection. The question of this study is whether PBT in free flap reconstructions may be associated with flap failure and anastomosis thrombosis.</div></div><div><h3>Methods</h3><div>Preferred Reporting Items Systematic Review and Meta-Analysis protocol was used, and the literature search was performed on Pubmed, Embase, and Scopus. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. Meta-analysis was performed.</div></div><div><h3>Results</h3><div>Fifteen articles were enrolled in the study, representing 7871 patients. Statistically significant risk ratios (RRs) were observed, indicating PBT was associated with an increased risk of both anastomosis thrombosis (RR 1.71, 95% confidence interval [CI] 1.12-2.59) and flap failure (RR 2.02, 95% CI 1.25-3.26). Further analysis led to the division of three subgroups due to the operation site. For breast reconstruction, the RR was 7.96 (95% CI 4.00-15.81) for flap failure and 2.94 (95% CI 1.88-4.61) for anastomosis thrombosis. For head and neck reconstruction, the RR were 1.22 (95% CI 0.86-1.73) and 1.02 (95% CI 0.59-1.75), respectively. In the mixed group, RR was 2.23 (95% CI 1.06-4.58) for flap failure and 1.23 (95% CI 0.59-2.56) for anastomosis thrombosis.</div></div><div><h3>Conclusions</h3><div>Although overall PBT is associated with a higher incidence of flap necrosis and anastomosis thrombosis, this association is statistically significant only in breast reconstruction. Further prospective studies focusing on specific flap surgery types are warranted.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 14-24"},"PeriodicalIF":1.7,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-03DOI: 10.1016/j.jss.2025.12.001
Utsav M. Patwardhan MD , Chakshu Soni MPH , Sindhu Mannava MD MS , Insiyah Campwala MD , Alexandra Vacaru BS , James Cope BMed , S.V. Soundappan MD , Donald Moores MD , Andrei Radulescu MD , Barrett P. Cromeens DO, PhD , Paul Waltz MD , Gerald Gollin MD
Introduction
The operative management of meconium ileus in infants often includes enterotomy or appendectomy with N-acetylcysteine (NAC) instillation. Some have adopted an approach whereby NAC is instead injected directly into the meconium-bearing ileum at multiple sites with a small-gauge needle. We hypothesized that this technique would facilitate the mobilization of meconium without an enterotomy or even appendectomy.
Methods
A retrospective study of neonates who underwent operative management of meconium ileus at 6 hospitals in the United States and Australia between 2010 and 2021 was conducted. Outcomes after NAC instillation at multiple sites with a 27G needle injection versus enterotomy or the appendiceal stump were assessed. The primary outcomes were operative duration and time to full enteral feedings.
Results
Inclusion criteria were met in 52 patients and 9 (17.3%) underwent needle injection of NAC. Meconium was evacuated via the appendiceal stump (33%) or colon and passed via rectum (67%) in all patients in whom NAC was injected via a needle but in only 4 (9%) of those who were administered NAC via an enterotomy. Time to first stool, first enteral feeding, goal enteral feedings, and postoperative length of stay did not differ based on the operative approach. The median operative time in the needle injection group was significantly shorter (90 versus 133 min, P = 0.009).
Conclusions
Needle injection of NAC appears to be safe and effective in clearing inspissated meconium in neonates who required operative management. It obviated the need for enteral violation in the majority of cases and resulted in reduced operative time.
前言：婴儿胎便性肠梗阻的手术治疗通常包括肠切开或阑尾切除联合n -乙酰半胱氨酸（NAC）灌注。有些人采用了一种方法，即用小尺寸针头将NAC直接注射到含有粪的回肠的多个部位。我们假设这项技术将促进胎便的动员，而无需肠切除术或甚至阑尾切除术。方法回顾性分析2010年至2021年在美国和澳大利亚6家医院接受手术治疗的胎便性肠梗阻新生儿。采用27G针注射在多个部位注射NAC与肠切开或阑尾残端相比的结果进行了评估。主要结果是手术时间和完全肠内喂养的时间。结果52例患者符合纳入标准，其中9例（17.3%）行针注射NAC。在所有通过针头注射NAC的患者中，胎便通过阑尾残端（33%）或结肠排出，并通过直肠排出（67%），而通过肠切开注射NAC的患者中只有4例（9%）。首次排便时间、首次肠内喂养时间、目标肠内喂养时间和术后住院时间均未因手术入路而异。针注射组中位手术时间明显短于对照组（90 min vs 133 min, P = 0.009）。结论针注NAC对需要手术治疗的新生儿浓粪清除安全有效。在大多数情况下，它避免了肠内侵犯的需要，并减少了手术时间。
{"title":"Operative Management of Meconium Ileus With Needle Injection of N-Acetylcysteine","authors":"Utsav M. Patwardhan MD , Chakshu Soni MPH , Sindhu Mannava MD MS , Insiyah Campwala MD , Alexandra Vacaru BS , James Cope BMed , S.V. Soundappan MD , Donald Moores MD , Andrei Radulescu MD , Barrett P. Cromeens DO, PhD , Paul Waltz MD , Gerald Gollin MD","doi":"10.1016/j.jss.2025.12.001","DOIUrl":"10.1016/j.jss.2025.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The operative management of meconium ileus in infants often includes enterotomy or appendectomy with N-acetylcysteine (NAC) instillation. Some have adopted an approach whereby NAC is instead injected directly into the meconium-bearing ileum at multiple sites with a small-gauge needle. We hypothesized that this technique would facilitate the mobilization of meconium without an enterotomy or even appendectomy.</div></div><div><h3>Methods</h3><div>A retrospective study of neonates who underwent operative management of meconium ileus at 6 hospitals in the United States and Australia between 2010 and 2021 was conducted. Outcomes after NAC instillation at multiple sites with a 27G needle injection <em>versus</em> enterotomy or the appendiceal stump were assessed. The primary outcomes were operative duration and time to full enteral feedings.</div></div><div><h3>Results</h3><div>Inclusion criteria were met in 52 patients and 9 (17.3%) underwent needle injection of NAC. Meconium was evacuated via the appendiceal stump (33%) or colon and passed via rectum (67%) in all patients in whom NAC was injected via a needle but in only 4 (9%) of those who were administered NAC via an enterotomy. Time to first stool, first enteral feeding, goal enteral feedings, and postoperative length of stay did not differ based on the operative approach. The median operative time in the needle injection group was significantly shorter (90 <em>versus</em> 133 min, <em>P</em> = 0.009).</div></div><div><h3>Conclusions</h3><div>Needle injection of NAC appears to be safe and effective in clearing inspissated meconium in neonates who required operative management. It obviated the need for enteral violation in the majority of cases and resulted in reduced operative time.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 9-13"},"PeriodicalIF":1.7,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882676","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 : 2026-01-01DOI: 10.1016/j.jss.2025.08.022
Jordan Johnson BS, Georgios Karamitros MD, MS, Franklin R. Gergoudis MD, William C. Lineaweaver MD
{"title":"Letter Regarding: Gender Disparities in Career Longevity Among Surgeons and Physicians: A Decade-Long Analysis","authors":"Jordan Johnson BS, Georgios Karamitros MD, MS, Franklin R. Gergoudis MD, William C. Lineaweaver MD","doi":"10.1016/j.jss.2025.08.022","DOIUrl":"10.1016/j.jss.2025.08.022","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 602-603"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687552","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 : 2026-01-01DOI: 10.1016/j.jss.2025.11.060
Nina D. Kosciuszek DO, MS, Kenneth W. Gow MD, MHA
{"title":"Response Regarding: Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends","authors":"Nina D. Kosciuszek DO, MS, Kenneth W. Gow MD, MHA","doi":"10.1016/j.jss.2025.11.060","DOIUrl":"10.1016/j.jss.2025.11.060","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 608-609"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jss.2025.10.032
Megan Kolbe BS , Andrew Francis MD, MS , Jian He MS , Benjamin Schmidt MD, FACS , Raphael Louie MD, MPH
Introduction
Merkel cell carcinoma (MCC) is a rare but aggressive cutaneous neuroendocrine tumor with high mortality rates. Recent US population studies have shown that the incidence of MCC is increasing. We aim to describe our institution's epidemiological trends and compare them with the National Cancer Institute's Surveillance, Epidemiology, and End Results database to determine if there is a region-specific increase in disease incidence.
Methods
We conducted a retrospective, single-institution review of patients diagnosed with MCC between 2010 and 2023. We evaluated the 5-y overall survival (OS) and recurrence-free survival. Kaplan–Meier estimates were used to assess the primary outcomes. The log-tank test and Cox regression modeling was performed to evaluate which factors influenced OS. We compared National Cancer Institute's Surveillance, Epidemiology, and End Results regional (Northeast, Midwest, South, and West) incidences between 2010 and 2021 to those of our cohort.
Results
Between 2010 and 2021, the incidence of MCC has increased within the United States from 7.0 to 8.2 per million. These increases were most pronounced in the South region between 2018 and 2021. We identified 82 patients diagnosed with MCC at our institution, with increasing cases starting in 2017. The 5-y OS was 52.9%, and recurrence-free survival stabilized at 68.8% after 2 y. The results of the OS subgroup comparisons indicated that age at diagnosis, Charlson Comorbidity Index, Eastern Cooperative Oncology Group, and treatment with chemotherapy were significantly associated with OS.
Conclusions
Akin to our experience in Virginia, the increase in MCC incidence is most pronounced in the southern states. As anticipated, our outcomes were influenced by patient comorbidities, advanced age, and need for systemic therapies.
{"title":"A Rare but Increasing Threat: An Evaluation of Regional and Single-Institution Trends in Merkel Cell Carcinoma","authors":"Megan Kolbe BS , Andrew Francis MD, MS , Jian He MS , Benjamin Schmidt MD, FACS , Raphael Louie MD, MPH","doi":"10.1016/j.jss.2025.10.032","DOIUrl":"10.1016/j.jss.2025.10.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Merkel cell carcinoma (MCC) is a rare but aggressive cutaneous neuroendocrine tumor with high mortality rates. Recent US population studies have shown that the incidence of MCC is increasing. We aim to describe our institution's epidemiological trends and compare them with the National Cancer Institute's Surveillance, Epidemiology, and End Results database to determine if there is a region-specific increase in disease incidence.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-institution review of patients diagnosed with MCC between 2010 and 2023. We evaluated the 5-y overall survival (OS) and recurrence-free survival. Kaplan–Meier estimates were used to assess the primary outcomes. The log-tank test and Cox regression modeling was performed to evaluate which factors influenced OS. We compared National Cancer Institute's Surveillance, Epidemiology, and End Results regional (Northeast, Midwest, South, and West) incidences between 2010 and 2021 to those of our cohort.</div></div><div><h3>Results</h3><div>Between 2010 and 2021, the incidence of MCC has increased within the United States from 7.0 to 8.2 per million. These increases were most pronounced in the South region between 2018 and 2021. We identified 82 patients diagnosed with MCC at our institution, with increasing cases starting in 2017. The 5-y OS was 52.9%, and recurrence-free survival stabilized at 68.8% after 2 y. The results of the OS subgroup comparisons indicated that age at diagnosis, Charlson Comorbidity Index, Eastern Cooperative Oncology Group, and treatment with chemotherapy were significantly associated with OS.</div></div><div><h3>Conclusions</h3><div>Akin to our experience in Virginia, the increase in MCC incidence is most pronounced in the southern states. As anticipated, our outcomes were influenced by patient comorbidities, advanced age, and need for systemic therapies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 549-559"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter Regarding: Effects of Irrigation With Normal Saline on Traumatic Brain Injury Combined With Seawater Immersion in Rats","authors":"S. Dhanya Dedeepya MD, Vaishali Goel PhD, Nivedita Nikhil Desai MD","doi":"10.1016/j.jss.2025.11.038","DOIUrl":"10.1016/j.jss.2025.11.038","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 604-605"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724078","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 : 2026-01-01DOI: 10.1016/j.jss.2025.10.051
Mallory N. Perez MD , Maxwell Wilberding BS , Goeto Dantes MD , Alison Lehane MD , Mehul V. Raval MD, MS , Gustave H. Falciglia MD , Nicholas E. Burjek MD , Jane L. Holl MD, MPH , Willemijn L.A. Schäfer PhD
Introduction
The Enhanced Recovery After Surgery Society published guidelines in 2020 for minimizing physiologic stress in neonatal patients who are undergoing intestinal surgery. This study explores stakeholder perceptions of the acceptability and adoption of a neonatal enhanced recovery protocol as well as barriers and facilitators to implementation.
Methods
We conducted seven semistructured focus groups, purposively selecting diverse stakeholders (N = 36) from six US hospitals. Transcripts were generated and transferred into MAXQDA for coding and analysis. We used a combined inductive and deductive approach to develop codes, followed by thematic analysis.
Results
Implementation of the guidelines was variable, with wide adoption of some components (e.g., breastmilk as preferred nutrition) and limited acceptability of others (e.g., early postoperative enteral feeds). We identified five key barriers/facilitators: (1) the heterogeneity of the neonatal surgical population (e.g., degree of prematurity); (2) competing stakeholder priorities (e.g., caregiver values versus clinician assessment of risks/benefits); (3) aligning care across teams (e.g., clinician-clinician, clinician-caregiver communication); (4) the clarity/specificity of component definitions (e.g., “goal-directed fluid management”); and (5) responsiveness to change (e.g., nursing willingness to learn and trial mucous fistula refeeding).
Conclusions
This study provides a preimplementation assessment of an enhanced recovery protocol for neonatal intestinal surgery, highlighting the specific needs of this vulnerable population and identifying actionable refinements to existing guidelines. Broad, effective implementation will require greater consensus on the target population, alignment with stakeholder priorities, clearer care coordination strategies, refined component definitions, and increased openness to practice change.
{"title":"Barriers and Facilitators to Enhanced Recovery Protocol Implementation for Neonatal Intestinal Surgery","authors":"Mallory N. Perez MD , Maxwell Wilberding BS , Goeto Dantes MD , Alison Lehane MD , Mehul V. Raval MD, MS , Gustave H. Falciglia MD , Nicholas E. Burjek MD , Jane L. Holl MD, MPH , Willemijn L.A. Schäfer PhD","doi":"10.1016/j.jss.2025.10.051","DOIUrl":"10.1016/j.jss.2025.10.051","url":null,"abstract":"<div><h3>Introduction</h3><div>The Enhanced Recovery After Surgery Society published guidelines in 2020 for minimizing physiologic stress in neonatal patients who are undergoing intestinal surgery. This study explores stakeholder perceptions of the acceptability and adoption of a neonatal enhanced recovery protocol as well as barriers and facilitators to implementation.</div></div><div><h3>Methods</h3><div>We conducted seven semistructured focus groups, purposively selecting diverse stakeholders (<em>N</em> = 36) from six US hospitals. Transcripts were generated and transferred into MAXQDA for coding and analysis. We used a combined inductive and deductive approach to develop codes, followed by thematic analysis.</div></div><div><h3>Results</h3><div>Implementation of the guidelines was variable, with wide adoption of some components (e.g., breastmilk as preferred nutrition) and limited acceptability of others (e.g., early postoperative enteral feeds). We identified five key barriers/facilitators: (1) the heterogeneity of the neonatal surgical population (e.g., degree of prematurity); (2) competing stakeholder priorities (e.g., caregiver values <em>versus</em> clinician assessment of risks/benefits); (3) aligning care across teams (e.g., clinician-clinician, clinician-caregiver communication); (4) the clarity/specificity of component definitions (e.g., “goal-directed fluid management”); and (5) responsiveness to change (e.g., nursing willingness to learn and trial mucous fistula refeeding).</div></div><div><h3>Conclusions</h3><div>This study provides a preimplementation assessment of an enhanced recovery protocol for neonatal intestinal surgery, highlighting the specific needs of this vulnerable population and identifying actionable refinements to existing guidelines. Broad, effective implementation will require greater consensus on the target population, alignment with stakeholder priorities, clearer care coordination strategies, refined component definitions, and increased openness to practice change.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 580-592"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724086","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 : 2026-01-01DOI: 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.
{"title":"Outpatient Laparoscopic Appendectomy PI","authors":"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","doi":"10.1016/j.jss.2025.11.039","DOIUrl":"10.1016/j.jss.2025.11.039","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>U</em> test. Significance was set at <em>P</em> < 0.05.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 0.014 and <em>P</em> = 0.039, respectively). Median time to OR remained stable at 7.0 h (interquartile range 6.0-10.0), with no significant yearly difference (<em>P</em> = 0.29). In 2020, signage was associated with higher antibiotic (<em>P</em> = 0.001) and imaging compliance (<em>P</em> = 0.001), but not shorter time to OR (<em>P</em> = 0.35). Complications were rare (2%).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 540-548"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862886","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 : 2026-01-01DOI: 10.1016/S0022-4804(26)00002-8
{"title":"Journal of Surgical Research","authors":"","doi":"10.1016/S0022-4804(26)00002-8","DOIUrl":"10.1016/S0022-4804(26)00002-8","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Page iii"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077450","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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