Journal of Surgical Research最新文献

英文中文

Barriers and Facilitators to Enhanced Recovery Protocol Implementation for Neonatal Intestinal Surgery 加强新生儿肠道手术恢复方案实施的障碍和促进因素。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2026-01-01 DOI: 10.1016/j.jss.2025.10.051

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.

导论：术后增强恢复学会于2020年发布了指南，旨在最大限度地减少接受肠道手术的新生儿患者的生理应激。本研究探讨了利益相关者对新生儿增强康复方案的可接受性和采用的看法，以及实施的障碍和促进因素。方法：我们进行了7个半结构化焦点小组，有目的地从6家美国医院选择不同的利益相关者（N = 36）。生成转录本并转移到MAXQDA进行编码和分析。我们使用归纳和演绎相结合的方法来开发代码，然后进行主题分析。结果：指南的实施是可变的，一些成分（例如，母乳作为首选营养）被广泛采用，而其他成分（例如，术后早期肠内喂养）的可接受性有限。我们确定了五个关键障碍/促进因素：(1)新生儿手术人群的异质性（例如，早产程度）；(2)相互竞争的利益相关者优先事项（例如，护理者价值观与临床医生对风险/收益的评估）；(3)协调跨团队的护理（例如，临床医生与临床医生、临床医生与护理者之间的沟通）；(4)各组成部分定义的清晰度/特异性（例如，“目标导向的流体管理”）；(5)对变化的反应性（如护理学习意愿和尝试粘膜瘘再喂养）。结论：本研究为新生儿肠道手术的增强恢复方案提供了实施前评估，突出了这一弱势群体的具体需求，并确定了现有指南的可操作改进。广泛而有效的实施将需要对目标人群达成更大的共识，与利益相关者的优先事项保持一致，更明确的护理协调战略，完善的组成部分定义，以及对实践变化的更大开放性。

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引用次数: 0

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

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of Surgical Research

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