Journal of Surgical Research最新文献_第9页

Letter Regarding: Effects of Irrigation With Normal Saline on Traumatic Brain Injury Combined With Seawater Immersion in Rats. 关于：生理盐水冲洗联合海水浸泡对大鼠创伤性脑损伤的影响。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-09 DOI: 10.1016/j.jss.2025.11.038

S Dhanya Dedeepya, Vaishali Goel, Nivedita Nikhil Desai

引用次数: 0

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 : 2025-12-09 DOI: 10.1016/j.jss.2025.10.051

Mallory N Perez, Maxwell Wilberding, Goeto Dantes, Alison Lehane, Mehul V Raval, Gustave H Falciglia, Nicholas E Burjek, Jane L Holl, Willemijn L A Schäfer

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。

{"title":"Barriers and Facilitators to Enhanced Recovery Protocol Implementation for Neonatal Intestinal Surgery.","authors":"Mallory N Perez, Maxwell Wilberding, Goeto Dantes, Alison Lehane, Mehul V Raval, Gustave H Falciglia, Nicholas E Burjek, Jane L Holl, Willemijn L A Schäfer","doi":"10.1016/j.jss.2025.10.051","DOIUrl":"https://doi.org/10.1016/j.jss.2025.10.051","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhancing Suturing Competency in Undergraduate Medical Students: Impact of Teaching Aesthetic Suturing for International Undergraduate Medical Students 提高医本科生的缝合能力：美学缝合教学对留学生的影响。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-09 DOI: 10.1016/j.jss.2025.11.034

Muhammad Tipu Sultan MBBS, MS, PhD , Xu Jiaxiang MD , Mina Dadashi BDS , Akbar Saeed Shah MBBS, MS , Li GuangShuai MD, PhD

Introduction

Suturing often receives limited attention in undergraduate medical education. Many students graduate with inadequate proficiency, particularly in handling aesthetically sensitive wounds. In several countries, general practitioners frequently serve as first-line providers for trauma care and wound closure, yet often lack formal training in cosmetic or tension-free techniques. As a result, patients may suffer long-term physical disfigurement and psychological distress due to poorly executed wound repair. Principles emphasized in plastic surgery, including precision, tissue preservation, wound edge approximation, edge eversion, symmetry, and scar minimization, provide an effective framework for teaching high-quality suturing from the undergraduate level.

Methods

This educational intervention enrolled 71 final-year international MBBS and BDS students who had previously received basic suturing instruction but had not been taught the principles of aesthetic wound closure. All participants attended a 3-4 h suturing workshop designed on plastic surgery principles of wound closure. The session included didactic instruction and hands on training using silicone skin models, focusing on layered closure, tension-free repair, edge eversion, and aesthetic alignment. Competency was assessed using a validated seven-domain, 35-point scorecard before and after training. A passing score of ≥28 was determined by expert consensus.

Results

Seventy students completed the full assessment. The mean score increased from 14.8 ± 5.65 to 29.26 ± 3.21 (P < 0.001), with a large effect size (Cohen's d = 2.56). Passing rates improved from 1.4% to 80%, with significant gains across all technical and aesthetic domains.

Conclusions

A single-structured suturing workshop incorporating aesthetic wound closure principles significantly improved both technical and cosmetic competency. Integrating these principles into undergraduate curricula may help raise the standard of wound management and strengthen students’ confidence for future clinical practice.

导读：在本科医学教育中，对缝合术的关注很少。许多学生毕业时并不熟练，特别是在处理审美敏感的伤口方面。在一些国家，全科医生经常作为创伤护理和伤口缝合的第一线提供者，但往往缺乏美容或无张力技术方面的正式培训。因此，由于伤口修复不当，患者可能会遭受长期的身体毁容和心理困扰。整形外科强调的原则，包括精确度、组织保存、伤口边缘近似、边缘外翻、对称性和疤痕最小化，为本科阶段的高质量缝合教学提供了有效的框架。方法：本教育干预纳入71名接受过基本缝合指导但未学习过美观缝合原则的国际MBBS和BDS学生。所有参与者都参加了一个3-4小时的缝合研讨会，该研讨会旨在了解整形外科伤口闭合的原理。会议包括教学指导和使用硅胶皮肤模型的实践培训，重点是分层闭合，无张力修复，边缘外翻和美学对齐。在培训前后使用经过验证的七域35分记分卡评估能力。≥28分为专家一致判定的及格分。结果：70名学生完成了完整的评估。平均评分由14.8±5.65上升至29.26±3.21 (P < 0.001)，且效应量较大（Cohen’s d = 2.56）。通过率从1.4%提高到80%，在所有技术和美学领域都有显著的提高。结论：采用美学缝合原则的单一结构缝合车间显著提高了技术和美容能力。将这些原则纳入本科课程有助于提高伤口管理水平，增强学生对未来临床实践的信心。

{"title":"Enhancing Suturing Competency in Undergraduate Medical Students: Impact of Teaching Aesthetic Suturing for International Undergraduate Medical Students","authors":"Muhammad Tipu Sultan MBBS, MS, PhD , Xu Jiaxiang MD , Mina Dadashi BDS , Akbar Saeed Shah MBBS, MS , Li GuangShuai MD, PhD","doi":"10.1016/j.jss.2025.11.034","DOIUrl":"10.1016/j.jss.2025.11.034","url":null,"abstract":"<div><h3>Introduction</h3><div>Suturing often receives limited attention in undergraduate medical education. Many students graduate with inadequate proficiency, particularly in handling aesthetically sensitive wounds. In several countries, general practitioners frequently serve as first-line providers for trauma care and wound closure, yet often lack formal training in cosmetic or tension-free techniques. As a result, patients may suffer long-term physical disfigurement and psychological distress due to poorly executed wound repair. Principles emphasized in plastic surgery, including precision, tissue preservation, wound edge approximation, edge eversion, symmetry, and scar minimization, provide an effective framework for teaching high-quality suturing from the undergraduate level.</div></div><div><h3>Methods</h3><div>This educational intervention enrolled 71 final-year international MBBS and BDS students who had previously received basic suturing instruction but had not been taught the principles of aesthetic wound closure. All participants attended a 3-4 h suturing workshop designed on plastic surgery principles of wound closure. The session included didactic instruction and hands on training using silicone skin models, focusing on layered closure, tension-free repair, edge eversion, and aesthetic alignment. Competency was assessed using a validated seven-domain, 35-point scorecard before and after training. A passing score of ≥28 was determined by expert consensus.</div></div><div><h3>Results</h3><div>Seventy students completed the full assessment. The mean score increased from 14.8 ± 5.65 to 29.26 ± 3.21 (<em>P</em> < 0.001), with a large effect size (Cohen's d = 2.56). Passing rates improved from 1.4% to 80%, with significant gains across all technical and aesthetic domains.</div></div><div><h3>Conclusions</h3><div>A single-structured suturing workshop incorporating aesthetic wound closure principles significantly improved both technical and cosmetic competency. Integrating these principles into undergraduate curricula may help raise the standard of wound management and strengthen students’ confidence for future clinical practice.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 138-146"},"PeriodicalIF":1.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724020","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}

引用次数: 0

Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial 鉴别青少年和年轻人毛鞘疾病复发的预测因素：一项随机对照试验的二次分析。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-08 DOI: 10.1016/j.jss.2025.11.005

Alexa G. Turpin MD , Lindsey Asti PhD, MPH , Carley Lutz BS , Jennifer Cooper PhD , Lindsay Gil MD, MPH , Cory N. Criss MD , Katherine J. Deans MD, MHSc , Peter C. Minneci MD, MHSc

Introduction

Pilonidal disease is a common condition affecting adolescents and young adults with high recurrence rates and disease-associated morbidity. Identification of patient-specific factors and treatments associated with decreased disease recurrence can assist providers with treatment selection and patient counseling.

Materials and methods

This is a planned secondary analysis of a single institution, randomized controlled trial which compared laser depilation as an adjunct to standard care versus standard care alone. Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease. Patients were randomized to receive laser depilation in conjunction with standard treatment versus standard treatment alone. Multivariable logistic regression modeling was performed to identify variables independently associated with disease recurrence including laser depilation, patient variables (biologic sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, health insurance status), and annual family income.

Results

Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial. After adjusting for sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, type of health insurance, and household income, laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001). After adjusting for other covariables, there was a significant interaction between laser hair treatment and health insurance type. Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58).

Conclusions

Laser depilation is associated with decreased pilonidal disease recurrence. However, there may be heterogeneity of treatment effect based on insurance status with laser depilation decreasing recurrence in patients with private insurance and being less effective in patients with public insurance. This heterogeneity of treatment effect may be related to barriers to care and social determinants of health and warrants further investigation.

简介：毛样疾病是一种影响青少年和年轻人的常见疾病，具有高复发率和疾病相关发病率。确定与减少疾病复发相关的患者特异性因素和治疗方法可以帮助提供者选择治疗方法和患者咨询。材料和方法：这是一项针对单一机构的随机对照试验的计划二次分析，该试验比较了激光脱毛作为标准治疗的辅助手段与单独的标准治疗。纳入标准为年龄在11 - 21岁，至少有1次毛鞘疾病病史，无活动性疾病的患者。患者随机接受激光脱毛联合标准治疗和单独标准治疗。采用多变量logistic回归模型来确定与疾病复发独立相关的变量，包括激光脱毛、患者变量（生物性别、体重指数、既往疾病发作、既往手术治疗、种族和民族、健康保险状况）和家庭年收入。结果：试验中200例患者获得了完整的1-y随访数据，纳入多变量分析。在调整性别、体重指数、既往疾病发作、既往手术治疗、种族和民族、健康保险类型和家庭收入后，激光毛发治疗与疾病复发率在1年内降低密切相关(优势比[OR]， 0.26[95%可信区间（CI）， 0.12-0.58]；P = 0.001)。在调整了其他协变量后，激光毛发治疗与健康保险类型之间存在显著的相互作用。激光毛发治疗与私人保险患者较低的疾病复发率显著相关（OR, 0.29 [95% CI, 0.16-0.55], P < 0.001），但与公共保险患者较低的疾病复发率无相关性（OR, 1.20 [95% CI, 0.63-2.28], P = 0.58）。结论：激光脱毛可减少毛鞘疾病的复发率。然而，基于保险状况的治疗效果可能存在异质性，激光脱毛在私人保险患者中减少复发，而在公共保险患者中效果较差。这种治疗效果的异质性可能与护理障碍和健康的社会决定因素有关，值得进一步调查。

{"title":"Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial","authors":"Alexa G. Turpin MD , Lindsey Asti PhD, MPH , Carley Lutz BS , Jennifer Cooper PhD , Lindsay Gil MD, MPH , Cory N. Criss MD , Katherine J. Deans MD, MHSc , Peter C. Minneci MD, MHSc","doi":"10.1016/j.jss.2025.11.005","DOIUrl":"10.1016/j.jss.2025.11.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Pilonidal disease is a common condition affecting adolescents and young adults with high recurrence rates and disease-associated morbidity. Identification of patient-specific factors and treatments associated with decreased disease recurrence can assist providers with treatment selection and patient counseling.</div></div><div><h3>Materials and methods</h3><div>This is a planned secondary analysis of a single institution, randomized controlled trial which compared laser depilation as an adjunct to standard care <em>versus</em> standard care alone. Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease. Patients were randomized to receive laser depilation in conjunction with standard treatment <em>versus</em> standard treatment alone. Multivariable logistic regression modeling was performed to identify variables independently associated with disease recurrence including laser depilation, patient variables (biologic sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, health insurance status), and annual family income.</div></div><div><h3>Results</h3><div>Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial. After adjusting for sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, type of health insurance, and household income, laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; <em>P</em> = 0.001). After adjusting for other covariables, there was a significant interaction between laser hair treatment and health insurance type. Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], <em>P</em> < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], <em>P</em> = 0.58).</div></div><div><h3>Conclusions</h3><div>Laser depilation is associated with decreased pilonidal disease recurrence. However, there may be heterogeneity of treatment effect based on insurance status with laser depilation decreasing recurrence in patients with private insurance and being less effective in patients with public insurance. This heterogeneity of treatment effect may be related to barriers to care and social determinants of health and warrants further investigation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 110-115"},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714907","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}

引用次数: 0

Characterizing Gastrostomy Tube Feeding Intolerance in the Surgical Intensive Care Unit 外科重症监护病房胃造口管喂养不耐受的特征。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-08 DOI: 10.1016/j.jss.2025.11.021

Halen Turner MD, Sabrina Morales BS, Alison Hanson RD, Thomas Carver MD

Introduction

Feeding intolerance (FI) after gastrostomy tube (GT) placement is understudied; however, it could have a significant impact on surgical intensive care unit (ICU) patients. The purpose of this study was to quantify the rate of FI after GT placement in patients who previously tolerated enteral nutrition (EN) and compare them to patients without FI after GT.

Methods

A single-center retrospective chart review from 2020 to 2023 analyzed surgical ICU patients who underwent GT placement. Intolerance was defined as cessation of EN due to nausea, vomiting, lack of gas or stool, abdominal distention, or high gastric residuals. Statistical analysis compared characteristics of patients with and without intolerance.

Results

A total of 86 patients underwent GT placement, with 21 (24.4%) developing FI after placement. Patients tolerated feeds for a median of 1 d before requiring cessation, and feeds were restarted via GT after a median of 5 d. The most common reason for cessation was vomiting (42.9%). Among these patients, 52.3% required a change in the route of nutrition delivery, and of these, 23.8% required total parenteral nutrition. Compared to patients who tolerated EN, intolerant patients were younger (57 versus 35, P = 0.03).

Conclusions

FI after GT placement has not been characterized in the literature; however, it occurred in 24.4% of patients who had previously tolerated EN. Awareness of FI is critical to prevent malnutrition, as 52.3% required an alternate route for nutrition.

导言：胃造口管（GT）置入后喂养不耐受（FI）的研究尚不充分；然而，它可能对外科重症监护病房（ICU）患者产生重大影响。本研究的目的是量化先前耐受肠内营养（EN）的患者在GT放置后FI的发生率，并将其与GT后无FI的患者进行比较。方法：单中心回顾性图表回顾，分析了2020年至2023年接受GT放置的外科ICU患者。不耐受被定义为由于恶心、呕吐、缺气或大便、腹胀或胃残留物高而停止EN。统计分析比较了有无不耐受患者的特征。结果：共有86例患者接受了GT放置，其中21例（24.4%）在放置后发生FI。患者在需要停止前耐受喂养的中位数为1天，并在中位数为5天后通过GT重新开始喂养。最常见的停止原因是呕吐（42.9%）。其中，52.3%的患者需要改变营养输送途径，其中，23.8%的患者需要全肠外营养。与耐受EN的患者相比，不耐受的患者更年轻（57 vs 35, P = 0.03）。结论：文献中尚未描述GT放置后的FI；然而，24.4%以前耐受EN的患者发生了这种情况。对营养不良的认识对预防营养不良至关重要，因为52.3%的人需要其他营养途径。

{"title":"Characterizing Gastrostomy Tube Feeding Intolerance in the Surgical Intensive Care Unit","authors":"Halen Turner MD, Sabrina Morales BS, Alison Hanson RD, Thomas Carver MD","doi":"10.1016/j.jss.2025.11.021","DOIUrl":"10.1016/j.jss.2025.11.021","url":null,"abstract":"<div><h3>Introduction</h3><div>Feeding intolerance (FI) after gastrostomy tube (GT) placement is understudied; however, it could have a significant impact on surgical intensive care unit (ICU) patients. The purpose of this study was to quantify the rate of FI after GT placement in patients who previously tolerated enteral nutrition (EN) and compare them to patients without FI after GT.</div></div><div><h3>Methods</h3><div>A single-center retrospective chart review from 2020 to 2023 analyzed surgical ICU patients who underwent GT placement. Intolerance was defined as cessation of EN due to nausea, vomiting, lack of gas or stool, abdominal distention, or high gastric residuals. Statistical analysis compared characteristics of patients with and without intolerance.</div></div><div><h3>Results</h3><div>A total of 86 patients underwent GT placement, with 21 (24.4%) developing FI after placement. Patients tolerated feeds for a median of 1 d before requiring cessation, and feeds were restarted via GT after a median of 5 d. The most common reason for cessation was vomiting (42.9%). Among these patients, 52.3% required a change in the route of nutrition delivery, and of these, 23.8% required total parenteral nutrition. Compared to patients who tolerated EN, intolerant patients were younger (57 <em>versus</em> 35, <em>P</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>FI after GT placement has not been characterized in the literature; however, it occurred in 24.4% of patients who had previously tolerated EN. Awareness of FI is critical to prevent malnutrition, as 52.3% required an alternate route for nutrition.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 132-137"},"PeriodicalIF":1.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714946","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}

引用次数: 0

Racial and Ethnic Disparities in Outcomes in Liver Transplantation for Hepatocellular Carcinoma 肝细胞癌肝移植预后的种族差异

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-06 DOI: 10.1016/j.jss.2025.11.016

Devika Dixit MD , Curtis Warren MPH , Sergio Duarte PhD , Dan Neal MS , Roniel Cabrera MD , Andreas G. Zori MD , Ali Zarrinpar MD, PhD

Introduction

Racial and ethnic disparities in liver transplantation (LT) for hepatocellular carcinoma are understudied.

Methods

Patient and tumor characteristics of all LT in the United States from April 2012 to June 2021 were obtained from a nationwide database (UNOS STAR files). Separate analyses were conducted for transplant and waitlist outcomes. Statistical tests were conducted to look for differences among racial/ethnic groups and assess survival outcomes.

Results

Asian patients had the highest graft and patient transplant and waitlist survival rates. Non-Hispanic Black (NHB) recipients had the lowest graft and patient survival rates after transplant at 6 mo, 1 y, and 3 y. Hispanic patients had the lowest waitlist survival. Hispanic patients had the highest Model for End-Stage Liver Disease at listing and the highest proportion of diabetes diagnosis, while NHB had the lowest proportion of private insurance.

Conclusions

NHB patients had poorest posttransplant survival rates and Hispanic patients had worst waitlist survival for LT in hepatocellular carcinoma possibly due to an interplay of socioeconomic and metabolic factors. Addressing these disparities necessitates a comprehensive approach, including areas like healthcare access improvements, lifestyle interventions, and policy development.

介绍：种族和民族差异在肝细胞癌肝移植（LT）的研究不足。方法：从全国数据库（UNOS STAR文件）中获取2012年4月至2021年6月美国所有LT的患者和肿瘤特征。对移植和等待结果分别进行了分析。进行统计检验以寻找种族/族裔群体之间的差异并评估生存结果。结果：亚洲患者有最高的移植和患者移植和等待生存率。非西班牙裔黑人（NHB）受者在移植后6个月、1年和3年的移植和患者生存率最低。西班牙裔患者的等待名单生存率最低。西班牙裔患者的终末期肝病模型最高，糖尿病诊断比例最高，而NHB患者的私人保险比例最低。结论：由于社会经济和代谢因素的相互作用，NHB患者移植后生存率最低，西班牙裔患者肝细胞癌移植后等待生存率最低。解决这些差异需要采取综合方法，包括改善医疗保健、生活方式干预和制定政策等领域。

{"title":"Racial and Ethnic Disparities in Outcomes in Liver Transplantation for Hepatocellular Carcinoma","authors":"Devika Dixit MD , Curtis Warren MPH , Sergio Duarte PhD , Dan Neal MS , Roniel Cabrera MD , Andreas G. Zori MD , Ali Zarrinpar MD, PhD","doi":"10.1016/j.jss.2025.11.016","DOIUrl":"10.1016/j.jss.2025.11.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial and ethnic disparities in liver transplantation (LT) for hepatocellular carcinoma are understudied.</div></div><div><h3>Methods</h3><div>Patient and tumor characteristics of all LT in the United States from April 2012 to June 2021 were obtained from a nationwide database (UNOS STAR files). Separate analyses were conducted for transplant and waitlist outcomes. Statistical tests were conducted to look for differences among racial/ethnic groups and assess survival outcomes.</div></div><div><h3>Results</h3><div>Asian patients had the highest graft and patient transplant and waitlist survival rates. Non-Hispanic Black (NHB) recipients had the lowest graft and patient survival rates after transplant at 6 mo, 1 y, and 3 y. Hispanic patients had the lowest waitlist survival. Hispanic patients had the highest Model for End-Stage Liver Disease at listing and the highest proportion of diabetes diagnosis, while NHB had the lowest proportion of private insurance.</div></div><div><h3>Conclusions</h3><div>NHB patients had poorest posttransplant survival rates and Hispanic patients had worst waitlist survival for LT in hepatocellular carcinoma possibly due to an interplay of socioeconomic and metabolic factors. Addressing these disparities necessitates a comprehensive approach, including areas like healthcare access improvements, lifestyle interventions, and policy development.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 116-131"},"PeriodicalIF":1.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701018","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}

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 : 2025-12-06 DOI: 10.1016/j.jss.2025.10.050

Annika Gompers, Jessica L Harding

引用次数: 0

A Lost Opportunity: Underutilization of Systemic Therapy in T3N0M0 Non–small Cell Lung Cancer 失去的机会：T3N0M0非小细胞肺癌的全身治疗利用不足。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-06 DOI: 10.1016/j.jss.2025.11.019

Christina K. Bedrosian BS , Eric S. Kawaguchi PhD , Li Ding MD , Graeme Rosenberg MD , Takashi Harano MD , Sean Wightman MD , Scott Atay MD , Anthony W. Kim MD , Gavitt A. Woodard MD , Brooks V. Udelsman MD MHS

Introduction

Treatment guidelines for non–small cell lung cancer (NSCLC) include systemic therapy for tumors >5 cm, even in the absence of metastatic/nodal disease. This study sought to evaluate the utilization rate of systemic therapy and any association with survival in this unique population with large tumors but no evidence of nodal spread.

Methods

Patients with resected NSCLC tumors >5 and ≤7 cm diagnosed between 2010 and 2019 were retrospectively selected from the National Cancer Database. Exclusion factors were metastatic disease, nodal involvement, and ≥R1 resection. Survival was compared between patients who received systemic therapy (chemotherapy, immunotherapy, or targeted therapy) and those treated with surgery alone.

Results

Of 8274 identified patients, 3787 (45.8%) received systemic therapy. Recipients tended to be younger (64.6 versus 69.5; P < 0.001), female (45.1% versus 42.1%; P = 0.01), privately insured (37.4% versus 24.4%; P < 0.001), treated at an academic center (39.2% versus 35.7%; P < 0.001), have a Charlson Comorbidity Index of 0 (54.0% versus 50.5%; P < 0.001), and have adenocarcinoma (47.5% versus 40.7%; P < 0.001). Five-year survival was 69.5% with systemic therapy compared to 54.0% with surgery only. Using a multivariable Cox regression, systemic therapy remained associated with a decreased mortality risk (hazard ratio: 0.78, 95% confidence interval: 0.72-0.85; P < 0.001). The primary reason for lack of systemic therapy for 3368 (75.1%) patients was “not planned as part of treatment”, followed by “recommended but refused” by patients/caregivers for 742 patients (16.5%).

Conclusions

Although systemic therapy for locally advanced NSCLC (T3N0M0) is associated with survival, it remains underutilized. Surgeons should be aware of this phenomenon and advocate accordingly.

导论：非小细胞肺癌（NSCLC）的治疗指南包括对直径小于5厘米的肿瘤进行全身治疗，即使没有转移性/淋巴结疾病。本研究旨在评估系统性治疗的使用率，以及在这一独特的肿瘤大但无淋巴结转移证据的人群中与生存率的关系。方法：从国家癌症数据库中回顾性选择2010年至2019年诊断的切除的非小细胞肺癌肿瘤bbb5和≤7 cm的患者。排除因素为转移性疾病、淋巴结受累和≥R1切除。比较接受全身治疗（化疗、免疫治疗或靶向治疗）和单纯手术治疗的患者的生存率。结果：在8274例确诊患者中，3787例（45.8%）接受了全身治疗。接受者倾向于年轻（64.6比69.5,P < 0.001）、女性（45.1%比42.1%,P = 0.01）、私人保险（37.4%比24.4%,P < 0.001）、在学术中心接受治疗（39.2%比35.7%,P < 0.001）、Charlson共病指数为0（54.0%比50.5%,P < 0.001）、患有腺癌（47.5%比40.7%,P < 0.001）。全身治疗的5年生存率为69.5%，而单纯手术的5年生存率为54.0%。使用多变量Cox回归，全身治疗仍然与死亡率降低相关（风险比：0.78,95%可信区间：0.72-0.85;P < 0.001）。3368例（75.1%）患者缺乏全身治疗的主要原因是“未计划作为治疗的一部分”，其次是742例（16.5%）患者“推荐但拒绝”。结论：尽管局部晚期NSCLC （T3N0M0）的全身治疗与生存率相关，但仍未得到充分利用。外科医生应该意识到这一现象并进行相应的宣传。

{"title":"A Lost Opportunity: Underutilization of Systemic Therapy in T3N0M0 Non–small Cell Lung Cancer","authors":"Christina K. Bedrosian BS , Eric S. Kawaguchi PhD , Li Ding MD , Graeme Rosenberg MD , Takashi Harano MD , Sean Wightman MD , Scott Atay MD , Anthony W. Kim MD , Gavitt A. Woodard MD , Brooks V. Udelsman MD MHS","doi":"10.1016/j.jss.2025.11.019","DOIUrl":"10.1016/j.jss.2025.11.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Treatment guidelines for non–small cell lung cancer (NSCLC) include systemic therapy for tumors >5 cm, even in the absence of metastatic/nodal disease. This study sought to evaluate the utilization rate of systemic therapy and any association with survival in this unique population with large tumors but no evidence of nodal spread.</div></div><div><h3>Methods</h3><div>Patients with resected NSCLC tumors >5 and ≤7 cm diagnosed between 2010 and 2019 were retrospectively selected from the National Cancer Database. Exclusion factors were metastatic disease, nodal involvement, and ≥R1 resection. Survival was compared between patients who received systemic therapy (chemotherapy, immunotherapy, or targeted therapy) and those treated with surgery alone.</div></div><div><h3>Results</h3><div>Of 8274 identified patients, 3787 (45.8%) received systemic therapy. Recipients tended to be younger (64.6 <em>versus</em> 69.5; <em>P</em> < 0.001), female (45.1% <em>versus</em> 42.1%; <em>P</em> = 0.01), privately insured (37.4% <em>versus</em> 24.4%; <em>P</em> < 0.001), treated at an academic center (39.2% <em>versus</em> 35.7%; <em>P</em> < 0.001), have a Charlson Comorbidity Index of 0 (54.0% <em>versus</em> 50.5%; <em>P</em> < 0.001), and have adenocarcinoma (47.5% <em>versus</em> 40.7%; <em>P</em> < 0.001). Five-year survival was 69.5% with systemic therapy compared to 54.0% with surgery only. Using a multivariable Cox regression, systemic therapy remained associated with a decreased mortality risk (hazard ratio: 0.78, 95% confidence interval: 0.72-0.85; <em>P</em> < 0.001). The primary reason for lack of systemic therapy for 3368 (75.1%) patients was “not planned as part of treatment”, followed by “recommended but refused” by patients/caregivers for 742 patients (16.5%).</div></div><div><h3>Conclusions</h3><div>Although systemic therapy for locally advanced NSCLC (T3N0M0) is associated with survival, it remains underutilized. Surgeons should be aware of this phenomenon and advocate accordingly.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 99-109"},"PeriodicalIF":1.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701082","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}

引用次数: 0

Letter Regarding: "Nodal Metastases in Oncocytic Carcinoma of the Thyroid Are Associated With Decreased Survival". 关于“甲状腺嗜瘤性癌淋巴结转移与生存率降低相关”的信函。

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-06 DOI: 10.1016/j.jss.2025.10.025

Hooman Hadianfard, Mohammad Movahed, Nima Masoudi

引用次数: 0

Implemented Interventions for Surgeon Well-Being: A Scoping Review 实施干预外科医生的福祉：范围审查

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2025-12-05 DOI: 10.1016/j.jss.2025.11.020

Rodney Ahdoot BS , Alexandra E. Herman MD , Bhuvan Pottepalem BS , Mark P. MacEachern MLIS , Kevin C. Chung MD, MS

Introduction

Surgeons operate in uniquely high-risk environments, facing significant physical and emotional demands and the pressures of academic achievement. These stressors contribute to diminished well-being, affecting both patient care and career longevity. Although burnout is widely studied, it represents only one facet of a surgeon's overall well-being. This study examines existing surgeon well-being interventions for faculty and residents, evaluating structures, themes, and outcome measures to identify gaps in current practices.

Methods

A systematic literature search was conducted across multiple databases to evaluate well-being interventions on surgery faculty and residents. Key components of well-being addressed were identified and categorized into themes within the professional domain, personal domain, and work-life balance.

Results

Sixty-one articles met the inclusion criteria. Among these, 28 studies focused on burnout, 27 on work-related stressors, 9 on career satisfaction, 16 on work-life balance, 16 on physical health, 18 on emotional health, and 2 on relationships. Regarding study design, 13 were randomized controlled trials, 5 were nonrandomized with two groups, 30 used a single-group design with pretest and posttest surveys, and 13 with posttest surveys. To measure outcomes, 37 studies used validated surveys, 34 studies used study-specific surveys, 9 used physiological measurements, and 6 used performance scales.

Conclusions

Surgeon well-being is a multifaceted issue encompassing aspects of professional and personal life. Most interventions have focused on reducing burnout and work-related stressors, measured primarily through surveys. The findings highlight a need for further well-being interventions for both residents and faculty surgeons, particularly focusing on career satisfaction and relationships.

外科医生在独特的高风险环境中工作，面临着巨大的身体和情感需求以及学术成就的压力。这些压力因素导致幸福感下降，影响患者护理和职业寿命。尽管职业倦怠被广泛研究，但它只代表了外科医生整体健康的一个方面。本研究考察了现有的外科医生对教师和住院医生的健康干预措施，评估了结构、主题和结果措施，以确定当前实践中的差距。方法通过系统的文献检索，对外科医师和住院医师的幸福感干预进行评价。幸福感的关键组成部分被确定并分类为专业领域、个人领域和工作与生活平衡的主题。结果61篇符合纳入标准。其中，28项研究关注职业倦怠，27项研究关注工作压力源，9项研究关注职业满意度，16项研究关注工作与生活的平衡，16项研究关注身体健康，18项研究关注情绪健康，2项研究关注人际关系。在研究设计方面，13项为随机对照试验，5项为非随机两组试验，30项为单组设计，采用前测和后测调查，13项采用后测调查。为了测量结果，37项研究使用了验证调查，34项研究使用了研究特异性调查，9项研究使用了生理测量，6项研究使用了绩效量表。外科医生的幸福是一个多方面的问题，包括职业和个人生活的各个方面。大多数干预措施主要通过调查来衡量，重点是减少倦怠和与工作有关的压力源。研究结果强调，住院医生和外科医生都需要进一步的健康干预，特别是关注职业满意度和人际关系。

{"title":"Implemented Interventions for Surgeon Well-Being: A Scoping Review","authors":"Rodney Ahdoot BS , Alexandra E. Herman MD , Bhuvan Pottepalem BS , Mark P. MacEachern MLIS , Kevin C. Chung MD, MS","doi":"10.1016/j.jss.2025.11.020","DOIUrl":"10.1016/j.jss.2025.11.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgeons operate in uniquely high-risk environments, facing significant physical and emotional demands and the pressures of academic achievement. These stressors contribute to diminished well-being, affecting both patient care and career longevity. Although burnout is widely studied, it represents only one facet of a surgeon's overall well-being. This study examines existing surgeon well-being interventions for faculty and residents, evaluating structures, themes, and outcome measures to identify gaps in current practices.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across multiple databases to evaluate well-being interventions on surgery faculty and residents. Key components of well-being addressed were identified and categorized into themes within the professional domain, personal domain, and work-life balance.</div></div><div><h3>Results</h3><div>Sixty-one articles met the inclusion criteria. Among these, 28 studies focused on burnout, 27 on work-related stressors, 9 on career satisfaction, 16 on work-life balance, 16 on physical health, 18 on emotional health, and 2 on relationships. Regarding study design, 13 were randomized controlled trials, 5 were nonrandomized with two groups, 30 used a single-group design with pretest and posttest surveys, and 13 with posttest surveys. To measure outcomes, 37 studies used validated surveys, 34 studies used study-specific surveys, 9 used physiological measurements, and 6 used performance scales.</div></div><div><h3>Conclusions</h3><div>Surgeon well-being is a multifaceted issue encompassing aspects of professional and personal life. Most interventions have focused on reducing burnout and work-related stressors, measured primarily through surveys. The findings highlight a need for further well-being interventions for both residents and faculty surgeons, particularly focusing on career satisfaction and relationships.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"317 ","pages":"Pages 82-89"},"PeriodicalIF":1.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683524","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}

引用次数: 0