Surgery open science最新文献

{"title":"The efficacy of adipose-derived stem cell therapy for complex perianal fistulas in Crohn's disease patients: A systematic review","authors":"Mohammed Aldakhil ,&nbsp;Raghad Ibrahim albarrak MBBS ,&nbsp;Jana Abdullah Alomar ,&nbsp;Leena Ibrahim Alnasr ,&nbsp;Rima Mohammed Alassaf ,&nbsp;Nouf khaled Alhumaid","doi":"10.1016/j.sopen.2025.11.002","DOIUrl":"10.1016/j.sopen.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that often leads to the development of complex perianal fistulas, significantly impairing patients' quality of life. Conventional medical and surgical treatments offer limited long-term efficacy, with high recurrence rates and associated complications. Adipose-derived stem cell therapy (ADSCT) has emerged as a promising regenerative therapy due to its anti-inflammatory and tissue-regenerative properties. However, discrepancies in clinical outcomes across studies warrant a systematic evaluation of its efficacy and safety.</div></div><div><h3>Objective</h3><div>This systematic review aims to critically assess the efficacy, safety, and recurrence rates of ADSCT for complex perianal fistulas in Crohn's disease patients, summarizing data from randomized controlled trials and observational studies.</div></div><div><h3>Methods</h3><div>This review included 19 studies published between 2009 and 2024 involving Crohn's disease patients treated with either autologous or allogeneic ADSCT. Extracted data included patient demographics, fistula characteristics, treatment protocols, and clinical outcomes such as fistula closure, partial healing, time to healing, recurrence, and adverse events. Study selection followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and is illustrated in a PRISMA flow diagram. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and adapted versions of the Newcastle-Ottawa Scale (NOS) and MINORS criteria for observational studies. Studies were categorized as excellent, good, or fair based on their total quality score.</div></div><div><h3>Results</h3><div>Fistula closure rates ranged from 23.1 % to 91 %, with an overall average of 62.5 %. Partial healing rates varied widely, between 9 % and 93.3 %. Time to healing ranged from 8 to 48 weeks, with an average of 25.3 weeks. Recurrence rates were reported in over half of the studies and reached up to 38.5 %, with a mean recurrence rate of 19.2 %. The majority of adverse events were mild and transient, including local inflammation, discomfort, and minor infections. No serious (Grade 3 or 4) complications were reported. Risk of bias assessment classified one study as excellent, two as good, and two as fair in methodological quality.</div></div><div><h3>Conclusion</h3><div>Adipose-derived stem cell therapy demonstrates promising efficacy and a favorable safety profile for the treatment of complex perianal fistulas in Crohn's disease. While ADSCT may achieve meaningful clinical response and symptom relief in a substantial proportion of patients, variability in outcomes and study designs highlights the need for standardized protocols and long-term follow-up in future trials.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"29 ","pages":"Pages 22-28"},"PeriodicalIF":1.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of deceased donor acute kidney injury (AKI) on renal transplant outcomes","authors":"Mikhail Nozdrin MBBS ,&nbsp;Maria Irene Bellini PhD ,&nbsp;Maria Selyanina BSc ,&nbsp;Maria Nozdrina BA ,&nbsp;Kavyesh Vivek MBBS ,&nbsp;Simona Mihalikova BSc ,&nbsp;Vassilios Papalois MD","doi":"10.1016/j.sopen.2025.11.001","DOIUrl":"10.1016/j.sopen.2025.11.001","url":null,"abstract":"<div><h3>Aims</h3><div>Donor AKI is a common reason for discarding deceased donor kidneys due to uncertainty regarding transplant outcomes. Our study investigated the effect of AKI in donor kidneys on post-transplantation outcomes.</div></div><div><h3>Methods</h3><div>Medline, Embase, Cochrane and Web of Science were searched. Risk of bias assessment was performed. 2984 studies were identified by the search, 34 met the inclusion criteria. A total of 103,529 kidney transplants were analysed, 97,165 (94 %) with and 6364 (6 %) without donor AKI.</div></div><div><h3>Results</h3><div>There was no significant difference between recipients of grafts from donors with terminal serum creatinine &gt;2.0 mg/dl and &lt; 2.0 mg/dl in 1 year serum creatinine (MD: -0.01, CI: −0.09-0.07, <em>P</em> = 0.84), 1 year patient survival (RR: 0.99, CI: 0.96–1.02, <em>P</em> = 0.52), as well as in 1 year (RR: 1.01, CI: 0.98–1.03, <em>P</em> = 0.61) and 5 year (RR: 0.99, CI: 0.94–1.04, <em>P</em> = 0.63) graft survival. DGF was the only parameter significantly worse in recipients of grafts from donors with terminal serum creatinine &gt;2.0 than to non-AKI recipients (RR: 1.89, CI: 1.64–2.17, <em>P</em> &lt; 0.01). In studies that compared the severity of AKI stage using the AKIN criteria, there was no significant difference in 1 year post-transplantation serum creatinine even between recipients of grafts from the most severe AKI stage (AKIN3) and the non-AKI group (AKIN0) (MD: -0.01, CI:-0.17–0.16, <em>P</em> = 0.92).</div></div><div><h3>Conclusions</h3><div>Donor AKI is associated with a higher incidence of DGF but has no effect on post-transplant patient and graft survival and, based on this analysis, should not be a sole reason for discarding kidneys.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"29 ","pages":"Pages 7-21"},"PeriodicalIF":1.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-axis versus long-axis ultrasound-guided thyroid nodule biopsy: A randomized controlled trial of diagnostic performance in Iraq","authors":"Mustafa Adnan Zaidan ,&nbsp;Hussein Ali Tawfeeq ,&nbsp;Ali Kamal Ghanim","doi":"10.1016/j.sopen.2025.11.003","DOIUrl":"10.1016/j.sopen.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound guided fine needle aspiration cytology (US-FNAC) is the gold standard of evaluation of thyroid nodule. Two main approaches are available - short axis (perpendicular) and long axis (parallel), and each has theoretical clinical advantages. Evidence comparing the diagnostic performance of the two in Middle Eastern populations is limited. Objective: To compare the sensitivity, specificity, and accuracy of US-FNAC of short-axis versus long-axis in thyroid nodules with implications for patient care.</div></div><div><h3>Methods</h3><div>A prospective multi-center randomized controlled trial was performed in Pioneer Private Laboratory and Mustafa Hafez Specialized Laboratory, Baghdad, Iraq from March to December 2024. A total of 196 nodules from patients ≥18 years were randomized to undergo short-axis or long-axis US-FNAC. Cytological results by the Bethesda System were correlated with histopathology. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were the primary outcomes.</div></div><div><h3>Results</h3><div>Of 196 nodules (mean age 47.8 ± 13.5 years; 79.6 % female), patient and nodule characteristics did not differ between groups. Long-axis US-FNAC was 73.9 % sensitive, 100 % specific, 87.0 % accurate, 100 % positive predictive and 79.3 % negative predictive. Short-axis US-FNAC showed sensitivity of 76.7 %, specificity of 100 %, accuracy of 89.2 %, positive predictive value of 100 % and negative predictive value of 83.3 %. There were no differences in accuracy of diagnosis (<em>p</em> = 0.524).</div></div><div><h3>Conclusions</h3><div>Short-axis and long-axis US-FNAC offer similar diagnostic performance of thyroid nodules in Iraqi patients. Although there were no differences in accuracy between procedures, operator experience, nodule characteristics, and patient factors could be used to choose the technique that best suited the clinical situation, which would allow for flexibility in clinical practice and potential improvements in patient comfort and procedural efficiency.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 73-79"},"PeriodicalIF":1.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collagenolytic Enterococcus faecalis induces DDR1 signaling, proliferation and altered immune infiltrate in colorectal peritoneal metastases","authors":"Richard Jacobson ,&nbsp;Sean Dineen ,&nbsp;John Mullinax ,&nbsp;Ryan Martin ,&nbsp;Sidharth Mishra ,&nbsp;Michelle Maurin ,&nbsp;Ramani Soundararajan ,&nbsp;Timothy Nywening ,&nbsp;Andreas Karachristos ,&nbsp;Hariom Yadav ,&nbsp;Timothy Yeatman ,&nbsp;Jason Fleming","doi":"10.1016/j.sopen.2025.10.011","DOIUrl":"10.1016/j.sopen.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Intratumoral pathogens are an emerging paradigm in metastatic colorectal cancer (CRC). Overgrowth of <em>Enterococcus faecalis</em> was shown to promote local recurrence in the colon, in a fashion dependent on collagenolytic virulence factors. The role of intratumoral enterococci in metastatic CRC is presently unknown.</div></div><div><h3>Methods</h3><div>We screened resected human metastatic CRC from the liver, lungs, and peritoneal surface for intratumoral bacteria with 16 s rRNA sequencing. We probed the effects of <em>E. faecalis</em> on CRC biology in vitro<em>,</em> with a focus on collagenolysis and the putative receptor for cleaved collagen, discoidin domain receptor 1 (DDR1) in CT26 CRC cells. We used a syngeneic, orthotopic mouse model of colorectal peritoneal metastases to measure the impact of <em>E. faecalis</em> on tumor bulk and immune infiltrate.</div></div><div><h3>Results</h3><div>Resected metastatic CRC from 70 patients were screened for intratumoral bacteria. <em>Enterococcus</em> species were identified in 10/13 patients with CRC peritoneal metastases and were enriched in peritoneal compared to non-peritoneal metastases. <em>E. faecalis</em> and CRC cells demonstrated cooperative collagenolysis in a fashion dependent on the secreted virulence factors GelE and SprE<em>.</em> Bacterial-induced collagenolysis led to increased DDR1 phosphorylation and downstream effects, specifically proliferation and endocytosis of cleaved collagen. In the mouse model, cell counts indicate intratumoral <em>E. faecalis</em> altered the immune compartment of the tumor microenvironment.</div></div><div><h3>Discussion</h3><div>Collagenolytic <em>E. faecalis</em> induce DDR1 pathway activation in CRC cells, alter the immune landscape in mouse models, and are enriched in human CRC peritoneal metastases. Further work is required to determine whether eradication of intratumoral bacteria can change tumor biology.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 65-72"},"PeriodicalIF":1.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of inflammatory biomarkers and surgical interventions on one-month recovery after rib fractures: A propensity-matched cohort study","authors":"Xiaojiao Zhu ,&nbsp;Jianwei Han ,&nbsp;Chuan Long ,&nbsp;Wenjun Cao ,&nbsp;Suwei Xu ,&nbsp;Yingding Ruan","doi":"10.1016/j.sopen.2025.10.009","DOIUrl":"10.1016/j.sopen.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess the collective influence of inflammatory indicators and surgical interventions on the one-month postoperative recovery outcomes in patients with rib fractures.</div></div><div><h3>Methods</h3><div>A retrospective analysis involved 70 surgical and 278 non - surgical rib - fracture patients. Primary outcomes were thoracic complication incidence and post - discharge oral analgesic use at one month. Secondary outcomes included hospital stay length and total costs. We collected various data and conducted propensity score matching (1:2 ratio) to control for confounders, followed by multivariate analyses.</div></div><div><h3>Results</h3><div>After PSM (60 surgical vs. 117 non-surgical patients), surgical reduced hospital stay by 10.4 days (β = −10.36 days, 95 % confidence interval [95 % CI]: −16.03 to −4.70; <em>P</em> &lt; 0.001), but increase in total costs by 30,808.80 CNY (P &lt; 0.001). Pre-existing thoracic complications independently predicted higher one-month postoperative complications (OR[95 % CI] = 4.05 [1.08, 18.15]; <em>P</em> = 0.048), while comorbidities lowered risk (OR[95 %CI] = 0.29 [0.08, 0.89]; <em>P</em> = 0.043). Elevated systemic immune-inflammation index (SII) (Coef [95 % CI] = 528.03 [28.05, 1028.00]; <em>P</em> = 0.039) and neutrophil-to-lymphocyte ratio (NLR) (Coef[95 % CI] = 3.50 [0.62, 6.37]; <em>P</em> = 0.017) were positively correlated with Injury Severity Score (ISS). In surgical patients, a higher lymphocyte-to-monocyte ratio (LMR) independently predicted a lower likelihood of ongoing analgesic use at one month (OR[95 %CI] = 0.70 [0.46, 0.95]; <em>P</em> = 0.046).</div></div><div><h3>Conclusion</h3><div>Surgical rib - fracture stabilization shortens hospital stay but raises treatment costs. High SII and NLR, along with thoracic complications, are linked to post - op complications. LMR and HGB levels are associated with analgesic needs, which may aid in tailored pain management.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 49-62"},"PeriodicalIF":1.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life after HPB surgery","authors":"Victor M. Zaydfudim","doi":"10.1016/j.sopen.2025.10.007","DOIUrl":"10.1016/j.sopen.2025.10.007","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 63-64"},"PeriodicalIF":1.7,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of pylorus preservation with outcomes of pancreaticoduodenectomy across the United States","authors":"Sona Mahrokhi MD ,&nbsp;Sara Sakowitz MD ,&nbsp;Esteban Aguayo MD ,&nbsp;Melissa Justo MD ,&nbsp;Robert Kropp MD ,&nbsp;Konmal Ali BS ,&nbsp;Barzin Badiee ,&nbsp;Timothy R. Donahue MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.10.005","DOIUrl":"10.1016/j.sopen.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Pylorus-preserving pancreaticoduodenectomy (PPPD) was developed to improve postoperative gastrointestinal function while maintaining oncologic adequacy. However, conflicting evidence and concerns persist regarding increased delayed gastric emptying, warranting a national-level investigation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 40,063 adult pancreaticoduodenectomy procedures from the ACS NSQIP database (2014–2023). Patients were stratified into pylorus-preserving and non-pylorus-preserving groups. Multivariable regression models evaluated independent associations between pylorus-preserving status and clinical outcomes including infectious complications, blood transfusions, delayed gastric emptying, and length of stay.</div></div><div><h3>Results</h3><div>Of 40,063 pancreaticoduodenectomy procedures, 13,882 (34.6 %) were pylorus-preserving. PPPD was associated with lower rates of infectious complications (25.9 vs 27.5 %, <em>P</em> = 0.01) and blood transfusions (13.6 vs 16.4 %, <em>P</em> &lt; 0.001), but higher delayed gastric emptying rates (17.1 vs 16.1 %, <em>P</em> = 0.02) and shorter length of stay (7 vs 8 days, <em>P</em> = 0.01). Readmission rates were similar (17.4 vs 17.9 %, <em>P</em> = 0.16). Following risk adjustment, PPPD remained associated with reduced infectious complications (AOR 0.94, 95 % CI 0.89–0.99) and blood transfusions (AOR 0.88, 95 % CI 0.82–0.95), but increased delayed gastric emptying (AOR 1.12, 95 % CI 1.04–1.21).</div></div><div><h3>Conclusion</h3><div>Despite declining utilization over the study period, PPPD offers significant advantages in reducing infectious complications and blood transfusion requirements while shortening operative times and hospital stay. However, the trade-off of increased delayed gastric emptying requires careful consideration in surgical decision-making. These findings support individualized approach selection based on patient complexity and surgeon expertise to optimize perioperative outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 36-42"},"PeriodicalIF":1.7,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and financial outcomes associated with gastrointestinal complications among patients with type B aortic dissection","authors":"Troy N. Coaston MSCR ,&nbsp;Amulya Vadlakonda MD ,&nbsp;Esteban Aguayo MD ,&nbsp;Zihan Gao MHSc ,&nbsp;Syed Shaheer Ali ,&nbsp;Oh Jin Kwon MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.10.006","DOIUrl":"10.1016/j.sopen.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal complications (GIC) are an uncommon but serious sequelae of type B aortic dissection (TBAD), potentially contributing to increased mortality and healthcare resource utilization. Limited studies have characterized these complications among TBAD patients. The present work sought to evaluate the clinical and financial implications of GIC and identifies factors associated with their development.</div></div><div><h3>Methods</h3><div>All hospitalizations entailing a primary diagnosis of TBAD were identified in the 2016–2020 Nationwide Readmissions Database. Patients were stratified into those who developed GIC and those who did not. Outcomes included in-hospital mortality, length of stay (LOS), hospitalization costs, and the need for abdominal surgery. Multivariable logistic and linear regressions were employed to assess associations between patient, facility, and treatment factors with clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of 24,927 TBAD hospitalizations, 2.5 % developed GIC, and 24.0 % of these cases required an abdominal procedure. Patients with GIC were younger (median 61 vs. 67 years; <em>p</em> &lt; 0.001), more commonly male (67.4 vs. 56.6 %; p &lt; 0.001), and more likely to have Medicaid insurance (20.9 vs. 12.5 %; p &lt; 0.001). GIC were independently associated with increased odds of in-hospital mortality (adjusted odds ratio 4.54; 95 % CI 3.41–6.04), greater LOS (β 5.80 days; 95 % CI 3.88–7.72), and increased costs (β $41,000; 95 % CI $31000–51,000).</div></div><div><h3>Conclusions</h3><div>GIC in TBAD patients was associated with substantial clinical and financial burdens. Further study of early identification and targeted interventions is warranted to mitigate these complications and optimize resource utilization in this high-risk population.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 43-48"},"PeriodicalIF":1.7,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liquid biopsies for risk stratification of intraductal papillary mucinous neoplasms","authors":"Nicolas Jorek ,&nbsp;Ingmar F. Rompen ,&nbsp;Louisa Bolm ,&nbsp;Thomas Hank ,&nbsp;Martin Loos ,&nbsp;Christoph W. Michalski ,&nbsp;Nerma Crnovrsanin","doi":"10.1016/j.sopen.2025.10.003","DOIUrl":"10.1016/j.sopen.2025.10.003","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 34-35"},"PeriodicalIF":1.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of tracheostomy timing with outcomes following traumatic brain injury","authors":"Syed Shaheer Ali ,&nbsp;Troy Coaston ,&nbsp;Konmal Ali ,&nbsp;Giselle Porter ,&nbsp;Esteban Aguayo ,&nbsp;Areti Tillou ,&nbsp;Peyman Benharash ,&nbsp;Galinos Barmparas ,&nbsp;on behalf of the Academic Trauma Research Consortium (ATRIUM)","doi":"10.1016/j.sopen.2025.10.001","DOIUrl":"10.1016/j.sopen.2025.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal timing for tracheostomy among patients with traumatic brain injury (TBI) remains controversial. Earlier tracheostomy is hypothesized to reduce sedation requirements and allow for earlier mobility. We examined the association of tracheostomy timing with clinical endpoints among a national cohort of TBI patients.</div></div><div><h3>Methods</h3><div>All adult patients (≥18 years) with TBI, defined as head abbreviated injury scale ≥3, undergoing tracheostomy were identified in the 2018 to 2021 Trauma Quality Improvement Program (TQIP) database. Patients were stratified into groups labeled <em>Early</em> (≤10 days) and <em>Delayed</em> (&gt;10 days) using the median day of tracheostomy initiation of the study cohort. Multivariable regression models were developed to assess the association between tracheostomy timing and outcomes including in-hospital mortality, pneumonia, and total ventilator days.</div></div><div><h3>Results</h3><div>Of 24,517 patients, 51.1 % underwent tracheostomy within 10 days of admission (<em>Early)</em>. Compared to <em>Delayed</em>, <em>Early</em> were more commonly younger (42 [28–59] vs 48 years [31–63]; <em>p</em> &lt; 0.001) and privately insured (42.9 vs 41.1 %, p &lt; 0.001). Following multivariable adjustment, factors associated with increased likelihood of early tracheostomy included penetrating trauma (AOR 1.53, 95 % CI 1.37–1.72; ref.: Blunt) and severe facial injury (AOR 1.55, 95 % CI 1.39–1.72.) While early tracheostomy did not alter mortality (AOR 1.10, 95 % CI 0.99–1.24), patients had reduced pneumonia (AOR 0.66, 95 % CI 0.62–0.21) and reduced ventilator days (β −7.05 days, 95 % CI -7.35- -6.75).</div></div><div><h3>Conclusion</h3><div>Early tracheostomy is associated with reduced complications without altering mortality. These findings suggest the safety and potential benefits of early tracheostomy. Further prospective studies are warranted to explore the underlying mechanisms.</div></div><div><h3>Two sentence summary</h3><div>Although the optimal timing for tracheostomy among patients with traumatic brain injury remains controversial, previous literature has shown timely tracheostomy to reduce sedation requirements and allow for earlier mobility. Our findings found early tracheostomy to be linked with reduced time on the ventilator, length of stay, and risk of complications.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 28-33"},"PeriodicalIF":1.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}