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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    Lung Transplant Type & Donor Age in Idiopathic Pulmonary Fibrosis: A Single Center Study

    Ander, Erik H.Kashem, AbulZhao, HuaqingMontgomery, Kelly...
    12页
    查看更多>>摘要：Backgroud: Idiopathic pulmonary fibrosis (IPF) accounts for a marked proportion of diagnoses on the US lung transplant (LTx) list. The effects of single (SLT) versus double LTx (DLT) and lung donor age on survival in IPF remain unclear and were investigated in this study. Methods: We retrospectively assessed survival of LTx recipients with IPF at a single institution from February 2012-March 2020. Survival was analyzed and compared between LTx types (SLT and DLT), donor ages, and the combined groups (LTx type & donor age) using Kaplan-Meier survival analysis and compared by log-rank test. P-values less than 0.05 were considered significant. Results: Of 744 LTx patients at our institution, 307 (41.3%) were diagnosed with IPF, of which 208 (67.8%) were SLT, and 97 (31.6%) were DLT (2 excluded patients underwent heart-lung transplantation). There was no significant difference in survival due to LTx type (P = 0.41) or for patients with donor age <50 or >= 50 y (P = 0.46). Once stratified by both LTx type and donor age, analysis showed no significant difference in survival between the four groups (P = 0.69). Conclusions: With ethical consideration for organ allocation, as the average age of the US population increases, donor lungs aged >= 50 are an increasingly useful resource in LTx. Our findings suggest donor age and LTx type do not significantly affect survival. Therefore, SLT, and donor lungs aged >= 50 ought to be more readily considered as non-inferior options for LTx in patients with IPF. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Cryoanalgesia is Associated With Decreased Postoperative Opioid Use in Minimally Invasive Repair of Pectus Excavatum

    Arshad, Seyed A.Ferguson, Dalya M.Garcia, Elisa, IHebballi, Nutan B....
    6页
    查看更多>>摘要：Background: Postoperative pain control is challenging after pectus excavatum repair. We aimed to understand the impact that cryoanalgesia had on opioid utilization and outcomes of pediatric patients undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A single-center retrospective cohort study was conducted of all patients (< 18 y) who underwent MIRPE (2011-2019). Patients receiving cryoanalgesia were compared to those who did not. The primary outcome was total postoperative, inpatient, opioid use, measured as milligrams of oral morphine equivalents per kilogram (OME/kg). Univariate and multi variable analyses were performed. Results: Of 35 patients, 20 received cryoanalgesia (57%). Baseline characteristics were similar. Patients who received cryoanalgesia had a lower opioid requirement: median 2.3 mg OME/kg (IQR 1.2-3.1), versus 4.9 mg OME/kg (IQR 2.9-5.8), P < 0.001. Accounting for receipt of cryoanalgesia, epidural, and/or patient-controlled analgesia, cryoanalgesia was associated with a 3.3 mg OME/kg reduction in opioid use ( P < 0.001). Median length of stay (LOS) was shorter in cryoanalgesia patients: 3.1 d (IQR 2.3-3.4), versus 5.1 d (IQR 4.3-5.4), P < 0.001. Complications within 90 d were similar between groups.
      原文链接:
    • NSTL
    • Elsevier

    Defining Risk and Risk Factors for Unplanned ICU Admission of Trauma Patients

    Ranney, Stephen E.Lee, Tim H.Callas, Peter W.Patashnik, Lloyd...
    7页
    查看更多>>摘要：Background: Unplanned ICU admissions (up-ICUad) are associated with poor outcomes. It is difficult to identify who is at risk for up-ICUad in trauma patients. This study aimed to identify injury patterns and comorbidities associated with up-ICUad and develop a predictive tool for who is at risk. Methods: A retrospective study compared trauma patients admitted to the floor who experienced an up-ICUad to similar patients without an up-ICUad. Univariate analysis and multivariate logistic regression identified independent risk factors associated with up-ICUad. Based on those factors, a Risk Score (RS) was created and compared between the two groups. Results: 2.15% of the 7206 patients experienced an up-ICUad. The up-ICUad group was older, experienced longer length of stay, and had higher mortality. Age, congestive heart failure, COPD, peptic ulcer disease, mild liver disease, CKD, and significant injuries to the thorax, spine, and lower extremities were independently associated with up-ICUad. A RS equation was created and was used for each patient. Conclusions: Trauma patients are at increased risk for up-ICUad based on specific factors. These factors can be used to calculate a RS to determine who is at greatest risk for an upICUad which may be helpful for preventing up-ICUad. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Assessing Brazilian Medical Student Awareness About Global Surgery: A Survey-Based Study

    Salgado, Lucas S.Campos, Leticia N.Yabrude, Angela T. Z.Buda, Alexandra M....
    10页
    查看更多>>摘要：Background: Global surgery is an interdisciplinary field that advocates for access to equitable, affordable surgical services for all people. Engaging medical students in the field can strengthen the surgical workforce in low-and middle-income countries. We aim to investigate Brazilian medical students' acknowledgment of global surgery and their preferred learning platforms. Materials and Methods: We performed a cross-sectional study through an anonymous Portuguese survey on Google Forms, consisting of 30 mixed multiple-choice and five-point Likert scale questions. Students enrolled in a Brazilian medical school from the second to sixth academic year fulfilled inclusion criteria. The association between qualitative variables was assessed using Chi-square, Fisher's exact test, or binary logistic model. Rsults: We received 1,345 responses from 208 medical schools. Only 20.9% (282/1,345) of participants reported awareness of global surgery, who were predominantly female. 96.5% (1,298/1,345) declared interest in knowing more about global surgery and participants indi cated social media (71.6%, 202/282) as the prevalent manner to gain awareness on it, followed by webinars (63.5%, 179/282). Extracurricular classes were the most preferable option among students (61.4%, 827/1,345) to get acquainted with the field, followed by internships (59.4%, 812/1,345), workshops (57%, 767/1,345), and social media (53.4%, 730/1,345). The main obstacles to pursue a global surgery career were lack of national opportunities (32%, 431/1,345) and adequate training (25.4%, 341/1,345). Conclusion: We outlined the most strategic pathways to raising awareness on global surgery among Brazilian medical students, providing relevant insights on its education in similar settings. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Bloodstream Infection in Patients With Intestinal Fistula: A Retrospective Study

    Chen, ChenWang, WenyueChen, FenYang, Dongliang...
    8页
    查看更多>>摘要：Background: To delineate the clinical characteristics of intestinal fistula patients with Bloodstream infection (BSI). Methods: Retrospective case series in Surgical Intensive Care Unit (SICU), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Among a cohort of 204 patients with a diagnosis of intestinal fistula, 46 who were complicated with BSI were analysed retrospectively. Data was collected from January 1, 2018 to February 1, 2020. Results: Among the 204 patients with intestinal fistula, 46 patients showed positive blood cultures, which clearly had BSIs. Parenteral nutrition (PN) time (OR 1.08, 95% CI 1.04 similar to 1.12, P < 0.01), transferred from external ICU (OR 3.68, 95% CI 1.48 similar to 9.17, P = 0.01), septic shock (OR 4.61, 95% CI 1.77 similar to 11.97, P < 0.01), APACHE II (OR 1.11, 95% CI 1.01 similar to 1.22, P = 0.04) were significantly associated with BSI in patients with intestinal fistula. When APACHE II score exceeds 12.0 points or PN time exceeds 18.0 D, the chance of BSI in patients with intestinal fistula increases significantly. In addition, compared with the non-BSI group, BSI group had a higher mortality and expenses in ICU, longer stay in ICU and total hospital stay, and worse quality of life (all P < 0.05). A total of 105 isolates from samples (including sputum, pus and blood) of 46 patients in the BSI group, among which were mainly gram negative rods and fungi, as well as blood isolates. Importantly, in patients with intestinal fistula, BSIs caused by fungi accounted for 23.4%. Conclusion: Long-term PN, transfer from external ICU, septic shock, and higher APACHE II scores are often associated with an increased probability of BSIs in patients with intestinal fistula and a higher mortality. Gram-negative bacteria are the main pathogenic bacteria in intestinal fistula patients with BSI, and patients with intestinal fistula are more likely to develop fungal BSIs. (C) 2021 The Authors. Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Mind the Difference: Characterizing the Impact of Behavioral Health Disorders on Facial Trauma

    Dugue, DavidTaylor, George A.Maroney, JennaSpaniol, Joseph R....
    9页
    查看更多>>摘要：Background: Patients with psychiatric diagnoses are at greater risk for traumatic injury than the general population. Current literature fails to characterize how premorbid behavioral health disorders (BHDs) complicate craniofacial trauma. This study aimed to describe the characteristics and outcomes of patients with premorbid BHD sustaining facial fractures. Methods: All adults in the 2013-2016 Trauma Quality Improvement Program datasets with facial fractures were identified. Demographics, injury characteristics, fracture patterns, and in-hospital outcomes were compared in patients with and without premorbid BHDs. BHDs included major psychiatric illnesses, alcohol or drug use disorders, attention deficit hyperactivity disorder, or dementia. Results: Twenty-five percent of the 240,104 subjects with facial fractures had at least one premorbid BHD. Assault (29.9% versus 23.9%, P < 0.001), self-inflicted injury (2.9% versus 1.2%, P < 0.001), and multiple facial fractures (40.2% versus 38.7%, P < 0.001) were more common among the BHD group. The BHD group displayed significantly higher rates of nearly all in hospital complications, including pneumonia (4.3% versus 3.3%, P < 0.001), substance withdrawal (3.9% versus 0.3%, P < 0.001), unplanned intubation (1.5% versus 0.9%, P < 0.001) and unplanned transfer to the intensive care unit (ICU, 1.3% versus 0.8%, P < 0.001). BHD was strongly predictive of pneumonia, unplanned intubation, and unplanned ICU admission in multivariate analyses. Conclusions: Patients with BHD represent a subset of facial trauma characterized by different mechanisms and patterns of injury and premorbid health status. BHDs are associated with higher in-hospital complication rates and resource utilization. Understanding the relationship between craniofacial trauma and premorbid BHD creates opportunities to improve morbidity and resource utilization in this group. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Gender Distribution of Deans Among US Medical Schools: Towards Equity in Academic Medicine

    Nguyen, JackieSen-Crowe, BrendonSutherland, MasonMcKenney, Mark...
    11页
    查看更多>>摘要：Background: Less than half of medical school professorships and decanal ranks are held by women. Our study investigates the gender-based geographical distribution and differences in lifetime peer-reviewed publications, H-index, and grant funding by the National Institutes of Health (NIH) of all allopathic medical school deans in the United States (US). Methods: A cross-sectional cohort study utilizing data from US allopathic medical school websites, PubMed, and the NIH Research Portfolio Online Reporting Tools regarding lifetime peer-reviewed publications and quantity/monetary sum of NIH grants received by medical school deans. Descriptive statistics, independent sample T-tests, and ANOVA were performed with statistical significance defined as P < 0.05. Results: Women occupied 33/157 (21.0%) dean positions overall. Compared to women, men possess higher mean number of lifetime peer-reviewed publications (112.0 vs. 55.2, P = 0.001) and H-index (43.2 vs. 25.7, P = 0.001); however, there are no differences in the mean number of NIH grants (27.5 vs. 19.1, P = 0.323) nor mean total NIH funding received ($18,931,336 vs. $14,289,529, P = 0.524). While significant differences in mean H-index between all US regions were found ( P = 0.002), no significant differences exist between major US regions regarding the mean lifetime publication count ( P = 0.223), NIH grants received ( P = 0.200), nor total NIH funding ( P = 0.824) received. Conclusion: A significant discrepancy in the gender distribution, lifetime peer-reviewed publications, and H-index of allopathic medical school deans exists across the US, highlighting the need for adequate support for women in academic medicine. Greater implementation of mentorship, increased institutional support, and diversity training can improve the representation of women in medical school decanal positions. (c) 2021 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Access to Left Ventricular Assist Device: Travel Time Does Not Tell The Whole Story

    Mehaffey, J. HunterCullen, J. MichaelHawkins, Robert B.Fonner, Clifford...
    7页
    查看更多>>摘要：Background: Negative health effects of traveling longer distances for surgical services have been reported. Given the high complexity of multidisciplinary care required for manage-ment of Left Ventricular Assist Device (LVAD) implantation, only 4 of 18 centers in our state perform these operations. Given the limited access we hypothesized increased travel time would adversely affect postoperative outcomes and 30-d mortality. Methods: A statewide Society of Thoracic Surgeons database was queried to identify patients undergoing Heartmate II/III and HVAD implantation, and 725 patients were identified. Travel time was calculated by zip code. Patients were stratified into regional and distant groups by the upper quartile of travel time (1-h). Preoperative variables and outcomes were compared between the groups. Multivariate analysis was performed to evaluate the impact of travel time in risk-adjusted models of 30-d mortality. Results: Median patient travel time to their LVAD center in our state is 32 min (mean 53 +/- 65 min, 46 +/- 71 miles). Patients in the distant group ( n = 191) had lower median incomes, higher self-pay status, higher rates of medical comorbid disease. Despite these differences there was no difference between the groups in ICU and/or hospital length of stay, readmis-sion, postoperative complications, or 30-d mortality. Multivariate regression demonstrated insurance status, age, and prior surgery predicted 30-d mortality, but not travel time. Conclusions: Despite only four centers in the state performing LVAD implantation, travel time was strongly associated with preoperative risk, and socioeconomic status but not postop-erative outcomes or 30-d mortality. Therefore, increasing access should focus on insurance, and patient characteristics not travel time. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Sentinel Lymph Node Positive Rate Predicts Non-Sentinel Lymph Node Metastasis in Breast Cancer

    Wang, XuefeiZhang, GuochaoZuo, ZhichaoZhu, Qingli...
    8页
    查看更多>>摘要：Background: To investigate retrospectively an association between the number of metastatic sentinel lymph nodes (SLNs) per total number of SLNs per patient (i.e., the SLN positive rate, or SLN-PR) and non-SLN metastasis in breast cancer. Methods: A large population (n = 2250) underwent SLN dissection from January 1, 2014 to January 1, 2020; 627 (27.87%) had at least one positive SLN (SLN+). Among these, 283 underwent axillary lymph node (ALN) dissection, and formed the test group. Four external validation groups comprised 43 patients treated in 2019. SLN mappings were examined using methylene blue and indocyanine green. Lymph node ultrasound, SLN-PR, and pathological characteristics were compared between patients with and without non-SLN metastasis. An SLN-PR cutoff value was calculated using receiver operating characteristic (ROC) curves. As- sociations between clinicopathological variables and SLN-PR with non-SLN metastasis were analyzed by multivariate logistic regression model. Results: The median age was 47 years (IQR: 42-56 y). The median number of resected SLNs was 4. Patients with positive non-SLNs (126/283, 44.52%) had a median of 2 positive node. SLN-PR > 0.333 was a risk factor for non-SLN positivity (area under the ROC curve, 0.726); and carried significantly higher risk of non-SLN metastasis (P < 0.001). This was validated in the external group. Conclusions: SLN-PR > 0.333 was associated with greater risk of non-SLN metastasis. This provides a reference to non-SLN metastasis in patients with SLN metastasis, an indication for ALN dissection and choice of adjuvant treatment. (C) 2021 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Ovarian Preservation and Recurrent Torsion in Children: Both Less Common Than We Thought

    Cioci, Alessia C.Parreco, Joshua P.Thorson, Chad M.Sola, Juan E....
    6页
    查看更多>>摘要：A B S T R A C T Purpose: Surgical management of pediatric ovarian torsion includes total oophorectomy (TO) or ovarian preservation surgery (OPS). This study sought to identify factors contributing to surgical management and readmission outcomes for ovarian torsion. Methods: The Nationwide Readmission Database from 2010-2014 was used to identify patients < 18 years admitted with ovarian torsion. Patient factors, hospital characteristics, and readmission outcomes were compared by TO and OPS. Standard statistical analysis was performed and results were weighted for national estimates. Results: There were 6028 patients (age 13 +/- 4 years) identified with ovarian torsion who underwent either TO (50%) or OPS (50%). Patients had secondary pathology of ovarian cyst (41%), benign mass (19%), and malignant mass (0.4%). OPS was more common in teaching hospitals (84% vs. 74% TO, P < 0.001), patients < 13 years of age (41% vs. 37% TO, P = 0.001), and those from high-income households (51% vs. 41% TO, P < 0.001). The overall readmission rate was 4%, with no difference between surgical approach (4.3% OPS vs. 4.4% TO, P = 0.882). Of those readmitted ( n = 265), readmission diagnoses were cyst (10%), malignant mass (9%), benign mass (7%), and torsion (5%). The overall rate of recurrent torsion was 0.2%, with no difference between OPS and TO (< 0.3% vs. < 0.2%, P = 0.282). Conclusion: Half of pediatric patients are undergoing TO for ovarian torsion in the U.S. and disparities exist with the utilization of OPS. There is no difference in rate of readmission or recurrent torsion between surgical approaches, and the overall rate of retorsion is lower than previously reported. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier