Journal of Surgical Research最新文献_第9页

Porcine Packed Red Blood Cells Demonstrate a Distinct Red Blood Cell Storage Lesion 猪包装红细胞显示出独特的红细胞贮存病变

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-17 DOI: 10.1016/j.jss.2024.09.024

Ryan C. Chae MD, Adam D. Price MD, Matthew R. Baucom MD, Lindsey J. Wattley MD, Christopher Q. Nguyen BS, Michael D. Goodman MD, Timothy A. Pritts MD, PhD

Introduction

The red blood cell (RBC) storage lesion has been well described in mouse and human blood but not in swine. Understanding the porcine RBC storage lesion is necessary prior to evaluating transfusion of stored packed red blood cells (pRBCs) in polytrauma models. We hypothesized that porcine pRBCs would undergo a similar storage lesion severity after 42 d.

Methods

Whole blood was collected from female Yorkshire pigs and pRBCs were isolated in additive storage solution 3. Female human whole blood was obtained from our local blood bank and pRBCs prepared. Human and porcine pRBCs were stored for 42 d and sampled weekly and evaluated for markers of the RBC storage lesion including biochemical measurements, eryptotic RBCs, band-3 expression, erythrocyte-derived microvesicles, and free hemoglobin concentrations.

Results

Porcine pRBCs demonstrated a hematocrit similar to human pRBCs. Both human and porcine pRBC units developed a progressive storage lesion. However, over 42 d of storage, porcine pRBCs maintained their pH and had decreased glucose utilization. Porcine pRBCs also demonstrated decreased levels of eryptosis compared to human samples and generated less erythrocyte-derived microvesicles with lower free hemoglobin concentrations.

Conclusions

Porcine pRBCs stored in additive storage solution 3 demonstrate a progressive RBC storage lesion over 42 d of storage but with less severity than human controls. Given the differences in porcine erythrocyte metabolism, further study of the storage lesion in porcine blood is needed in addition to incorporating the use of stored porcine pRBCs in a swine model of hemorrhagic shock to more closely mimic clinical scenarios.

导言：红细胞（RBC）贮存病变在小鼠和人类血液中已有很好的描述，但在猪血液中却没有。在评估多发性创伤模型中输注储存的包装红细胞（pRBC）之前，有必要了解猪红细胞储存病变。我们假设猪的 pRBC 在 42 d 后会出现类似的储存病变严重程度。方法从雌性约克夏猪采集全血，在添加剂储存溶液 3 中分离 pRBC。从当地血库采集雌性人类全血并制备 pRBC。将人和猪的 pRBC 储存 42 天，每周取样并评估 RBC 储存病变的标志物，包括生化测量、红细胞凋亡、band-3 表达、红细胞衍生微囊和游离血红蛋白浓度。人和猪的 pRBC 单位都出现了渐进性储存病变。然而，在 42 天的储存过程中，猪 pRBC 保持了其 pH 值，并且葡萄糖利用率降低。与人类样本相比，猪 pRBC 的红细胞渗出水平也有所下降，并且产生的红细胞衍生微囊较少，游离血红蛋白浓度较低。结论在添加剂储存溶液 3 中储存的猪 pRBC 在储存 42 天后会出现渐进性 RBC 储存病变，但严重程度低于人类对照组。鉴于猪红细胞新陈代谢的差异，除了在猪失血性休克模型中使用储存的猪 pRBC 以更接近地模拟临床情况外，还需要进一步研究猪血中的储存病变。

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引用次数: 0

Implications of Using a Clinical Practice Guideline on Outcomes in Pediatric Empyema 使用《临床实践指南》对小儿肺水肿疗效的影响

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-17 DOI: 10.1016/j.jss.2024.09.045

Brianna L. Spencer MD, Dimitra M. Lotakis MD, Anjali Vaishnav BS, Jessica Carducci BS, Lauren Hoff MD, Elizabeth Speck MD, Erin E. Perrone MD

Introduction

Various randomized control trials in the pediatric population have shown no therapeutic advantage of video-assisted thoracoscopic surgery over fibrinolytic therapy (tissue plasminogen activator [tPA]) for empyema management. However, literature detailing changes in practice management and protocol implementation is limited. In 2018, we instituted clinical practice guidelines (CPGs) for empyema management utilizing tissue plasminogen activatorinstillation via a small bore chest tube as initial therapy. Before standardization, surgeon preference drove management. Our aim was to determine differences in management and outcomes following institutional CPG implementation.

Methods

A single-institution retrospective study (2002-2022) examined patients 0-18 y of age diagnosed with pneumonia and associated empyema (loculated pleural fluid on ultrasound or computed-tomographic scan). The comparison groups were pre- and post-CPG implementation groups. Comparative statistics were performed, and the significance level was set at P < 0.05.

Results

Sixty-one patients met the inclusion criteria: 33 (54%) preimplementation and 28 (46%) postimplementation. The demographics and diagnostic imaging modalities were similar between groups. There were no significant differences in time to initiate antibiotics, antibiotic duration, intensive care unit length of stay (LOS), or total hospital LOS. The utilization of video-assisted thoracoscopic surgery as initial intervention significantly decreased from 66% to 10% after protocol implementation (P < 0.01); the failure rates of initial therapy choice were similar (12% versus 10%, P = 0.87). Marked reduction in total patients undergoing operative intervention at any point during the course of therapy was observed, 76% preimplementation versus 21% postimplementation (P < 0.01).

Conclusions

In children treated for empyema, the overall incidence of operative intervention significantly decreased following CPG implementation. The changes in antibiotic usage, intensive care unit/total LOS, and initial therapy failure rates did not differ. In our experience, the implementation of a CPG was instrumental in adherence to national guidelines.

导言：在儿科人群中进行的多项随机对照试验表明，在治疗肺水肿方面，视频辅助胸腔镜手术与纤维蛋白溶解疗法（组织纤溶酶原激活剂 [tPA]）相比没有治疗优势。然而，详细介绍实践管理和方案实施变化的文献十分有限。2018 年，我们制定了临床实践指南 (CPG)，利用组织浆蛋白酶原激活剂通过小口径胸管进行灌注，作为治疗肺水肿的初始疗法。在标准化之前，外科医生的偏好驱动着管理。我们的目的是确定机构实施 CPG 后在管理和疗效方面的差异。方法一项单一机构的回顾性研究（2002-2022 年）对 0-18 岁诊断为肺炎并伴有肺水肿（超声或计算机断层扫描显示有定位胸腔积液）的患者进行了检查。比较组为实施 CPG 前和实施 CPG 后的两组。结果61名患者符合纳入标准：实施前 33 例（54%），实施后 28 例（46%）。两组患者的人口统计学特征和影像诊断方式相似。开始使用抗生素的时间、抗生素持续时间、重症监护室住院时间（LOS）和总住院时间均无明显差异。方案实施后，使用视频辅助胸腔镜手术作为初始干预的比例从 66% 显著降至 10%（P < 0.01）；初始治疗选择的失败率相似（12% 对 10%，P = 0.87）。在治疗过程中的任何阶段接受手术干预的患者总数明显减少，实施前为 76%，实施后为 21%（P < 0.01）。抗生素用量、重症监护室/总住院日和初始治疗失败率的变化并无差异。根据我们的经验，实施 CPG 有助于遵守国家指导方针。

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引用次数: 0

Is Repeat Computed Tomography Angiography for Asymptomatic Grade 1 Blunt Cerebrovascular Injuries Cost-Effective? 无症状 1 级钝性脑血管损伤的重复计算机断层扫描血管造影是否具有成本效益？

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-17 DOI: 10.1016/j.jss.2024.09.015

Cynthia J. Susai MD, Nathan J. Alcasid MD, Kian C. Banks MD, April E. Mendoza MD, Camille Jackson MD, Shahram Aarabi MD, Lara Senekjian MD, Gregory P. Victorino MD

Introduction

For all blunt cerebrovascular injuries (BCVIs), the standard recommendation is to obtain repeat computed tomography angiography (CTA) in approximately 7-10 d postinjury to evaluate for progression of BCVI. Given the low likelihood that repeat CTA would result in a change in management apart from continuing antithrombotic therapy in grade 1 BCVI, we hypothesized that repeat CTA in this subset of BCVI would not be cost-effective.

Methods

We performed a decision-analytic model to evaluate the cost-effectiveness of repeat CTA at 7-10 d in the base case of a 50-y-old blunt trauma patient with an asymptomatic grade 1 BCVI on antithrombotic therapy. Cost, probability estimates, and utilities in quality-adjusted life years (QALYs) were accessed from published literature. Deterministic analyses were performed.

Results

Decision-analytic model identified that repeating the CTA was the optimal strategy, with improved effectiveness offsetting a slightly higher cost. Although the strategy with the repeat CTA incurred a net cost of 694.20, the utility is significantly better, with QALYS of 0.94 (repeat CTA) versus 0.86 (no repeat CTA). Deterministic sensitivity analysis revealed most influential variables were the cost of CTA, utility of unnecessary antithrombotic treatment after resolved BCVI, cost of antithrombotic therapy, and utility of endovascular intervention reducing stroke risk.

Conclusions

In patients with asymptomatic grade I BCVI, repeating CTA for grade I BCVI is overall cost-effective, as the improvement in QALYs is substantial enough to offset a slightly higher cost. This supports repeating the CTA as the cost-effective management strategy for asymptomatic grade I BCVI.

导言对于所有钝性脑血管损伤（BCVI），标准建议是在伤后约 7-10 d 内重复进行计算机断层扫描血管造影（CTA），以评估 BCVI 的进展情况。鉴于对 1 级 BCVI 患者除继续抗血栓治疗外，重复 CTA 导致治疗方案改变的可能性很低，我们假设对这一 BCVI 亚组患者重复 CTA 不具成本效益。方法我们建立了一个决策分析模型，以 50 岁、无症状、1 级 BCVI 且正在接受抗血栓治疗的钝性创伤患者为基本病例，评估 7-10 d 重复 CTA 的成本效益。成本、概率估计值和以质量调整生命年（QALYs）表示的效用均来自已发表的文献。结果决策分析模型发现，重复 CTA 是最佳策略，有效性的提高抵消了略高的成本。虽然重复 CTA 的策略会产生 694.20 美元的净成本，但效用却明显更好，QALYS 为 0.94（重复 CTA），而 0.86（不重复 CTA）。确定性敏感性分析显示，最有影响的变量是 CTA 的成本、BCVI 解决后不必要的抗血栓治疗的效用、抗血栓治疗的成本以及血管内介入治疗降低卒中风险的效用。结论在无症状 I 级 BCVI 患者中，重复 CTA 治疗 I 级 BCVI 总体上具有成本效益，因为 QALYs 的改善足以抵消稍高的成本。这支持将重复 CTA 作为治疗无症状 I 级 BCVI 的经济有效的管理策略。

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引用次数: 0

Thoracoscopic Repair for Kluth Type Ⅲb3 Esophageal Atresia and Distal TracheoesophagealFistula 胸腔镜修复克鲁特Ⅲb3型食管闭锁和气管食管远端瘘术

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-17 DOI: 10.1016/j.jss.2024.09.055

Bing Li MD , Wei Bing Chen MD , Shun Lin Xia MD , Shi Ting Li MD

Introduction

This report aims to present our initial miniseries of successful thoracoscopic repair for esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) of Kluth type Ⅲb3 in accordance with Kluth's classification.

Methods

From January 2012 to January 2024, ten patients with Kluth type Ⅲb3 EA-TEF were treated by thoracoscopic surgery. The therapeutic methods and surgical outcomes were retrospectively reviewed.

Results

All procedures were completed thoracoscopically without conversions. A preoperative bronchoscopy assessment was conducted in four of the cases, revealing that the fistula from the distal segment was located high on the trachea at the level of T2 vertebral. The mean age of the patients at the time of operation was 2.0 ± 0.7 d (range, 1-3 d), and the mean weight at operation was 2.6 ± 0.4 kg (range, 1.8-3.0 kg). The mean operative time (skin to skin) for the entire series was 137.0 ± 8.9 min (range, 120-150 min). Oral feeding was initiated on the postoperative day 8.0 ± 1.9 (range, 6-12 d), and the mean duration for patients after surgery was 14.0 ± 2.4 d (range, 12-20 d). The postoperative period has been uneventful with no occurrences of mortality or morbidity to date. Three cases of formatted anastomotic stricture required at least one esophageal dilation after surgery.

Conclusions

Pediatric surgeons should be aware of the rare variants of EA-TEF to avoid the diagnostic and management pitfalls. Patients with Kluth type Ⅲb3 EA-TEF were amenable to repair by thoracoscopic surgery.

方法从2012年1月至2024年1月，对10例Kluth Ⅲb3型食管闭锁（EA）和远端气管食管瘘（TEF）患者进行了胸腔镜手术治疗。结果所有手术均在胸腔镜下完成，无转换手术。对其中四例患者进行了术前支气管镜评估，结果显示来自远段的瘘管位于气管T2椎体水平的高位。手术时患者的平均年龄为（2.0±0.7）岁（1-3岁不等），平均体重为（2.6±0.4）公斤（1.8-3.0公斤不等）。整个系列的平均手术时间（皮肤到皮肤）为 137.0 ± 8.9 分钟（120-150 分钟不等）。术后第 8.0 ± 1.9 天（6-12 天）开始口服喂养，术后患者的平均喂养时间为 14.0 ± 2.4 天（12-20 天）。术后情况良好，至今未出现死亡或发病情况。结论小儿外科医生应了解 EA-TEF 的罕见变体，以避免诊断和处理上的误区。KluthⅢb3型EA-TEF患者可以通过胸腔镜手术进行修复。

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引用次数: 0

How Many Sentinel Lymph Nodes Should We Excise in Patients With Melanoma? 黑色素瘤患者应切除多少前哨淋巴结？

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-16 DOI: 10.1016/j.jss.2024.09.040

Jason M. Lizalek MD, Collin E. Dougherty BS, Bradley N. Reames MD, MS, Jason Foster MD, Juan A. Santamaria MD, Joshua M.V. Mammen MD, PhD

Introduction

The management of many patients with early-stage melanoma includes sentinel lymph node (SLN) biopsy for prognostic and treatment planning purposes. While the minimum necessary number of SLNs to examine has been determined for patients with other malignancies, it has not been delineated in melanoma. The current study evaluates risk factors for SLN positivity and the associated number of SLNs that are necessary to examine for appropriate staging.

Materials and methods

The National Cancer Database participant user file from 2018 to 2020 was queried for clinically node-negative patients who underwent SLN biopsy. Descriptive statistics were obtained. Analysis of variance statistical analyses were performed.

Results

Eight thousand forty eight melanoma patients out of 48,748 were identified from 2018 to 2020 that had lymph node positivity on SLN biopsy. The median age of patients was 64. The male-to-female ratio was 1.47. Chi-squared analysis revealed that there was a statistically significant difference in positivity rate between at least two groups (P = 0.006) for primary melanoma site, male sex (P < 0.01), race, age, histologic type, Breslow thickness, and lymphovascular invasion (P < 0.001). SLN positivity rate increased with the number of SLNs examined until plateauing at 4 SLNs. There was no statistical difference between positivity for 3 SLNs and larger numbers of SLNs examined. Propensity matching revealed no statistically significant difference in positive rate when more than 2 SLNs were biopsied.

Conclusions

SLN positivity is proportionally related to the number of SLNs examined, suggesting that surgeons should attempt to remove a minimum of 2 SLNs for the optimal staging of patients with melanoma.

导言：许多早期黑色素瘤患者的治疗都包括前哨淋巴结（SLN）活检，以预测预后和制定治疗计划。虽然对其他恶性肿瘤患者进行前哨淋巴结活检所需的最低数量已经确定，但对黑色素瘤患者进行前哨淋巴结活检所需的最低数量尚未确定。目前的研究评估了SLN阳性的风险因素以及为进行适当分期而必须检查的相关SLN数量。材料和方法查询了2018年至2020年期间接受SLN活检的临床结节阴性患者的国家癌症数据库参与者用户文件。获得了描述性统计数据。进行了方差分析统计分析。结果在2018年至2020年的48748名黑色素瘤患者中，确定了848名在SLN活检中淋巴结阳性的患者。患者年龄中位数为 64 岁。男女比例为 1.47。Chi-squared分析显示，在原发性黑色素瘤部位、男性性别（P <0.01）、种族、年龄、组织学类型、布瑞斯洛厚度和淋巴管侵犯（P <0.001）方面，至少两组之间的阳性率存在显著统计学差异（P = 0.006）。SLN阳性率随着检查的SLN数量的增加而增加，直到4个SLN时趋于平稳。3个SLN阳性率与检查的SLN数量之间没有统计学差异。倾向匹配显示，活检 2 个以上 SLN 时，阳性率无统计学差异。结论 SLN 阳性率与检查的 SLN 数量成正比，这表明外科医生应尝试切除至少 2 个 SLN，以便对黑色素瘤患者进行最佳分期。

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引用次数: 0

By Any Other Name: Bowel Dysfunction After Proctectomy for Cancer and Its Predictive Factors in Administrative Databases 任何其他名称：行政数据库中的癌症直肠切除术后肠道功能障碍及其预测因素

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-16 DOI: 10.1016/j.jss.2024.09.027

Ira L. Leeds MD, MBA, ScM , Nathan A. Coppersmith MD , Miranda S. Moore MPH , Ahmad Saleh BS , Kingsley Cruickshank BS , Haddon Pantel MD , Vikram Reddy MD, PhD , Anne K. Mongiu MD, PhD

Introduction

Diagnosis, outcomes, and costs of care associated with bowel dysfunction after proctectomy for cancer remain underexplored in population-based studies. The lack of administrative coding for bowel dysfunction or low anterior resection syndrome has historically limited secondary data set outcomes analysis. The purpose of this study was to identify a bowel dysfunction phenotype in administrative claims data and characterize its prevalence, predictive factors, and costs.

Materials and methods

Patients were identified with employer-sponsored commercial insurance (MarketScan research databases) undergoing proctectomy for cancer for a retrospective cohort study. Bowel dysfunction was defined as any patient with diagnostic codes for diarrhea, constipation, incontinence, pelvic floor diagnostic testing, or rehabilitative procedures that occurred in the 18 mo to follow surgery. We performed Poisson regression to identify statistically significant covariates of bowel dysfunction occurrence following low anterior resection. A secondary comparative analysis was also performed of total costs of healthcare utilization following gastrointestinal continuity.

Results

6426 proctectomy patients were identified, out of which 2131 had surgery for cancer. 847 patients undergoing proctectomy for cancer (39.7%) experienced bowel dysfunction during 18 mo of follow-up. The most common diagnoses were constipation (53.5%) and diarrhea (40.3%). Diagnostic procedures and rehabilitative procedures were performed in only 29.8% of those with symptoms. Neoadjuvant chemotherapy administration with radiation (incidence rate ratio = 1.23, 95% CI: 1.01-1.51) and without (incidence rate ratio = 1.20, 95% CI: 1.01-1.42) remained associated with postoperative bowel dysfunction when controlling for other factors. Chemoradiation therapy alone was not associated with bowel dysfunction. The median total follow-up costs with bowel dysfunction were $30,769 greater (P < 0.001).

Conclusions

More than one-third of patients have symptomatic bowel dysfunction within 18 mo after restored continuity, with multiagent chemotherapy being the strongest independent predictor. Bowel dysfunction is associated with more than twice healthcare costs postop.

导言：在基于人群的研究中，与癌症直肠切除术后肠道功能障碍相关的诊断、结果和护理成本仍未得到充分探讨。由于缺乏肠功能障碍或低位前切除综合征的行政编码，二级数据集的结果分析一直受到限制。本研究的目的是在行政索赔数据中识别肠道功能障碍表型，并描述其患病率、预测因素和成本。材料和方法通过雇主赞助的商业保险（MarketScan 研究数据库）识别因癌症接受直肠切除术的患者，进行回顾性队列研究。肠道功能障碍的定义是在手术后 18 个月内出现腹泻、便秘、失禁、盆底诊断测试或康复程序等诊断代码的任何患者。我们进行了泊松回归，以确定低位前路切除术后发生肠道功能障碍的具有统计学意义的协变量。我们还对胃肠道连续性手术后的总医疗费用进行了二次比较分析。847名因癌症接受直肠切除术的患者（39.7%）在18个月的随访期间出现了肠道功能障碍。最常见的诊断为便秘（53.5%）和腹泻（40.3%）。只有 29.8% 的症状患者接受了诊断和康复治疗。在控制其他因素的情况下，新辅助化疗与放疗（发生率比=1.23，95% CI：1.01-1.51）和非新辅助化疗（发生率比=1.20，95% CI：1.01-1.42）仍与术后肠道功能紊乱有关。单纯化放疗与肠功能紊乱无关。结论超过三分之一的患者在恢复连续性后18个月内出现症状性肠道功能障碍，其中多药化疗是最强的独立预测因素。肠道功能障碍与术后两倍以上的医疗费用相关。

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引用次数: 0

Outcomes After Pectus Excavatum Repair: A Nationwide Comparison of Nuss Versus Ravitch Operations 胸大肌修复术后的效果：Nuss 与 Ravitch 手术的全国性比较

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-16 DOI: 10.1016/j.jss.2024.09.025

Carlos Theodore Huerta MD , Daniel M. Alligood MD , Jenna K. Davis MD , Walter A. Ramsey MD , Michael D. Cobler-Lichter MD , Larisa Shagabayeva MD , Jessica M. Delamater MD, MPH , Alexandra E. Hernandez MD , Joshua P. Parreco MD , Eduardo A. Perez MD , Juan E. Sola MD , Chad M. Thorson MD, MSPH

Introduction

Pectus excavatum is the most prevalent chest wall deformity. Repair may be offered via Nuss or Ravitch technique. This study aims to investigate the outcomes of these repairs using a national cohort.

Methods

The Nationwide Readmission Database was queried from 2016 to 2020 for patients aged 12-21 y old with pectus excavatum. Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. The results were weighted for national estimates.

Results

A total of 10,053 patients with pectus excavatum underwent repair (86% Nuss, n = 8673 and 14% Ravitch, n = 1380). Baseline characteristics were similar between cohorts. Nuss repair patients traveled more frequently out of state for repair (10.5% versus 8.7%) and were in the highest income quartiles (61.1% versus 57.3%), both P < 0.05. Of reporting hospitals, 60% performed only the Nuss procedure. The Ravitch cohort experienced higher rates of complications during index admission, including chest tube placement (5.1% versus 2.2%), bleeding (2.4% versus 0.6%), air leak (0.9% versus 0.3%), and respiratory failure (1.0% versus 0.3%), as well as longer median length of stay (4 versus 3 d), all with a P value < 0.05. While both cohorts had similar overall readmission rates, Ravitch repairs had higher rates of readmissions for bleeding (18.3% versus 4.5%), pain (32.9% versus 13.5%), and psychiatric complications (31.7% versus 21.2%), all with a P value < 0.05. Ravitch repairs also incurred higher total hospital costs ($18,670 versus 17,462, P < 0.001).

Conclusions

Nuss repairs were associated with fewer index complications with no increase in readmissions compared to Ravitch procedures. However, disparities may exist in access to Nuss repair.

导言：胸廓外翻是最常见的胸壁畸形。可通过 Nuss 或 Ravitch 技术进行修复。本研究旨在利用全国性队列调查这些修复术的效果。方法查询了 2016 年至 2020 年期间全国再入院数据库中 12 至 21 岁的乳房下垂患者。使用标准统计检验分析了人口统计学、医院特征和结果。结果共有10053名胸下垂患者接受了修复手术（86%为Nuss，n=8673；14%为Ravitch，n=1380）。两组患者的基线特征相似。努斯修复术患者更常到州外进行修复（10.5% 对 8.7%），且收入最高的四分位数（61.1% 对 57.3%），P 均为 0.05。在提交报告的医院中，60%的医院只实施了 Nuss 手术。Ravitch队列在入院时并发症发生率较高，包括胸管置入（5.1% 对 2.2%）、出血（2.4% 对 0.6%）、漏气（0.9% 对 0.3%）和呼吸衰竭（1.0% 对 0.3%），中位住院时间也较长（4 天对 3 天），P 值均为 0.05。虽然两组患者的总再入院率相似，但 Ravitch 修复术患者因出血（18.3% 对 4.5%）、疼痛（32.9% 对 13.5%）和精神并发症（31.7% 对 21.2%）而再入院的比例更高，P 值均为 0.05。结论与 Ravitch 手术相比，Nuss 修复术并发症较少，再住院率也没有增加。然而，在接受 Nuss 修复术方面可能存在差异。

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引用次数: 0

History of Preoperative Use of Gabapentin Before Lower Extremity Bypass Predisposes Patients to a High Risk of Opioid Use and Dependence in a Dose-dependent Manner 下肢搭桥术前使用加巴喷丁的病史易使患者产生阿片类药物使用和剂量依赖的高风险

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-15 DOI: 10.1016/j.jss.2024.09.026

Fadi Samaan BS , Ahsan Zil-E-Ali MBBS, MPH , Billal Alamarie BS , Abdul Wasay Paracha BS , Nkemjika Nwaneri BS, MS , Faisal Aziz MD, FACS, DFSVS

Introduction

This study assesses the association of preoperative use of gabapentinoids (GBPs) with postoperative risk of opioid-related disorders in peripheral artery disease patients undergoing lower extremity bypass operation.

Methods

This is a retrospective propensity score-matched analysis of patients undergoing peripheral artery bypass in TriNetX, a multicenter national database. Two study groups were constituted based on the preoperative history of prescribed GBPs. Primary outcomes were opioid-related disorders and mortality. The outcomes were reported at two-time endpoints that is, at 1 and 5 y.

Results

This study population included a total of 23,706 patients. After propensity score-matched analysis, each group contained 5130 patients. The primary outcomes showed a significant increase in postoperative opioid-related disorders at the 1 and 5-y time points between GBPs and no GBPs groups: 1-y outcome (2.0% versus 1.1%; adj. P = 0.007) and 5-y outcome (4.5% versus 3.5%; adj. P = 0.035). Logistic regression analysis revealed an increase in the 1-y (adjusted odds ratio= 1.664; 95% CI [1.217, 2.273], P = 0.001) and 5-y (OR = 1.353; 95% CI [1.107, 1.653], P = 0.003) odds of opioid-related disorders in patients on GBPs. A secondary analysis showed a significant dose-dependent increase in the associated risk of 5-y opioid-related disorders in patients with a history of prescribed gabapentin.

Conclusions

In patients undergoing lower extremity bypass with a history of gabapentin use, there is an associated increased long-term risk of opioid-related disorders in a dose-dependent fashion. Overall, this study highlights weighing risks and benefits of prescribing GBPs for pain control versus their long-term associated risk of opioid-related disorders among other adverse outcomes.

简介：本研究评估了接受下肢搭桥手术的外周动脉疾病患者术前使用加巴喷丁类药物（GBPs）与术后阿片类药物相关疾病风险之间的关系。方法：这是一项回顾性倾向评分匹配分析，研究对象是在全国多中心数据库 TriNetX 中接受外周动脉搭桥手术的患者。根据术前处方 GBPs 的病史组成两个研究组。主要结果是阿片类药物相关疾病和死亡率。结果这项研究共纳入 23706 名患者。经过倾向评分匹配分析后，每组包含 5130 名患者。主要结果显示，在 1 年和 5 年的时间点上，使用 GBPs 组和未使用 GBPs 组的术后阿片类药物相关失调明显增加：1 年结果（2.0% 对 1.1%；adj. P = 0.007）和 5 年结果（4.5% 对 3.5%；adj. P = 0.035）。逻辑回归分析显示，使用 GBPs 的患者 1 年（调整后的几率= 1.664；95% CI [1.217，2.273]，P = 0.001）和 5 年（OR = 1.353；95% CI [1.107，1.653]，P = 0.003）阿片类药物相关紊乱的几率增加。结论在接受下肢搭桥术且有加巴喷丁使用史的患者中，阿片类药物相关疾病的长期风险会增加，且呈剂量依赖性。总之，本研究强调了在处方 GBPs 用于疼痛控制的风险和益处与其阿片类药物相关疾病的长期风险以及其他不良后果之间的权衡。

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引用次数: 0

When Is Diversion Indicated After Right-Sided Colon Resections? 右侧结肠切除术后何时需要转流？

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-15 DOI: 10.1016/j.jss.2024.09.056

Richard Sassun MD , David W. Larson MD, MBA , Katherine A. Bews MS , Scott R. Kelley MD , Kellie L. Mathis MD , Elizabeth B. Habermann PhD , Nicholas P. McKenna MD, MS

Introduction

Ileocolonic anastomoses have a low anastomotic leak (AL) risk, resulting in infrequent diverting loop ileostomy use. Identifying patients who warrant diverting loop ileostomy with right-sided resection is challenging due to this low incidence of AL. Therefore, a multicenter database was used to develop an AL risk score to help inform when diversion should be strongly considered after right-sided resections.

Materials and methods

Patients undergoing elective right-sided resections within the 2012-2020 American College of Surgeons National Surgical Quality Improvement Program-targeted colectomy participant user files were identified. Multivariable logistic regression identified AL risk factors that were then converted to point values to develop an AL risk score. The developed AL risk score was then assessed for visual correspondence and analyzed for internal validity.

Results

42,176 patients underwent right-sided resection without diversion, and the incidence of AL was 2.4%. The risk calculator exhibited excellent calibration and fair discrimination. Strong visual correspondence was observed for predicted and actual AL rates within the 95% confidence interval for nine of ten risk score deciles.

Conclusions

An internally validated AL risk score for elective ileocolic resections was developed. Most patients had scores that categorized them at a low risk of AL. The diversion after elective right-sided resections should be reserved for extreme cases.

导言回结肠吻合术的吻合口漏（AL）风险很低，因此很少使用分流回肠造口术。由于AL发生率较低，因此鉴别哪些患者需要进行右侧切除的憩室回肠造口术具有挑战性。因此，研究人员利用多中心数据库制定了 AL 风险评分，以帮助确定右侧切除术后何时应强烈考虑转流。材料和方法在 2012-2020 年美国外科学院国家外科质量改进计划目标结肠切除术参与者用户档案中，对接受选择性右侧切除术的患者进行了鉴定。多变量逻辑回归确定了AL风险因素，然后将这些因素转换成点值，得出AL风险评分。结果42176名患者接受了无转流的右侧切除术，AL发生率为2.4%。风险计算器显示出良好的校准性和公平的区分度。在 10 个风险评分十分位数中，有 9 个十分位数的预测 AL 发生率和实际 AL 发生率在 95% 置信区间内有很强的视觉对应性。大多数患者的评分将其归类为低 AL 风险。选择性右侧切除术后的转流应保留给极端病例。

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引用次数: 0

Pediatric Ewing Sarcoma Presentation, Treatment, and Outcomes Across Sociodemographic Groups 不同社会人口群体的小儿尤文肉瘤表现、治疗和结果

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-10-12 DOI: 10.1016/j.jss.2024.09.037

Connor D. Fritz MS , Anthony V. Basta BA , Jonathan Gill MD , Valerae O. Lewis MD , Justin E. Bird MD , Mary T. Austin MD, MPH

Introduction

In this study, we evaluate the association between sociodemographics and disease presentation, treatment, and survival for children, adolescents, and young adults with Ewing sarcoma.

Methods

Case-level data were downloaded from The Surveillance, Epidemiology, and End Results database. Cases included patients ages 0-24 who were diagnosed with Ewing sarcoma between 2004 and 2020.

Results

One thousand two hundred forty four patients were included in the analysis. When compared to non-Hispanic White (NHW) patients, Hispanic patients were more likely to present with tumors ≥8 cm (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.24-2.36) and metastases (OR = 1.65, 95% CI = 1.23-2.20). Black patients were less likely to receive chemotherapy (OR = 0.25, 95% CI = 0.07-0.97). The 5-year disease-specific survival rate was 73% for NHW patients, 65% for Black patients, 67% for Asian patients and 66% for Hispanic patients. When accounting for confounding factors, Hispanic and Asian patients had higher probabilities of death due to cancer compared to NHW patients (HR = 1.41, 95% CI = 1.10-1.81; HR = 1.64, 95% CI = 1.09-2.48, respectively). Young adults and adolescents were significantly more likely to present with metastases, experience ≥1 month between diagnosis and treatment, and had lower survival.

Conclusions

Significant differences in Ewing sarcoma presentation, treatment, and survival were observed across age groups and race/ethnicity. Future work should focus on expanding access to care in underserved groups. Further qualitative studies could assist in determining the exact factors that prevent patients from accessing care or examine how genetic factors that contribute to Ewing sarcoma severity differ across demographic groups.

导言在这项研究中，我们评估了患有尤文肉瘤的儿童、青少年和年轻成人的社会人口统计学与疾病表现、治疗和生存之间的关联。方法从监测、流行病学和最终结果数据库下载病例级数据。病例包括2004年至2020年期间被诊断为尤文肉瘤的0-24岁患者。与非西班牙裔白人（NHW）患者相比，西班牙裔患者更有可能出现肿瘤≥8厘米（几率比（OR）=1.71，95%置信区间（CI）=1.24-2.36）和转移（OR=1.65，95%置信区间（CI）=1.23-2.20）。黑人患者接受化疗的可能性较低（OR = 0.25，95% CI = 0.07-0.97）。非华裔患者的5年疾病特异性生存率为73%，黑人患者为65%，亚裔患者为67%，西班牙裔患者为66%。考虑到混杂因素，西班牙裔和亚裔患者因癌症死亡的概率高于非白血病患者（HR = 1.41，95% CI = 1.10-1.81；HR = 1.64，95% CI = 1.09-2.48）。结论不同年龄组和种族/民族的尤文肉瘤发病、治疗和生存率存在显著差异。今后的工作重点应放在扩大医疗服务不足群体的就医机会上。进一步的定性研究有助于确定阻碍患者获得治疗的确切因素，或研究不同人口群体中导致尤文肉瘤严重程度的遗传因素有何不同。

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引用次数: 0