Pub Date : 2024-04-17DOI: 10.1016/j.sipas.2024.100248
Carolina Vigna, Ana Sofia Ore, Anne Fabrizio, Evangelos Messaris
Background
Disparities exist the management of rectal cancer. We sought to evaluate short-term surgical outcomes among different racial/ethnic groups following rectal cancer resection.
Materials and Methods
National Surgical Quality Improvement Program (NSQIP) database (2016–2019) was queried. Patients undergoing rectal cancer resection were categorized by race/ethnicity. Circumferential resection margin positivity rate and postoperative outcomes were evaluated. 1:1 Propensity score matching (PSM) was used.
Results
Of 1,753 patients, 80.2 % were White, 7.6 % Black, 8.5 % Asian and 3.7 % Hispanic. On unadjusted analysis, Hispanic patients presented longer operative time(p = 0.029), and Black patients higher postoperative ileus(p = 0.003) and readmission(p = 0.023) rates. After PSM, Hispanics had a significantly higher circumferential resection margin positivity rate(p = 0.032), Black patients higher postoperative ileus rate(p = 0.014) and longer LOS(p = 0.0118) when compared to White counterparts.
Conclusion
Racial disparities were found in short-term postoperative outcomes. Hispanic patients presented higher margin positivity rate and Black patients worst 30-day postoperative outcomes. Comparative studies evaluating trends and a higher number of minority patients included in databases are warranted.
{"title":"Evaluation of racial/ethnic disparities in surgical outcomes after rectal cancer resection: An ACS-NSQIP analysis","authors":"Carolina Vigna, Ana Sofia Ore, Anne Fabrizio, Evangelos Messaris","doi":"10.1016/j.sipas.2024.100248","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100248","url":null,"abstract":"<div><h3>Background</h3><p>Disparities exist the management of rectal cancer. We sought to evaluate short-term surgical outcomes among different racial/ethnic groups following rectal cancer resection.</p></div><div><h3>Materials and Methods</h3><p>National Surgical Quality Improvement Program (NSQIP) database (2016–2019) was queried. Patients undergoing rectal cancer resection were categorized by race/ethnicity. Circumferential resection margin positivity rate and postoperative outcomes were evaluated. 1:1 Propensity score matching (PSM) was used.</p></div><div><h3>Results</h3><p>Of 1,753 patients, 80.2 % were White, 7.6 % Black, 8.5 % Asian and 3.7 % Hispanic. On unadjusted analysis, Hispanic patients presented longer operative time(<em>p</em> = 0.029), and Black patients higher postoperative ileus(<em>p</em> = 0.003) and readmission(<em>p</em> = 0.023) rates. After PSM, Hispanics had a significantly higher circumferential resection margin positivity rate(<em>p</em> = 0.032), Black patients higher postoperative ileus rate(<em>p</em> = 0.014) and longer LOS(<em>p</em> = 0.0118) when compared to White counterparts.</p></div><div><h3>Conclusion</h3><p>Racial disparities were found in short-term postoperative outcomes. Hispanic patients presented higher margin positivity rate and Black patients worst 30-day postoperative outcomes. Comparative studies evaluating trends and a higher number of minority patients included in databases are warranted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100248"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000159/pdfft?md5=b8c6b9dcb291130b1c29412c364bcf2f&pid=1-s2.0-S2666262024000159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.sipas.2024.100247
Lisa J. Toelle , Allison G. McNickle , Declan Feery , Salman Mohammed , Paul J. Chestovich , Kavita Batra , Douglas R. Fraser
Background
Pulmonary contusions (PC) are common after blunt chest trauma and can be identified with computed tomography (CT). Complex scoring systems for grading PC exist, however recent scoring systems rely on computer-generated algorithms that are not readily available at all hospitals. We developed a scoring system for grading PC to predict the need for prolonged mechanical ventilation and initial hospital admission location.
Methods
A retrospective review was performed of adult blunt trauma patients with PC identified on initial chest CT during 2020. Data elements related to demographics, injury characteristics, disposition and healthcare utilization were extracted. The primary outcome was the need for mechanical ventilation for greater than 48 h. A novel scoring system, the Pulmonary Contusion Score (PCS) was developed. The maximum score was 10, with each lobe contributing up to 2 points. A score of 0 was given for no contusion present in the lobe, 1 for less than 50 % contusion, and 2 for greater than 50 % contusion. A PCS of 4 was hypothesized to correlate with need for mechanical ventilation for over 48 h. A confusion matrix of the scoring algorithm was created, and inter-rater concordance was calculated from a randomly selected 125 patients.
Results
A total of 217 patients were identified. 118 patients (54 %) were admitted to the ICU, but only 23 patients (19 %) were intubated, and only 17 patients (8 %) required mechanical ventilation > 48 h. Sensitivity of the scoring system was 20 %, while specificity was 93 %. Negative predictive value was 93 %. Inter-rater agreement was 77 %.
Conclusion
The PCS is a scoring system with high specificity and negative predictive value that can be used to evaluate the need for mechanical ventilation after sustaining blunt PC and can help properly allocate hospital resources.
{"title":"The pulmonary contusion score: Development of a simple scoring system for blunt lung injury","authors":"Lisa J. Toelle , Allison G. McNickle , Declan Feery , Salman Mohammed , Paul J. Chestovich , Kavita Batra , Douglas R. Fraser","doi":"10.1016/j.sipas.2024.100247","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100247","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary contusions (PC) are common after blunt chest trauma and can be identified with computed tomography (CT). Complex scoring systems for grading PC exist, however recent scoring systems rely on computer-generated algorithms that are not readily available at all hospitals. We developed a scoring system for grading PC to predict the need for prolonged mechanical ventilation and initial hospital admission location.</p></div><div><h3>Methods</h3><p>A retrospective review was performed of adult blunt trauma patients with PC identified on initial chest CT during 2020. Data elements related to demographics, injury characteristics, disposition and healthcare utilization were extracted. The primary outcome was the need for mechanical ventilation for greater than 48 h. A novel scoring system, the Pulmonary Contusion Score (PCS) was developed. The maximum score was 10, with each lobe contributing up to 2 points. A score of 0 was given for no contusion present in the lobe, 1 for less than 50 % contusion, and 2 for greater than 50 % contusion. A PCS of 4 was hypothesized to correlate with need for mechanical ventilation for over 48 h. A confusion matrix of the scoring algorithm was created, and inter-rater concordance was calculated from a randomly selected 125 patients.</p></div><div><h3>Results</h3><p>A total of 217 patients were identified. 118 patients (54 %) were admitted to the ICU, but only 23 patients (19 %) were intubated, and only 17 patients (8 %) required mechanical ventilation > 48 h. Sensitivity of the scoring system was 20 %, while specificity was 93 %. Negative predictive value was 93 %. Inter-rater agreement was 77 %.</p></div><div><h3>Conclusion</h3><p>The PCS is a scoring system with high specificity and negative predictive value that can be used to evaluate the need for mechanical ventilation after sustaining blunt PC and can help properly allocate hospital resources.</p></div><div><h3>Level of evidence</h3><p>IV - diagnostic criteria</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100247"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000147/pdfft?md5=50257186706e56b5fde8be903d780796&pid=1-s2.0-S2666262024000147-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140621752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.sipas.2024.100246
Renxi Li , Stephen Huddleston
Background
Coronary Artery Bypass Grafting (CABG) is a high-risk surgery. Cardiovascular diseases are strongly associated with comorbidities. This study aimed to assess the prediction of in-hospital mortality by comorbidities in patients who underwent CABG.
Methods
The National Inpatient Sample database was used to extract patients who received 1, 2, 3, and 4+ CABG between Q4 2015 and 2020. Best-fit model by logistic regressions was used to predict in-hospital mortality by Elixhauser Comorbidity Index (ECI). Moreover, age was adjusted in ECI prediction.
Results
There were 190,524, 83,725, 48,147, and 13,540 patients who underwent 1, 2, 3, and 4+ CABG, respectively. In-hospital mortality was best predicted by ECI in 3 CABG (c-statistic = 0.63, 95 % CI = 0.62–0.65), followed by 4+ CABG (c-statistic = 0.63, 95 % CI = 0.60–0.66), 1 CABG (c-statistic = 0.62, 95 % CI = 0.61–0.63), and 2 CABG (c-statistic = 0.62, 95 % CI = 0.61–0.63). After adjusting for age, ECI adequately predicted in-hospital mortality in 4+ CABG (c-statistic = 0.72, 95 % CI = 0.69–0.75) and 3 CABG (c-statistic = 0.69, 95 % CI = 0.68–0.71). Predictive powers for age-adjusted ECI were comparable in 1 CABG (c-statistic=0.67, 95 % CI = 0.66–0.68) and 2 CABG (c-statistic = 0.67, 95 % CI = 0.65–0.68).
Conclusions
ECI was a moderate (c-statistic 0.6–0.7) predictor of in-hospital mortality in all CABG. Age-adjusted ECI could effectively predict in-hospital mortality, especially in patients who underwent 3 and 4+ CABG.
{"title":"Predicting in-hospital mortality using Elixhauser comorbidity in patients underwent single and multiple coronary artery bypass surgery","authors":"Renxi Li , Stephen Huddleston","doi":"10.1016/j.sipas.2024.100246","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100246","url":null,"abstract":"<div><h3>Background</h3><p>Coronary Artery Bypass Grafting (CABG) is a high-risk surgery. Cardiovascular diseases are strongly associated with comorbidities. This study aimed to assess the prediction of in-hospital mortality by comorbidities in patients who underwent CABG.</p></div><div><h3>Methods</h3><p>The National Inpatient Sample database was used to extract patients who received 1, 2, 3, and 4+ CABG between Q4 2015 and 2020. Best-fit model by logistic regressions was used to predict in-hospital mortality by Elixhauser Comorbidity Index (ECI). Moreover, age was adjusted in ECI prediction.</p></div><div><h3>Results</h3><p>There were 190,524, 83,725, 48,147, and 13,540 patients who underwent 1, 2, 3, and 4+ CABG, respectively. In-hospital mortality was best predicted by ECI in 3 CABG (<em>c</em>-statistic = 0.63, 95 % CI = 0.62–0.65), followed by 4+ CABG (<em>c</em>-statistic = 0.63, 95 % CI = 0.60–0.66), 1 CABG (<em>c</em>-statistic = 0.62, 95 % CI = 0.61–0.63), and 2 CABG (<em>c</em>-statistic = 0.62, 95 % CI = 0.61–0.63). After adjusting for age, ECI adequately predicted in-hospital mortality in 4+ CABG (<em>c</em>-statistic = 0.72, 95 % CI = 0.69–0.75) and 3 CABG (<em>c</em>-statistic = 0.69, 95 % CI = 0.68–0.71). Predictive powers for age-adjusted ECI were comparable in 1 CABG (<em>c</em>-statistic=0.67, 95 % CI = 0.66–0.68) and 2 CABG (<em>c</em>-statistic = 0.67, 95 % CI = 0.65–0.68).</p></div><div><h3>Conclusions</h3><p>ECI was a moderate (<em>c</em>-statistic 0.6–0.7) predictor of in-hospital mortality in all CABG. Age-adjusted ECI could effectively predict in-hospital mortality, especially in patients who underwent 3 and 4+ CABG.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100246"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000135/pdfft?md5=b5189c977c86c425a945bd1d04e9c41a&pid=1-s2.0-S2666262024000135-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140557791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While hepatocellular carcinoma (HCC) remains the leading cause of liver transplant (LT) for liver tumors, indications have broadened over the years. Data regarding patient characteristics and outcomes of LT for liver tumors are limited.
Methods
From Jan-2002 to March-2022, 14,406 LT recipients for various liver tumors were identified in United Network for Organ Sharing database. Overall post-transplant survival analysis was performed with Kaplan-Meier method and multivariable Cox proportional-hazards model.
Results
During the study period, indications for LT for various hepatic tumors were HCC (88.5 %), benign tumors (5.1 %), cholangiocarcinoma (3.9 %), angiosarcoma (0.7 %), bile duct cancer (0.7 %), secondary tumors (0.5 %) and others (0.7 %). Compared to non-HCC, LT recipients for HCC were older (median age 61 vs 54 years, P < 0.001), more often male (77% vs 48 %, P < 0.001), more often Hispanic (16% vs 8.0 %), had higher BMI (28.2 vs 25.3, P < 0.001) and higher prevalence of Hepatitis C (53% vs 3.9 %, P < 0.001). Donor characteristics across various groups were similar. One-year survival in LT recipients of HCC was higher (HCC: 91.7% vs. non-HCC: 90.3 %) with adjusted Hazard Ratio (aHR) of 0.87; 95 % CI 0.77–0.99, P = 0.033 in a multivariable Cox regression analysis. Compared to HCC, survival outcomes were worse in cholangiocarcinoma (aHR 1.70; 95 %CI 1.43–2.01, P < 0.001), bile duct cancer (aHR 3.03; 95 %CI 2.12–4.33, P < 0.001), secondary tumors including colon cancer and neuroendocrine tumors (aHR 1.88; 95 % CI 1.24–2.85, P = 0.003), with best survival in patients with benign tumors (aHR 0.57; 95 %CI 0.46–0.70, P < 0.001).
Conclusions
LT is performed for various liver tumors with variable outcomes among these primary indications.
{"title":"Indications and outcomes of liver transplantation for liver tumors in the United States","authors":"Kenji Okumura, Abhay Dhand, Kamil Hanna, Ryosuke Misawa, Hiroshi Sogawa, Gregory Veillette, Seigo Nishida","doi":"10.1016/j.sipas.2024.100245","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100245","url":null,"abstract":"<div><h3>Background</h3><p>While hepatocellular carcinoma (HCC) remains the leading cause of liver transplant (LT) for liver tumors, indications have broadened over the years. Data regarding patient characteristics and outcomes of LT for liver tumors are limited.</p></div><div><h3>Methods</h3><p>From Jan-2002 to March-2022, 14,406 LT recipients for various liver tumors were identified in United Network for Organ Sharing database. Overall post-transplant survival analysis was performed with Kaplan-Meier method and multivariable Cox proportional-hazards model.</p></div><div><h3>Results</h3><p>During the study period, indications for LT for various hepatic tumors were HCC (88.5 %), benign tumors (5.1 %), cholangiocarcinoma (3.9 %), angiosarcoma (0.7 %), bile duct cancer (0.7 %), secondary tumors (0.5 %) and others (0.7 %). Compared to non-HCC, LT recipients for HCC were older (median age 61 vs 54 years, <em>P</em> < 0.001), more often male (77% vs 48 %, <em>P</em> < 0.001), more often Hispanic (16% vs 8.0 %), had higher BMI (28.2 vs 25.3, <em>P</em> < 0.001) and higher prevalence of Hepatitis C (53% vs 3.9 %, <em>P</em> < 0.001). Donor characteristics across various groups were similar. One-year survival in LT recipients of HCC was higher (HCC: 91.7% vs. non-HCC: 90.3 %) with adjusted Hazard Ratio (aHR) of 0.87; 95 % CI 0.77–0.99, <em>P</em> = 0.033 in a multivariable Cox regression analysis. Compared to HCC, survival outcomes were worse in cholangiocarcinoma (aHR 1.70; 95 %CI 1.43–2.01, <em>P</em> < 0.001), bile duct cancer (aHR 3.03; 95 %CI 2.12–4.33, <em>P</em> < 0.001), secondary tumors including colon cancer and neuroendocrine tumors (aHR 1.88; 95 % CI 1.24–2.85, <em>P</em> = 0.003), with best survival in patients with benign tumors (aHR 0.57; 95 %CI 0.46–0.70, <em>P</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>LT is performed for various liver tumors with variable outcomes among these primary indications.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000123/pdfft?md5=6edd88d1fb293f935ce91927c2c3c344&pid=1-s2.0-S2666262024000123-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140894413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-02DOI: 10.1016/j.sipas.2024.100244
Shivangi Parmar , Emily Eachus , Orly Morgan , Boris Yang , Violet Victoria , Suhas Seshadri , Armen Henderson , Stefan Kenel-Pierre , Joshua Laban
Background
The effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness.
Methods
Clinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had.
Results
Of 300 participants, 18 % (N = 55) had a history of surgery, most common being 1) orthopedics (N = 20), 2) vascular (N = 18), 3) general (N = 6), 4) acute trauma response (N = 5), 5) ophthalmology (N = 4), 6) surgical oncology (N = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, n = 300)=10.9, p < 0.001] and Type II Diabetes [X2 (1, n = 300)=10.5, p = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation.
Conclusion
Little research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.
背景住房不安全对外科护理的影响研究不足，而且在很大程度上不为人所知。迄今为止，有关无家可归者手术效果的研究要么集中在以庇护所为基础的病人身上，要么不区分病人是有庇护所的还是无庇护所的，尽管在护理需求和健康风险方面存在显著差异。方法对在免费流动诊所接受治疗的 300 名无家可归者的临床病史、药物清单和血压记录进行去身份化处理，并在 R studio 4.3.0 中下载和分析。结果 在 300 名参与者中，18%（N = 55）有手术史，最常见的手术有：1）骨科（N = 20）；2）血管科（N = 18）；3）普外科（N = 6）；4）急性创伤反应科（N = 5）；5）眼科（N = 4）；6）肿瘤外科（N = 2）。出院后，13% 的患者因伤口感染返回医院，9% 的患者再次入院接受治疗。Chi Square检验显示，高血压[X2 (1, n = 300)=10.9, p < 0.001]和II型糖尿病[X2 (1, n = 300)=10.5, p = 0.0012]显著增加了需要血管手术的可能性，尤其是下肢伤口清创或截肢。研究结果表明，无家可归者在获得癌症治疗方面可能存在障碍，而且需要外科手术治疗的血管疾病风险增加。未来的研究需要了解、解决和克服当前的外科护理障碍，以帮助这个高危和服务不足的群体。
{"title":"Surgical risks and care trends: A cross sectional study of people experiencing homelessness presenting at a free clinic care in Miami-Dade County","authors":"Shivangi Parmar , Emily Eachus , Orly Morgan , Boris Yang , Violet Victoria , Suhas Seshadri , Armen Henderson , Stefan Kenel-Pierre , Joshua Laban","doi":"10.1016/j.sipas.2024.100244","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100244","url":null,"abstract":"<div><h3>Background</h3><p>The effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness.</p></div><div><h3>Methods</h3><p>Clinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had.</p></div><div><h3>Results</h3><p>Of 300 participants, 18 % (<em>N</em> = 55) had a history of surgery, most common being 1) orthopedics (<em>N</em> = 20), 2) vascular (<em>N</em> = 18), 3) general (<em>N</em> = 6), 4) acute trauma response (<em>N</em> = 5), 5) ophthalmology (<em>N</em> = 4), 6) surgical oncology (<em>N</em> = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, <em>n</em> = 300)=10.9, <em>p</em> < 0.001] and Type II Diabetes [X2 (1, <em>n</em> = 300)=10.5, <em>p</em> = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation.</p></div><div><h3>Conclusion</h3><p>Little research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000111/pdfft?md5=e7a3e5f9196b9324a5ff46681f19cc7f&pid=1-s2.0-S2666262024000111-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140548558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.
Results
We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, p = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, p = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, p = <0.004).
Conclusions
Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.
{"title":"Impact of nursing home admission on in-hospital mortality and morbidity and length of stay: A case-control analysis","authors":"Claudio Canal , Anne-Sophie Mittlmeier , Valentin Neuhaus , Hans-Christoph Pape , Mathias Schlögl","doi":"10.1016/j.sipas.2024.100243","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100243","url":null,"abstract":"<div><h3>Methods</h3><p>We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.</p></div><div><h3>Results</h3><p>We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, <em>p</em> = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, <em>p</em> = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, <em>p</em> = <0.004).</p></div><div><h3>Conclusions</h3><p>Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266626202400010X/pdfft?md5=dd3de3c847b126c1e6b6d000e3f9c42f&pid=1-s2.0-S266626202400010X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140344591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1016/j.sipas.2024.100242
Austin Kluis, Aasim Afzal, Greg Milligan, J. Michael DiMaio, Nitin Kabra, David A. Rawitscher, Timothy J. George
Introduction
Although left ventricular assist device (LVAD) implantation is associated with improved survival in patients with end-stage heart failure, the impact of preoperative pulmonary function on short-term outcomes is unclear.
Methods
We conducted a retrospective review of all primary LVAD implants at a single institution. Common measures of preoperative pulmonary function were evaluated. Survival was estimated using the Kaplan-Meier method.
Results
From 2017–2022, 107 patients underwent primary LVAD implantation. Prior to implantation, 68 (63.6 %) were on room air, 28 (26.4 %) were on nasal cannula, 2 (1.9 %) were on noninvasive positive pressure ventilation, and 9 (8.5 %) were on the ventilator. The average preoperative fraction of inspired oxygen (FiO2) was 25.3 ± 8.2 % while the mean percentage predicted forced expiratory volume in 1 second (FEV1) was 71.4 ± 20.9 %. Overall, 1-year survival was 86.8 %, the median postoperative ventilator time was 20.4 [4.2-77.7] h, and 18 (16.8 %) patients required postoperative tracheostomy. When stratified by pulmonary function, lower FEV1 and increased preoperative FiO2 were associated with decreased 1-year survival
Conclusions
In conclusion, preoperative pulmonary function is associated with short-term LVAD survival, postoperative ventilatory time, and need for tracheostomy. Therefore, rigorous pulmonary function evaluation may help in appropriate preoperative risk stratification.
{"title":"Preoperative pulmonary function is associated with left ventricular assist device outcomes","authors":"Austin Kluis, Aasim Afzal, Greg Milligan, J. Michael DiMaio, Nitin Kabra, David A. Rawitscher, Timothy J. George","doi":"10.1016/j.sipas.2024.100242","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100242","url":null,"abstract":"<div><h3>Introduction</h3><p>Although left ventricular assist device (LVAD) implantation is associated with improved survival in patients with end-stage heart failure, the impact of preoperative pulmonary function on short-term outcomes is unclear.</p></div><div><h3>Methods</h3><p>We conducted a retrospective review of all primary LVAD implants at a single institution. Common measures of preoperative pulmonary function were evaluated. Survival was estimated using the Kaplan-Meier method.</p></div><div><h3>Results</h3><p>From 2017–2022, 107 patients underwent primary LVAD implantation. Prior to implantation, 68 (63.6 %) were on room air, 28 (26.4 %) were on nasal cannula, 2 (1.9 %) were on noninvasive positive pressure ventilation, and 9 (8.5 %) were on the ventilator. The average preoperative fraction of inspired oxygen (FiO2) was 25.3 ± 8.2 % while the mean percentage predicted forced expiratory volume in 1 second (FEV1) was 71.4 ± 20.9 %. Overall, 1-year survival was 86.8 %, the median postoperative ventilator time was 20.4 [4.2-77.7] h, and 18 (16.8 %) patients required postoperative tracheostomy. When stratified by pulmonary function, lower FEV1 and increased preoperative FiO2 were associated with decreased 1-year survival</p></div><div><h3>Conclusions</h3><p>In conclusion, preoperative pulmonary function is associated with short-term LVAD survival, postoperative ventilatory time, and need for tracheostomy. Therefore, rigorous pulmonary function evaluation may help in appropriate preoperative risk stratification.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000093/pdfft?md5=bcaae70819b2517254c29af31b8989af&pid=1-s2.0-S2666262024000093-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140328184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared a pandemic by the World Health Organization. The Swiss government decreed a public lockdown to reduce and restrict further infections. The aim of this investigation was to analyze the impact of the first COVID-19 lockdown on the performance of general and visceral surgery procedures.
Materials and Methods
A retrospective study was performed on the basis of the surgical registry of the working group for quality assurance in surgery (“Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie” or AQC). All patients with specific surgical diagnoses (complicated gastric or duodenal ulcer, acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus, cutaneous and perianal abscess) were analyzed during 2019 and the corresponding lockdown period of March 14 through April 26, 2020. Data regarding patients’ characteristics, diagnoses, and treatments were analyzed.
Results
In total, 3,330 patients were analyzed, with 2,203 patients treated in 2019 and 1,127 patients treated in 2020. There was a reduction in the number of all investigated diagnoses during the pandemic period, with statistically significant differences in acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus (all p < 0.001), and cutaneous abscess (p = 0.01). The proportion of complicated appendicitis (p = 0.02), complicated hernia (p < 0.001), and complicated gallstone disease (choledocholithiasis p = 0.01; inflammation, p = 0.001) was significantly higher during the lockdown period. The surgical urgency rate in all patients was higher during the lockdown period compared to the control period (p < 0.001).
Conclusions
The socioeconomic lockdown significantly impacted the number of general and visceral surgery procedures in Switzerland. The reasons for the reduction are multifactorial.
导言2019年冠状病毒病（COVID-19）是一种急性病毒感染，世界卫生组织宣布其为大流行病。瑞士政府颁布了公共封锁令，以减少和限制进一步的感染。这项调查旨在分析第一次 COVID-19 封锁对普外科和内脏外科手术的影响。材料与方法根据外科质量保证工作组（Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie，简称 AQC）的外科登记册进行了一项回顾性研究。在2019年以及2020年3月14日至4月26日的相应封锁期内，对所有具有特定手术诊断（复杂性胃溃疡或十二指肠溃疡、急性阑尾炎、疝气、憩室疾病、胆石症、皮样窦、皮肤和肛周脓肿）的患者进行了分析。结果共分析了3330名患者，其中2019年治疗了2203名患者，2020年治疗了1127名患者。在大流行期间，所有调查诊断的数量都有所减少，其中急性阑尾炎、疝气、憩室病、胆石症、皮样窦（所有 p < 0.001）和皮肤脓肿（p = 0.01）的差异具有统计学意义。在封锁期间，复杂性阑尾炎（p = 0.02）、复杂性疝气（p < 0.001）和复杂性胆石症（胆石症 p = 0.01；炎症，p = 0.001）的比例明显较高。结论社会经济封锁严重影响了瑞士普外科和内脏外科手术的数量。导致手术数量减少的原因是多方面的。
{"title":"Retrospective registry-based nationwide analysis of the COVID-19 lockdown effect on the volume of general and visceral non-malignant surgical procedures","authors":"René Fahrner , Eliane Dohner , Fiona Joséphine Kierdorf , Claudio Canal , Valentin Neuhaus","doi":"10.1016/j.sipas.2024.100241","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100241","url":null,"abstract":"<div><h3>Introduction</h3><p>Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared a pandemic by the World Health Organization. The Swiss government decreed a public lockdown to reduce and restrict further infections. The aim of this investigation was to analyze the impact of the first COVID-19 lockdown on the performance of general and visceral surgery procedures.</p></div><div><h3>Materials and Methods</h3><p>A retrospective study was performed on the basis of the surgical registry of the working group for quality assurance in surgery (“Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie” or AQC). All patients with specific surgical diagnoses (complicated gastric or duodenal ulcer, acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus, cutaneous and perianal abscess) were analyzed during 2019 and the corresponding lockdown period of March 14 through April 26, 2020. Data regarding patients’ characteristics, diagnoses, and treatments were analyzed.</p></div><div><h3>Results</h3><p>In total, 3,330 patients were analyzed, with 2,203 patients treated in 2019 and 1,127 patients treated in 2020. There was a reduction in the number of all investigated diagnoses during the pandemic period, with statistically significant differences in acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus (all <em>p</em> < 0.001), and cutaneous abscess (<em>p</em> = 0.01). The proportion of complicated appendicitis (<em>p</em> = 0.02), complicated hernia (<em>p</em> < 0.001), and complicated gallstone disease (choledocholithiasis <em>p</em> = 0.01; inflammation, <em>p</em> = 0.001) was significantly higher during the lockdown period. The surgical urgency rate in all patients was higher during the lockdown period compared to the control period (<em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>The socioeconomic lockdown significantly impacted the number of general and visceral surgery procedures in Switzerland. The reasons for the reduction are multifactorial.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000081/pdfft?md5=75a3ce301b9c8f3a92a1b2cb93d00fc0&pid=1-s2.0-S2666262024000081-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140164035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent studies have shown that receptor status of breast cancer change between primary tumor and recurrence, which may influence treatment strategy and prognosis, but there are few reports on receptor discordance between primary tumors and local recurrence (LR) after nipple-sparing mastectomy (NSM).
Patients and methods
We collected 74 patients who had LR after NSM for newly diagnosed stages 0 to 3 breast cancer between 2008 and 2016 at 14 institutions. We classified into 4 subtypes based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2). We evaluated clinicopathological factors that correlate with receptor discordance and assessed the impact of receptor discordance on survival.
Results
Discordance rates in estrogen receptor (ER), progesterone receptor (PgR) and HER2 were 9.5, 10.8 and 5.4 %, respectively. The most common change was from HR-/HER2+ to HR+/HER2+, and this pattern of receptor change occurred only in patients with nipple–areolar recurrence. Non-invasive tumors in LR, nipple–areolar recurrence (NAR), HR-/HER2+ primary tumor subtype, and the presence of chemotherapy for primary tumors were significantly associated with receptor discordance. With a median follow-up of 44.5 months (4–153 months), patients in the receptor-discordant group had no disease-free survival (DFS) event after LR resection (5-year DFS; 100 % in the receptor-discordant group vs 85.1 % in the receptor-concordant group; p = 0.2).
Conclusion
Our study demonstrates that the presence of chemotherapy for primary tumors, nipple-areolar recurrence, and its related factors (non-invasive tumor in LR, HR-/HER2+ primary tumor subtype) were associated with receptor discordance. However, further studies with longer follow-up periods and larger sample sizes are needed.
{"title":"Receptor discordance after nipple-sparing mastectomy","authors":"Rena Kojima , Makoto Ishitobi , Naomi Nagura , Ayaka Shimo , Hirohito Seki , Akiko Ogiya , Teruhisa Sakurai , Yukiko Seto , Shinsuke Sasada , Chiya Oshiro , Michiko Kato , Takahiko Kawate , Naoto Kondo , Tadahiko Shien","doi":"10.1016/j.sipas.2024.100239","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100239","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies have shown that receptor status of breast cancer change between primary tumor and recurrence, which may influence treatment strategy and prognosis, but there are few reports on receptor discordance between primary tumors and local recurrence (LR) after nipple-sparing mastectomy (NSM).</p></div><div><h3>Patients and methods</h3><p>We collected 74 patients who had LR after NSM for newly diagnosed stages 0 to 3 breast cancer between 2008 and 2016 at 14 institutions. We classified into 4 subtypes based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2). We evaluated clinicopathological factors that correlate with receptor discordance and assessed the impact of receptor discordance on survival.</p></div><div><h3>Results</h3><p>Discordance rates in estrogen receptor (ER), progesterone receptor (PgR) and HER2 were 9.5, 10.8 and 5.4 %, respectively. The most common change was from HR-/HER2+ to HR+/HER2+, and this pattern of receptor change occurred only in patients with nipple–areolar recurrence. Non-invasive tumors in LR, nipple–areolar recurrence (NAR), HR-/HER2+ primary tumor subtype, and the presence of chemotherapy for primary tumors were significantly associated with receptor discordance. With a median follow-up of 44.5 months (4–153 months), patients in the receptor-discordant group had no disease-free survival (DFS) event after LR resection (5-year DFS; 100 % in the receptor-discordant group vs 85.1 % in the receptor-concordant group; <em>p</em> = 0.2).</p></div><div><h3>Conclusion</h3><p>Our study demonstrates that the presence of chemotherapy for primary tumors, nipple-areolar recurrence, and its related factors (non-invasive tumor in LR, HR-/HER2+ primary tumor subtype) were associated with receptor discordance. However, further studies with longer follow-up periods and larger sample sizes are needed.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100239"},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000068/pdfft?md5=b7091c311e0271e7e2fb777cf2be4321&pid=1-s2.0-S2666262024000068-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140063140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1016/j.sipas.2024.100238
Alyssa M. Goodwin, Steven S. Kurapaty, Jacqueline E. Inglis, Srikanth N. Divi, Alpesh A. Patel, Wellington K. Hsu
Background
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides risk estimates of postoperative complications. While several studies have examined the accuracy of the ACS-Surgical Risk Calculator (SRC) within a single specialty, the respective conclusions are limited by sample size. We sought to conduct a meta-analysis to determine the accuracy of the ACS-SRC among various surgical specialties.
Study design
Clinical studies that utilized the ACS-SRC, predicted complication rates compared to actual rates, and analyzed at least one metric reported by ACS-SRC met the inclusion criteria. Data for each specialty were pooled using the DerSimonian and Laird random-effect models and analyzed with the binary random-effect model to produce risk difference (RD) and 95 % confidence intervals (CIs) using Open Meta[Analyst].
Results
The initial search yielded 281 studies and, after applying inclusion and exclusion criteria, a total of 53 studies remained with a total sample of 30,134 patients spanning 10 surgical specialties. When considering any complication and death, the ACS-SRC significantly underpredicted complications for: Orthopaedic Surgery (RD –0.067, p = 0.008), Spine (RD -0.027, p < 0.001), Urology (RD -0.03, p < 0.001), Surgical Oncology (RD -0.045, p < 0.001), and Gynecology (RD -0.098, p = 0.01).
Conclusion
The ACS-SRC proved useful in General, Acute Care, Colorectal, Otolaryngology, and Cardiothoracic Surgery, but significantly underpredicted complication rates in Spine, Orthopaedics, Urology, Surgical Oncology, and Gynecology. These data indicate the ACS-SRC is a reliable predictor in some specialties, but its use should be cautioned in the remaining specialties evaluated here.
{"title":"A meta-analysis of the American college of surgeons risk calculator's predictive accuracy among different surgical sub-specialties","authors":"Alyssa M. Goodwin, Steven S. Kurapaty, Jacqueline E. Inglis, Srikanth N. Divi, Alpesh A. Patel, Wellington K. Hsu","doi":"10.1016/j.sipas.2024.100238","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100238","url":null,"abstract":"<div><h3>Background</h3><p>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides risk estimates of postoperative complications. While several studies have examined the accuracy of the ACS-Surgical Risk Calculator (SRC) within a single specialty, the respective conclusions are limited by sample size. We sought to conduct a meta-analysis to determine the accuracy of the ACS-SRC among various surgical specialties.</p></div><div><h3>Study design</h3><p>Clinical studies that utilized the ACS-SRC, predicted complication rates compared to actual rates, and analyzed at least one metric reported by ACS-SRC met the inclusion criteria. Data for each specialty were pooled using the DerSimonian and Laird random-effect models and analyzed with the binary random-effect model to produce risk difference (RD) and 95 % confidence intervals (CIs) using Open Meta[A<em>nalyst</em>].</p></div><div><h3>Results</h3><p>The initial search yielded 281 studies and, after applying inclusion and exclusion criteria, a total of 53 studies remained with a total sample of 30,134 patients spanning 10 surgical specialties. When considering any complication and death, the ACS-SRC significantly underpredicted complications for: Orthopaedic Surgery (RD –0.067, <em>p</em> = 0.008), Spine (RD -0.027, <em>p</em> < 0.001), Urology (RD -0.03, <em>p</em> < 0.001), Surgical Oncology (RD -0.045, <em>p</em> < 0.001), and Gynecology (RD -0.098, <em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>The ACS-SRC proved useful in General, Acute Care, Colorectal, Otolaryngology, and Cardiothoracic Surgery, but significantly underpredicted complication rates in Spine, Orthopaedics, Urology, Surgical Oncology, and Gynecology. These data indicate the ACS-SRC is a reliable predictor in some specialties, but its use should be cautioned in the remaining specialties evaluated here.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100238"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000056/pdfft?md5=d20a6752b84c885e3126caa50207a7e2&pid=1-s2.0-S2666262024000056-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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