首页期刊导航|The Journal of surgical research.
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The Journal of surgical research.
Academic Press
The Journal of surgical research.

Academic Press

0022-4804

The Journal of surgical research./Journal The Journal of surgical research.
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    Short-Term Concerns Primarily Determine Patient Preference for Abdominal Aortic Aneurysm Repair

    O'Connell J.Goodney P.P.Jones J.M.Hu Y.D....
    10页
    查看更多>>摘要：? 2021Introduction: Abdominal aortic aneurysm (AAA) repair may be performed through open or endovascular approaches, but the factors influencing a patient's repair-type preference are not well characterized. Here we performed a qualitative analysis to better understand factors influencing patient preference within the Preference for Open Versus Endovascular Repair of AAA Trial. Methods: Open-ended responses regarding primary (n = 21) and secondary (n = 47) factors influencing patient preference underwent qualitative analysis using the constant comparative method with iterative reviews. Codes were used to generate themes and themes grouped into categories, with each step conducted via consensus agreement between three researchers. Relative prevalence of themes were compared to ascertain trends in patient preference. Results: Patient responses regarding both primary and secondary factors fell into four categories: Short-term concerns, long-term concerns, advice & experience, and other. Patients most frequently described short-term concerns (23) as their primary influence, with themes including post-op complications, hospitalization & recovery, and intraoperative concerns. Long-term concerns were more prevalent (20) as secondary factors, which included themes such as survival, and chronic management. The average age of patients voicing only long-term concerns as a primary factor was 11 years younger than those listing only short-term concerns. Conclusion: Short-term concerns relating to the procedure and recovery are more often the primary factor influencing patient preference, while long term concerns play a more secondary role. Long-term concerns are more often a primary factor in younger patients. Vascular surgeons should consider this information in shared decision making to reach an optimal outcome.
      原文链接:
    • NSTL
    • Elsevier

    Evaluating the Routine Use of Head Computed Tomography Angiography in Blunt Cerebrovascular Trauma

    Alfanek Z.Herzog A.Taylor N.Jensen H....
    5页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: The aim of this study was to evaluate a protocol change that mandated routine incorporation of head computed tomography angiography (CTA) for the work-up of suspected blunt cerebrovascular injury (BCVI) at an academic Level I trauma center. Methods: The BCVI screening guidelines at our institution changed in 2018 to include the addition of a head CTA for all patients receiving a neck CTA as part of our BCVI screening guidelines. We performed a retrospective chart review of patients between 2018 and 2019 who were 18 years or older and met screening criteria for BCVI based on our institutional guidelines. The head CTAs of this cohort were assessed for findings that could potentially alter the course of the patients’ treatment. Results: A total of 319 patients fit this criterion and had a head CTA as part of their trauma workup. Findings that could potentially alter a patient's clinical course were identified in 6.6% (n = 21) of the head CTA's. These included decreased arterial perfusion (n = 9), active bleeds (n = 6), vessel occlusions (n = 1), aneurysms (n = 1), and vasospasms (n = 2). Of these 21 patients, 8 had clinically significant findings that affected their course of management (2.5% of total sample). They also had a higher mortality rate and ISS compared to the rest of the cohort. Conclusions: In patients with clinically suspected BCVI, the addition of head CTA to the existing BCVI screening guideline identified clinically significant vascular abnormalities that affected management in 2.5% of cases.
      原文链接:
    • NSTL
    • Elsevier

    Partial Latissimus Dorsi Muscle Flap With Implant for Immediate Breast Reconstruction

    Wu X.Xu J.Zhu G.Li X....
    8页
    查看更多>>摘要：? 2021Purpose: Latissimus dorsi flap is a widely used technique in breast reconstruction. Here we describe a modified method, the partial latissimus dorsi muscle flap with vertical incision for immediate implant-based breast reconstruction which has been used at our institution since 2014. Our primary objective is to determine the safety, prognostic benefit, and cosmetic outcome of this surgical procedure. Methods: The study included a cohort of 31 breast cancer patients who underwent unilateral breast reconstruction with detailed follow-up information at Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2014 to March 2015. All procedures were performed by the same surgical team at the department of breast surgery. The data for selecting the appropriate implant and evaluating the surgical outcome were collected. The cosmetic outcome was evaluated by the BREAST-Q 1 y after surgery. Results: After a median follow-up of 69 mo, none of the patients showed local recurrence (although two patients had distant metastasis). The 5-y distant metastasis-free survival was 93.5%. The median duration of surgical procedure was 2 h and 24 min with few surgical and functional complications. Based on BREAST-Q, the outcome of Satisfaction with Breasts was “excellent” or “good” in 96.7% of the patients. Conclusions: Partial latissimus dorsi muscle flap with the vertical incision is a safe, effective, time-saving, and feasible alternative to the whole latissimus dorsi flap which has superior cosmetic outcome and reduces recovery time. It is, therefore, worth advocating for application in clinical practice.
      原文链接:
    • NSTL
    • Elsevier

    Corrigendum to “Large Incisional Hernias Increase in Size” [Journal of Surgical Research 2019; 244: 160-165.] (Journal of Surgical Research (2019) 244 (160–165), (S0022480419304032), (10.1016/j.jss.2019.06.016))

    Arnesen R.B.Christensen J.K.Bisgaard T.Jorgensen L.N....
    2页
    查看更多>>摘要：? 2021The authors of this article have requested the following corrections to the manuscript (bold text added to indicate key changes): 1 In the Methods section, where it reads “The secondary outcomes were changes in the horizontal and vertical defect sizes and the hernia sac volume (V), given as V = π x length x width x depth x 4/310.” it should read “The secondary outcomes were changes in the horizontal and vertical defect sizes and the hernia sac volume (V), given as V = π x (length/2) x (width/2) x (depth/2) x 4/3 10.”2 In the Results section, where it reads “The median hernia sac volume increased from 5.11 L (2.28 – 8.09) to 6.25 L (3.03 – 10.39), P < 0.001.” it should read “The median hernia sac volume increased from 0.64 L (0.29 – 1.01) to 0.78 L (0.38 – 1.30), P < 0.001.” Similarly, in Table 2, the corresponding hernia sac volumes should be corrected.The authors apologize for these errors and any inconvenience they have caused. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.
      原文链接:
    • NSTL
    • Elsevier

    High and Low Frequency Domino Liver Transplantation Centers Demonstrate Similar Performance Outcomes

    Panichella J.Curtis H.Nguyen K.Resweber H....
    7页
    查看更多>>摘要：? 2021Introduction: A Domino Liver Transplant (DLT) is a successfully validated surgical option for a subset of patients awaiting liver transplant. Increased utilization of DLTs could increase the donor organ pool. However, DLTs occur primarily at a small number of high volume centers, and are rarely performed at lower volume transplant centers. This study compares DLT recipient performance outcomes between high frequency DLT centers and low frequency DLT centers. Methods: The UNOS/OPTN STAR database was queried for DLTs performed at transplant centers between 1996-2018. 193 patients were identified and categorized into high (>5 DLTs) or low (≤5 DLTs) frequency centers. Our primary endpoint was allograft survival. Our secondary endpoints were graft status at last follow up and mortality secondary to cardiac, renal, or respiratory failure. Results: Overall median allograft survival between high and low volume DLT centers was similar (48.2 months versus 42.7 months, P >0.314). The one-year (82% versus 76%), three-year (57% versus 56%), and five-year (45% versus 43%) survival percentages were also similar between the high and low volume DLT centers respectively. Overall mortality from cardiac (high 4% versus low 1.7%), renal (high 0.8% versus low 1.7%), or respiratory failure (high 0.8% versus low 1.7%) was similarly low in both groups. Conclusion: Low volume and high volume DLT centers are associated with similar outcomes of allograft survival and mortality. DLTs should be utilized more frequently, when the criteria are met, including in centers with limited experience, to expand the donor pool, decrease time on the waitlist, and improve overall survival. Disclosures: There are no disclosures. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
      原文链接:
    • NSTL
    • Elsevier

    The Utility of Lower Extremity Screening Duplex for The Detection of Deep Vein Thrombosis in Trauma

    Teichman A.L.Walls D.Choron R.L.Butts C.A....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Trauma patients are high-risk for venous thromboembolism (VTE). Lower extremity screening duplex ultrasonography (LESDUS) is controversial and not standardized for early VTE diagnosis. By implementing risk stratification and selective screening, we aim to optimize resource utilization. Materials and methods: A retrospective review were conducted at a Level-1 Trauma Center, January 2015-October 2019. LESDUS was performed within 72-h of presentation, then weekly. Demographics, VTE data, and outcomes were collected from the trauma registry. Risk assessment profile (RAP) score was calculated based on collected data. Results: Of 5,645 patients included, 2,813 (49.8%) were screened for lower extremity deep vein thrombosis (LEDVT). Of 187 patients with LEDVT, 154 were diagnosed on LESDUS, 18 after negative LESDUS, and 15 in unscreened patients. Patients with VTE were older (61y versus 55, P < 0.01), more often male (70.9% versus 29.1%, P = 0.03), had higher ISS (16 versus 10, P < 0.01), longer hospital length of stay (LOS) (11.5 d versus 3, P < 0.01), longer ICU LOS (4.5 d versus 1, P < 0.01), and increased mortality (9.1% versus 4.3%, P = 0.01). RAP was higher in VTE patients versus those without (nine versus three, P < 0.01). RAP ≥8 was 62.5% sensitive and 70.4% specific for VTE. Chemoprophylaxis delay also correlated with increased VTE (OR = 1.48, 95% CI = 1.03-2.12). Conclusions: VTE remains a significant complication in trauma patients. Despite a universal LESDUS protocol, only 50% of patients underwent screening and 20% of all LE DVTs were not identified on LESDUS. To optimize resource utilization and protocol adherence, LESDUS should only be performed if RAP ≥8 or if unable to administer timely chemoprophylaxis.
      原文链接:
    • NSTL
    • Elsevier

    Traumatic Pediatric Fatalities: Are They Preventable?

    Lewis S.L.Liebe H.Jeffery C.Sebastian R....
    7页
    查看更多>>摘要：? 2021Introduction: Trauma related injury remains the leading cause of mortality in pediatric patients, many of which are preventable. The goal of our study was to identify the mechanism of injury (MOI) in pediatric trauma-related fatalities and determine if these injuries were preventable to direct future injury prevention efforts within trauma programs. Methods: After IRB approval, a retrospective, single-institution review of pediatric (age ≤18) trauma fatalities from 2010 to 2019 was performed. MOI, use of protective devices, demographics, and whether the injury was preventable were collected. Patients were divided into five age cohorts, and frequencies and proportions were used to summarize data. Bivariate testing was done using Fisher's exact and Monte Carlo estimates for the exact test. Results: MOI was found to vary by age with non-accidental trauma found to be the most common cause of trauma related deaths in children <1 (88.5%) and 1-4 (33.3%). MVC was the most common MOI in children >5 y, with 68.4% in the 5-9, 34.4% in the 10-14, and 45.8% in the 15-18 age group. The majority of fatalities resulted from a preventable injury (P < 0.0001) in the younger children with a negative association as age increased: 92.3% <1, 53.3% in 1-4, 36.8% in 5-9, 46.9% in 10-14 and 48.6% in 15-18. Of the preventable injuries, non-accidental trauma was the most common MOI in children <5, while GSW was the most common MOI in children >10. Conclusions: This study demonstrates many pediatric fatalities are the result of a preventable traumatic injury. This data can guide focused traumatic injury prevention efforts.
      原文链接:
    • NSTL
    • Elsevier

    Outpatient Botulinum Injections for Early Obstructive Symptoms in Patients with Hirschsprung Disease

    Svetanoff W.J.Briggs K.Fraser J.A.Lopez J....
    6页
    查看更多>>摘要：? 2021Introduction: Botulinum toxin (BT) injections may play a role in preventing Hirschsprung associated enterocolitis (HAEC) episodes related to internal anal sphincter (IAS dysfunction). Our aim was to determine the association of outpatient BT injections for early obstructive symptoms on the development of HAEC. Methods: A retrospective review of children who underwent definitive surgery for Hirschsprung disease (HSCR) from July 2010 – July 2020 was performed. The timing from pull-through to first HAEC episode and to first BT injection was recorded. Primary analysis focused on the rate of HAEC episodes and timing between episodes in patients who did and did not receive BT injections. Results: Eighty patients were included. Sixty patients (75%) were male, 15 (19%) were diagnosed with trisomy 21, and 58 (72.5%) had short-segment disease. The median time to pull-through was 150 days (IQR 16, 132). Eight patients (10%) had neither an episode of HAEC or BT injections and were not included in further analysis. Forty-six patients (64%) experienced at least one episode of HAEC, while 64 patients (89%) had at least one outpatient BT injection. Compared to patients who never received BT injections (n = 9) and those who developed HAEC prior to BT injections (n = 35), significantly fewer patients who received BT injections first (n = 28) developed enterocolitis (P < 0.001), with no patient developing more than one HAEC episode. Conclusion: Outpatient BT is associated with decreased episodes of HAEC and increased interval between HAEC episodes requiring inpatient treatment. Scheduling outpatient BT injections to manage obstructive symptoms may be beneficial after pull-through for HSCR.
      原文链接:
    • NSTL
    • Elsevier

    Patient Satisfaction is Equivalent for Inpatient and Outpatient Minimally-Invasive Adrenalectomy

    Pigg R.A.Fazendin J.M.Porterfield J.R.Chen H....
    5页
    查看更多>>摘要：? 2021Introduction: Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions. Outpatient adrenalectomy has been shown to be safe and effective, but patients’ perspectives have yet to be addressed. This study compares patient satisfaction following inpatient and outpatient adrenalectomy. Methods: An institutional database was queried for minimally-invasive adrenalectomies performed from 2017 to 2020. Patients were contacted up to two times to participate in a phone survey consisting of 25 questions modeled after the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey (OAS CAHPS) assessing preparation for surgery, discharge experience, post-operative course, and overall satisfaction. Statistical analysis was performed using Kruskal Wallis, Wilcoxon-Mann Whitney, and Chi-square tests, as appropriate. Results: One hundred five adrenalectomy patients were identified, of which 98 were contacted and 58 responded (59%). Two surgeons contributed patients, with no difference in the percentage of patients in the outpatient group (51.7% versus 62.1%, P = 0.423). Outpatient adrenalectomy patients had slightly higher overall experience scores, but this difference was not statistically significant (9.12 ± 1.36 versus 8.93 ± 1.51, P = 0.367). Patients undergoing outpatient adrenalectomy were more likely to have their discharge plan discussed pre-operatively (94% versus 62%, P = 0.005), but no significant differences were noted between inpatient and outpatient groups regarding preparation for surgery, readiness for discharge, night of surgery experiences, or self-reported pain or complications (P > 0.05 for all). Significantly higher overall experience scores were reported by patients counseled about their discharge plan (9.27 versus 7.9, P = 0.036), felt prepared for recovery (9.39 versus 5.5, P < 0.001), received information about pain control (9.13 versus 7.00, P = 0.031), felt prepared at time of discharge (9.33 versus 5.80, P < 0.001), and received information about potential complications (9.29 versus 7.00, P = 0.001). Although not statistically significant, there was a trend towards outpatients being more likely to choose the same approach if they were to undergo surgery again (97% versus 84%, P = 0.081). Conclusions: Patient satisfaction following adrenalectomy is significantly associated with patients’ self-reported degree of preparation for surgery and discharge, with no significant difference in patient satisfaction between inpatient and outpatient groups. Patients undergoing outpatient adrenalectomy would be likely to choose the same approach compared to inpatients. Targeted pre-operative counseling can contribute to enhanced patient outcomes for all patients undergoing adrenalectomy.
      原文链接:
    • NSTL
    • Elsevier

    Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen

    Sykes A.G.Sisson W.B.Gonda D.D.Kling K.M....
    6页
    查看更多>>摘要：? 2021Background: Ventriculoperitoneal shunt (VPS) placement into the reoperative abdomen can be challenging due to intraperitoneal adhesions. Laparoscopic guidance may provide safe abdominal access and identify an area for optimal cerebrospinal fluid drainage. The study aim was to compare laparoscopic-assisted VPS placement to an “open” approach in patients with prior abdominal surgery. Materials and Methods: A retrospective review was performed of children undergoing VPS placement into a reoperative abdomen from 2009-2019. Clinical data were collected, and patients undergoing laparoscopy (LAP) were compared to those undergoing an open approach (OPEN). Results: A total of 120 children underwent 169 VPS placements at a median age of 8 y (IQR 2-15 y), and a mean number of two prior abdominal operations (IQR 1-2). Laparoscopy was used in 24% of cases. Shunt-related complications within 30 d were lower in the LAP group (0% versus 19%, P = 0.001), as were VPS-related postoperative emergency department visits (0% versus 13%, P = 0.003) and readmissions (0% versus 13%, P = 0.013). Shunt malfunction rates were higher (42% OPEN versus 25% LAP, P = 0.03) and occurred sooner in the OPEN group (median 26 versus 78 wk, P = 0.01). The LAP group demonstrated shorter operative times (63 versus 100 min, P < 0.0001), and the only bowel injury. Time to feeds, length of stay, and mortality were similar between groups. Conclusions: Laparoscopic guidance during VPS placement into the reoperative abdomen is associated with a decrease in shunt-related complications, longer shunt patency, and shorter operative times. Prospective study may clarify the potential benefits of laparoscopy in this setting.
      原文链接:
    • NSTL
    • Elsevier