Pub Date : 2026-02-01Epub Date: 2026-01-17DOI: 10.1016/j.jss.2025.12.025
Kevin T. Mutore MD , Katalina Acevedo BA, MS , Phillip Taboada BS , Munir Buhaya MD, Geli Kane BA, Anthony Froix MD, Thomas Shoultz MD
Introduction
Racial and ethnic minorities remain significantly underrepresented in the health care workforce. Despite ongoing efforts, gains in representation have been limited and the disparity widens across successive stages of medical training. Early interventions are essential to empower underrepresented minority students interested in health care with the tools to navigate the educational path toward health careers. This study evaluated whether a three-session college preparatory course could influence the attitudes and perceived preparedness for college among high school students enrolled in a medical and surgical exposure program.
Methods
Seventy-nine 10th grade students participated in a three-session workshop. Preintervention and postintervention surveys were administered using a modified version of the validated College-Going Self-Efficacy Scale and College Planning Behaviors Scale. Paired presurvey and postsurvey data were analyzed using student's t-tests and Fisher's exact tests, with statistical significance defined as P < 0.05.
Results
Forty-four students (56%) completed both surveys. Postintervention, more students had researched the college application process (P = 0.02), college costs (P < 0.01), and identified someone to answer their college-related questions (P < 0.01). Students also reported increased confidence in choosing a good college (P = 0.01) and belief in their academic ability to finish college (P = 0.02).
Conclusions
This is the first study to assess and improve college planning attitudes and behaviors in high school students participating in a surgery exposure program. This suggests that integrating college preparation into health care exposure programs may better support students' educational advancement. Future work should examine whether these improvements lead to increased college application and matriculation rates.
{"title":"Improving College Readiness Through a High School Surgery Exposure Program","authors":"Kevin T. Mutore MD , Katalina Acevedo BA, MS , Phillip Taboada BS , Munir Buhaya MD, Geli Kane BA, Anthony Froix MD, Thomas Shoultz MD","doi":"10.1016/j.jss.2025.12.025","DOIUrl":"10.1016/j.jss.2025.12.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial and ethnic minorities remain significantly underrepresented in the health care workforce. Despite ongoing efforts, gains in representation have been limited and the disparity widens across successive stages of medical training. Early interventions are essential to empower underrepresented minority students interested in health care with the tools to navigate the educational path toward health careers. This study evaluated whether a three-session college preparatory course could influence the attitudes and perceived preparedness for college among high school students enrolled in a medical and surgical exposure program.</div></div><div><h3>Methods</h3><div>Seventy-nine 10th grade students participated in a three-session workshop. Preintervention and postintervention surveys were administered using a modified version of the validated College-Going Self-Efficacy Scale and College Planning Behaviors Scale. Paired presurvey and postsurvey data were analyzed using student's <em>t</em>-tests and Fisher's exact tests, with statistical significance defined as <em>P</em> < 0.05.</div></div><div><h3>Results</h3><div>Forty-four students (56%) completed both surveys. Postintervention, more students had researched the college application process (<em>P</em> = 0.02), college costs (<em>P</em> < 0.01), and identified someone to answer their college-related questions (<em>P</em> < 0.01). Students also reported increased confidence in choosing a good college (<em>P</em> = 0.01) and belief in their academic ability to finish college (<em>P</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>This is the first study to assess and improve college planning attitudes and behaviors in high school students participating in a surgery exposure program. This suggests that integrating college preparation into health care exposure programs may better support students' educational advancement. Future work should examine whether these improvements lead to increased college application and matriculation rates.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 200-207"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978707","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 : 2026-02-01Epub Date: 2026-01-23DOI: 10.1016/j.jss.2025.12.039
Martha Godfrey MD , Ming-Li Wang MD
Although surgical training programs have formalized curricula for professional knowledge and skills acquisition, there is still a gap in nonclinical knowledge that surgical trainees suffer when transitioning to practice (TTP). Financial literacy is one topic that has been identified by both trainees and program directors as a high-yield topic for TTP. Traditionally, surgical trainees relied on formative experience, self-motivated learning, or one-off local institutional efforts. Due to the high demands of time in surgical training and the frequent accumulation of large amounts of educational debt during this process, financial well-being may be neglected, which can lead to professional and personal stress and burnout. The paucity of formal education on this TTP topic causes surgical graduates to rely on informal mentorship during contract negotiation or expensive legal advice. This situation jeopardizes long-term recruitment and retention of surgeons from nonprivileged backgrounds who are less likely to have access to robust informal financial literacy resources. Financially literate surgeons are more likely to enjoy careers that have longevity and high overall career satisfaction. The topic of financial literacy was the focus of a Hot Topic session during the 2025 Academic Surgical Congress. This article covers the content included in that session, including TTP challenges, employment contract basics, negotiation, compensation models, and insurance. This serves as a real-world guide for those who are preparing for TTP or those interested in supporting the recruitment and retention of the next generation of surgical trainees.
{"title":"Blending Life and the Scalpel: A Financial Literacy Workshop for the Transition Beyond Training","authors":"Martha Godfrey MD , Ming-Li Wang MD","doi":"10.1016/j.jss.2025.12.039","DOIUrl":"10.1016/j.jss.2025.12.039","url":null,"abstract":"<div><div>Although surgical training programs have formalized curricula for professional knowledge and skills acquisition, there is still a gap in nonclinical knowledge that surgical trainees suffer when transitioning to practice (TTP). Financial literacy is one topic that has been identified by both trainees and program directors as a high-yield topic for TTP. Traditionally, surgical trainees relied on formative experience, self-motivated learning, or one-off local institutional efforts. Due to the high demands of time in surgical training and the frequent accumulation of large amounts of educational debt during this process, financial well-being may be neglected, which can lead to professional and personal stress and burnout. The paucity of formal education on this TTP topic causes surgical graduates to rely on informal mentorship during contract negotiation or expensive legal advice. This situation jeopardizes long-term recruitment and retention of surgeons from nonprivileged backgrounds who are less likely to have access to robust informal financial literacy resources. Financially literate surgeons are more likely to enjoy careers that have longevity and high overall career satisfaction. The topic of financial literacy was the focus of a Hot Topic session during the 2025 Academic Surgical Congress. This article covers the content included in that session, including TTP challenges, employment contract basics, negotiation, compensation models, and insurance. This serves as a real-world guide for those who are preparing for TTP or those interested in supporting the recruitment and retention of the next generation of surgical trainees.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 339-345"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034672","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 : 2026-02-01Epub 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":"2026-02-01","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}
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":"2026-02-01","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 : 2026-02-01Epub Date: 2026-01-07DOI: 10.1016/j.jss.2025.11.065
Nicholas Galouzis MD, MBA, Maria Fotinos BS, Evelyn V. Alexander MD, Forrest Bethel DO, Mohammad R. Khreiss MD, Lusine Mesropyan DO, Carrie Luu MD, Taylor S. Riall MD, PhD
Introduction
The use of total neoadjuvant chemotherapy (TNC) for pancreatic adenocarcinoma (PDAC) is increasing. This study evaluated the association between chemotherapy timing [TNC, perioperative (PERIOP), adjuvant (ADJ)] and total duration of chemotherapy on survival in PDAC.
Methods
Single-institution, retrospective study (2020-2023) of PDAC patients that underwent surgical resection and chemotherapy with an intended 6-mo course. We compared overall survival and chemotherapy completion rates between TNC, PERIOP, and ADJ groups.
Results
Of 115 patients, 10 received TNC, 69 PERIOP, and 36 ADJ chemotherapy. Pancreaticoduodenectomy was performed in 64.4% of patients. Resectable disease was more common in the ADJ group (97.2%) compared to PERIOP (47.8%) or TNC (30.0%, P < 0.01) groups, with vascular resection more common in TNC compared to PERIOP or ADJ groups (40.0% versus 7.2% versus 8.3%, P = 0.02). The TNC group was more frequently node negative (70.0% versus 43.5% PERIOP versus 36.1% ADJ, P = 0.02). Median survival from first treatment was similar between the groups (TNC 43 versus PERIOP 40 versus ADJ 38 mo, P = 0.70). By definition, all TNC patients completed 6 mo of chemotherapy. Completion of chemotherapy was much less common in the in the PERIOP group (40.6%) and the ADJ group (36.1%, P < 0.01), as patients were unable to tolerate chemotherapy after surgery. Patients who completed 6 mo of chemotherapy, regardless of timing relative to surgery, had a median overall survival of 43 mo compared to 35 mo in those who did not (hazard ratio 0.37, 95% confidence interval: 0.19-0.73; P < 0.01).
Conclusions
Completion of 6 mo of chemotherapy was associated with improved survival, regardless of timing. As postoperative completion rates remain low, TNC may facilitate higher chemotherapy completion rates.
全新辅助化疗（TNC）在胰腺腺癌（PDAC）中的应用越来越多。本研究评估化疗时间[TNC，围手术期（PERIOP），辅助（ADJ）]和总化疗时间对PDAC患者生存的影响。方法采用单机构、回顾性研究（2020-2023），对接受手术切除和化疗的PDAC患者进行为期6个月的研究。我们比较了TNC、PERIOP和ADJ组的总生存期和化疗完成率。结果115例患者中，TNC化疗10例，PERIOP化疗69例，ADJ化疗36例。64.4%的患者行胰十二指肠切除术。可切除的疾病在ADJ组（97.2%）比PERIOP组（47.8%）或TNC组（30.0%,P < 0.01）更常见，血管切除在TNC组比PERIOP组或ADJ组（40.0%比7.2%比8.3%,P = 0.02）更常见。TNC组更常出现淋巴结阴性（70.0% vs 43.5% PERIOP vs 36.1% ADJ, P = 0.02）。两组首次治疗后的中位生存期相似（TNC 43个月vs . PERIOP 40个月vs . ADJ 38个月，P = 0.70）。根据定义，所有TNC患者完成了6个月的化疗。由于术后患者无法耐受化疗，PERIOP组（40.6%）和ADJ组（36.1%,P < 0.01）化疗完成率较低。完成6个月化疗的患者，无论与手术相关的时间如何，中位总生存期为43个月，而未完成化疗的患者为35个月（风险比0.37,95%可信区间：0.19-0.73;P < 0.01）。结论：无论时间如何，完成6个月的化疗与生存率的提高有关。由于术后完成率仍然很低，TNC可能促进更高的化疗完成率。
{"title":"Association of Neoadjuvant Therapy on Pathologic and Clinical Outcomes for Pancreatic Adenocarcinoma","authors":"Nicholas Galouzis MD, MBA, Maria Fotinos BS, Evelyn V. Alexander MD, Forrest Bethel DO, Mohammad R. Khreiss MD, Lusine Mesropyan DO, Carrie Luu MD, Taylor S. Riall MD, PhD","doi":"10.1016/j.jss.2025.11.065","DOIUrl":"10.1016/j.jss.2025.11.065","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of total neoadjuvant chemotherapy (TNC) for pancreatic adenocarcinoma (PDAC) is increasing. This study evaluated the association between chemotherapy timing [TNC, perioperative (PERIOP), adjuvant (ADJ)] and total duration of chemotherapy on survival in PDAC.</div></div><div><h3>Methods</h3><div>Single-institution, retrospective study (2020-2023) of PDAC patients that underwent surgical resection and chemotherapy with an intended 6-mo course. We compared overall survival and chemotherapy completion rates between TNC, PERIOP, and ADJ groups.</div></div><div><h3>Results</h3><div>Of 115 patients, 10 received TNC, 69 PERIOP, and 36 ADJ chemotherapy. Pancreaticoduodenectomy was performed in 64.4% of patients. Resectable disease was more common in the ADJ group (97.2%) compared to PERIOP (47.8%) or TNC (30.0%, <em>P</em> < 0.01) groups, with vascular resection more common in TNC compared to PERIOP or ADJ groups (40.0% <em>versus</em> 7.2% <em>versus</em> 8.3%, <em>P</em> = 0.02). The TNC group was more frequently node negative (70.0% <em>versus</em> 43.5% PERIOP <em>versus</em> 36.1% ADJ, <em>P</em> = 0.02). Median survival from first treatment was similar between the groups (TNC 43 <em>versus</em> PERIOP 40 <em>versus</em> ADJ 38 mo, <em>P</em> = 0.70). By definition, all TNC patients completed 6 mo of chemotherapy. Completion of chemotherapy was much less common in the in the PERIOP group (40.6%) and the ADJ group (36.1%, <em>P</em> < 0.01), as patients were unable to tolerate chemotherapy after surgery. Patients who completed 6 mo of chemotherapy, regardless of timing relative to surgery, had a median overall survival of 43 mo compared to 35 mo in those who did not (hazard ratio 0.37, 95% confidence interval: 0.19-0.73; <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>Completion of 6 mo of chemotherapy was associated with improved survival, regardless of timing. As postoperative completion rates remain low, TNC may facilitate higher chemotherapy completion rates.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 64-74"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927882","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 : 2026-02-01Epub Date: 2026-01-07DOI: 10.1016/j.jss.2025.12.011
Brian Kasagga MBChB , Joseph Thaimye MBChB , Daniel Lawal MBChB , Boma Esther Jacks MD , Benjamin Chukwunonso Okonkwo MBBS , Obieze Nwanna-Nzewunwa MD
Introduction
Pediatric liver diseases are a significant mortality burden in low-income countries particularly in Africa, where access to life-saving pediatric liver transplantation (PLT) is limited. We aimed to determine the current state of PLT in Africa based on the available literature, identify key barriers to access, and propose solutions.
Methods
We conducted a comprehensive search of peer-reviewed articles, reports, and gray literature from databases such as Google Scholar, PubMed Central, Web of Science, and African Journal Online. We included studies on PLT between January 2000 and July 2024. Data were extracted, collated, and summarized following the Arksey, O'Malley, and Joanna Briggs Institute frameworks.
Results
Only two African countries have PLT programs, located in South Africa and Egypt. Approximately 548 PLTs were performed, with 388 in South Africa and 160 in Egypt. Biliary atresia is the leading indication (43.1%). Sixty-six percent of patients wait longer than a year for a transplant. Living donors are predominantly used, with deceased donor programs primarily located in South Africa. Compared to global 1-y and 5-y survival rates of 86.6% and 77.7%, survival in Africa is at 79.4% and 67.4%, respectively. PLT complications include biliary (41%), vascular (16%), and enteric (10%). Major challenges include limited access and infrastructure, donor shortages, late referrals, diagnostic delays, financial and socioeconomic barriers, clinical and postoperative complications, and policy bottlenecks.
Conclusions
PLT in Africa has limited access and poorer outcomes compared to global trends. Addressing these requires increasing resources, improved early diagnosis, expanded deceased donor programs, policy development, education, and resource allocation.
在低收入国家，儿童肝脏疾病是一个重要的死亡率负担，特别是在非洲，那里获得拯救生命的儿童肝移植（PLT）的机会有限。我们的目标是根据现有文献确定非洲PLT的现状，确定获取PLT的主要障碍，并提出解决方案。方法我们从谷歌Scholar、PubMed Central、Web of Science和African Journal Online等数据库中对同行评议的文章、报告和灰色文献进行了全面搜索。我们纳入了2000年1月至2024年7月间关于PLT的研究。数据是按照Arksey、O'Malley和Joanna Briggs研究所的框架提取、整理和总结的。只有两个非洲国家有PLT项目，分别是南非和埃及。大约进行了548例plt，其中388例在南非，160例在埃及。胆道闭锁是主要适应症（43.1%）。66%的患者等待移植的时间超过一年。主要使用活体捐赠者，而已故捐赠者计划主要位于南非。与全球1年和5年生存率分别为86.6%和77.7%相比，非洲的生存率分别为79.4%和67.4%。PLT并发症包括胆道（41%）、血管（16%）和肠道（10%）。主要挑战包括获取途径和基础设施有限、供体短缺、转诊延迟、诊断延误、财政和社会经济障碍、临床和术后并发症以及政策瓶颈。结论与全球趋势相比，非洲的splt可及性有限，结果较差。解决这些问题需要增加资源、改善早期诊断、扩大已故捐赠者计划、制定政策、教育和资源分配。
{"title":"Status, Advances, and Challenges in Pediatric Liver Transplantation in Africa: A Scoping Review","authors":"Brian Kasagga MBChB , Joseph Thaimye MBChB , Daniel Lawal MBChB , Boma Esther Jacks MD , Benjamin Chukwunonso Okonkwo MBBS , Obieze Nwanna-Nzewunwa MD","doi":"10.1016/j.jss.2025.12.011","DOIUrl":"10.1016/j.jss.2025.12.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric liver diseases are a significant mortality burden in low-income countries particularly in Africa, where access to life-saving pediatric liver transplantation (PLT) is limited. We aimed to determine the current state of PLT in Africa based on the available literature, identify key barriers to access, and propose solutions.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of peer-reviewed articles, reports, and gray literature from databases such as Google Scholar, PubMed Central, Web of Science, and African Journal Online. We included studies on PLT between January 2000 and July 2024. Data were extracted, collated, and summarized following the Arksey, O'Malley, and Joanna Briggs Institute frameworks.</div></div><div><h3>Results</h3><div>Only two African countries have PLT programs, located in South Africa and Egypt. Approximately 548 PLTs were performed, with 388 in South Africa and 160 in Egypt. Biliary atresia is the leading indication (43.1%). Sixty-six percent of patients wait longer than a year for a transplant. Living donors are predominantly used, with deceased donor programs primarily located in South Africa. Compared to global 1-y and 5-y survival rates of 86.6% and 77.7%, survival in Africa is at 79.4% and 67.4%, respectively. PLT complications include biliary (41%), vascular (16%), and enteric (10%). Major challenges include limited access and infrastructure, donor shortages, late referrals, diagnostic delays, financial and socioeconomic barriers, clinical and postoperative complications, and policy bottlenecks.</div></div><div><h3>Conclusions</h3><div>PLT in Africa has limited access and poorer outcomes compared to global trends. Addressing these requires increasing resources, improved early diagnosis, expanded deceased donor programs, policy development, education, and resource allocation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 52-63"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927883","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 : 2026-02-01Epub Date: 2026-01-21DOI: 10.1016/j.jss.2025.12.035
Wendelyn M. Oslock MD, MBA, MSPH , Lauren Wood MPH , Arundhati Sawant MBBS , Nathan C. English MBChB , Bayley A. Jones MD, MSPH , Victor Perim MD , Colin Martin MD , Daniel I. Chu MD, MSPH , Ruzmyn Vilcassim MS, PhD
Introduction
Air pollution negatively impacts health outcomes for chronic conditions and has been linked to the development of surgically managed diseases. Its impact on surgical outcomes, however, is not well understood.
Methods
In this cross-sectional study, we linked institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to publicly available air pollutant data from 2006 to 2021. We compared the length of stay (LOS), 30-day complications, and readmission for patients undergoing colorectal surgery based on patient home county exposure to particulate matter <2.5 μm in diameter (PM2.5) during the year of their operation. Patient demographics, comorbidities, procedural characteristics, as well as social vulnerability were included. Statistical analysis included chi-square tests, Kruskal–Wallis rank sum, Pearson correlation, as well as logistical and linear regression modeling.
Results
A total of 1892 surgical encounters were linked to PM2.5. Overall, patients were a median 58.7 years of age, 53% female, 35% Black, 45% had private insurance, and 71% came from areas with a high Social Vulnerability Index. Most procedures were elective (77%) and open (54%). The median LOS was 5 days (interquartile range, 3-9) with a 30-day readmission rate of 12% and 30% of patients experiencing at least one complication. On multivariable analysis, PM2.5 exposure was associated with LOS. Compared to patients from areas with low PM2.5, those from moderately elevated and high PM2.5 had an incidence rate ratio of 1.08 [95% confidence interval: 1.04-1.13] and 1.08 [1.02-1.15], respectively.
Conclusions
Air pollution is associated with longer LOS following colorectal surgery. Although readmission and complication rates were not found to be statistically significant, the limited sample size warrants larger study populations.
{"title":"Long-term Particulate Matter Exposure and Prolonged Length of Stay After Surgery—A Novel Association","authors":"Wendelyn M. Oslock MD, MBA, MSPH , Lauren Wood MPH , Arundhati Sawant MBBS , Nathan C. English MBChB , Bayley A. Jones MD, MSPH , Victor Perim MD , Colin Martin MD , Daniel I. Chu MD, MSPH , Ruzmyn Vilcassim MS, PhD","doi":"10.1016/j.jss.2025.12.035","DOIUrl":"10.1016/j.jss.2025.12.035","url":null,"abstract":"<div><h3>Introduction</h3><div>Air pollution negatively impacts health outcomes for chronic conditions and has been linked to the development of surgically managed diseases. Its impact on surgical outcomes, however, is not well understood.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we linked institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to publicly available air pollutant data from 2006 to 2021. We compared the length of stay (LOS), 30-day complications, and readmission for patients undergoing colorectal surgery based on patient home county exposure to particulate matter <2.5 μm in diameter (PM<sub>2.5</sub>) during the year of their operation. Patient demographics, comorbidities, procedural characteristics, as well as social vulnerability were included. Statistical analysis included chi-square tests, Kruskal–Wallis rank sum, Pearson correlation, as well as logistical and linear regression modeling.</div></div><div><h3>Results</h3><div>A total of 1892 surgical encounters were linked to PM<sub>2.5</sub>. Overall, patients were a median 58.7 years of age, 53% female, 35% Black, 45% had private insurance, and 71% came from areas with a high Social Vulnerability Index. Most procedures were elective (77%) and open (54%). The median LOS was 5 days (interquartile range, 3-9) with a 30-day readmission rate of 12% and 30% of patients experiencing at least one complication. On multivariable analysis, PM<sub>2.5</sub> exposure was associated with LOS. Compared to patients from areas with low PM<sub>2.5</sub>, those from moderately elevated and high PM<sub>2.5</sub> had an incidence rate ratio of 1.08 [95% confidence interval: 1.04-1.13] and 1.08 [1.02-1.15], respectively.</div></div><div><h3>Conclusions</h3><div>Air pollution is associated with longer LOS following colorectal surgery. Although readmission and complication rates were not found to be statistically significant, the limited sample size warrants larger study populations.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 281-289"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030161","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 : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub 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":"2026-02-01","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 : 2026-02-01Epub Date: 2026-01-14DOI: 10.1016/j.jss.2025.11.071
Hongke Wu MD, MS, MPH , Ye Liu MD, MPH, DrPH
Introduction
Spatial analysis helps to understand geographic influences on surgical outcomes, healthcare access, and resource allocation.
Materials and methods
This commentary reviews spatial methods, including Kernel Density Estimation, indicators of spatial autocorrelation, spatial autoregression models, and Bayesian spatial modeling.
Results
Kernel Density Estimation and Local Moran's Index effectively identify geographic clusters of surgical complications. Spatial autoregression models quantify direct and indirect (spillover) effects, and Bayesian approaches provide stable estimates, especially for small-area studies. Despite these advantages, careful consideration of methodological challenges and limitations is crucial for accurate interpretation and application of spatial analytical findings in surgical research.
Conclusions
Spatial analysis provides powerful tools for examining geographic disparities in surgical care, but thoughtful application and interpretation are essential to ensure valid and actionable insights.
{"title":"Spatial Analysis in Surgical Research","authors":"Hongke Wu MD, MS, MPH , Ye Liu MD, MPH, DrPH","doi":"10.1016/j.jss.2025.11.071","DOIUrl":"10.1016/j.jss.2025.11.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Spatial analysis helps to understand geographic influences on surgical outcomes, healthcare access, and resource allocation.</div></div><div><h3>Materials and methods</h3><div>This commentary reviews spatial methods, including Kernel Density Estimation, indicators of spatial autocorrelation, spatial autoregression models, and Bayesian spatial modeling.</div></div><div><h3>Results</h3><div>Kernel Density Estimation and Local Moran's Index effectively identify geographic clusters of surgical complications. Spatial autoregression models quantify direct and indirect (spillover) effects, and Bayesian approaches provide stable estimates, especially for small-area studies. Despite these advantages, careful consideration of methodological challenges and limitations is crucial for accurate interpretation and application of spatial analytical findings in surgical research.</div></div><div><h3>Conclusions</h3><div>Spatial analysis provides powerful tools for examining geographic disparities in surgical care, but thoughtful application and interpretation are essential to ensure valid and actionable insights.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 193-199"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978671","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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