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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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    Disparities in Demographics and Outcomes Based on Trauma Center Ownership

    Broecker, Justine S.Ryan, J. L.McCracken, JohannaLangland-Orban, Barbara...
    6页
    查看更多>>摘要：Introduction: Ownership may influence trauma center (TC) location. For-profit (FP) TCs require a favorable payor mix to thrive, whereas not-for-profit (NFP) centers may rely on government funding, grants, and patient volume. We hypothesized that the demographics of trauma patients would be different for NFP and FP TCs due to ownership type. We also hypothesized that these demographic differences might be associated with outcomes such as length of stay, reported complications, and mortality. Methods: We used the Florida Agency for Health Care Administration (AHCA) 2016-2017 inpatient dataset to examine differences in outcomes by trauma center ownership type. Negative binomial and logistical regression was used to compare trauma ownership, length of stay (LOS), reported complications, and mortality of severely injured nonelderly adult trauma patients. Results: Our study analyzed risk factors and outcomes for 10,700 trauma alert patients. Patients treated at FP TCs were less likely to be Black (OR 0.70, 95% CI: 0.62-0.78), to be uninsured (OR 0.40, 95% CI 0.36-0.45), have Medicare (OR 0.53, 95% CI 0.43-0.66), or Medicaid (OR 0.57, 95% CI 0.50-0.65) (all P < 0.001). Patients treated at FP centers were less likely to have comorbidities (OR 0.89, 95% CI 0.82-0.96) and were associated with a longer LOS (0.10, 95% 0.05-0.15, P < 0.001) in nonelderly adult trauma patients. FP TCs were associated with fewer reported complications (OR 0.83, 95% CI 0.74-0.94) and were associated with a higher likelihood of mortality in nonelderly adults (OR 1.70, 95% CI 1.35-2.12, P < 0.001). Conclusions: Among this cohort of severe International Classification of Diseases-based injury severity score (ICISS) patients, complications were less likely, but LOS and mortality were increased among FP TC patients. FP centers cared for fewer patients who were Black, uninsured, or who were Medicare/Medicaid/noncommercial insurance. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Predictors of Survival: A Retrospective Review of Gastroschisis and Intestinal Atresia in Rwanda

    Davis, James R.Nsengiyumva, AliceIgiraneza, DeborahHong, Philip...
    9页
    查看更多>>摘要：Introduction: Neonatal surgical diseases are prime examples of the global disparity in surgical access and outcomes, with survival for conditions like gastroschisis reaching above 95% in high-income settings but usually fatal in low-income settings. This study aims to examine outcomes and predictors of mortality in patients with two specific neonatal surgical conditions that often require early transfer and prolonged inpatient care (gastroschisis and intestinal atresia) at Rwanda's main pediatric referral hospital. Methods: A single-institution retrospective chart review of neonates with gastroschisis and intestinal atresia was conducted between January 2016 and June 2019. Abstracted data included demographics, referral history, admission interventions, operative details, inhospital complications, nutrition patterns, length of stay, and mortality. Daily logs were created to evaluate feeding status, infection status, and antibiotic usage. Descriptive and univariate analysis was conducted, with the primary outcome being survival to hospital discharge. Results: A total of 112 patients met inclusion criteria (82% gastroschisis [n = 92] and 18% intestinal atresia [n = 20]). Median age at arrival was 0 d (GS) [IQR 0-1 d] and 8.5 d (IA) [IQR 4-10 d] (P < 0.0001). Survival to discharge was 22.8% (GS) (n = 21) and 60% (IA) (n = 12) with a mean length of stay of 28.3 d (GS) and 18.4 d (IA). The median number of days to initiation of oral feeds was 8.5 d [IQR 7-11] for gastroschisis survivors. Conclusions: Neonatal surgical conditions that require early transfer and prolonged nutritional intervention are challenging in low-resource settings, but through treatment by a comprehensive pediatric surgical service, improving survival is possible. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Self-Assessment in General Surgery Applicants: An Insight Into Interview Performance

    Rosenzveig, AliciaRaiche, IsabelleFung, Benjamin S. C.Gawad, Nada...
    6页
    查看更多>>摘要：Introduction: Selecting medical students for residency is a competitive process, with a narrow range of scores separating middle-ranked applicants. Self-assessment is a fundamental skill for any competent physician with a demonstrated correlation to diagnostic ability, examination scores, and technical skills, but has yet to be investigated in residency selection. The objective of this study was to investigate the relationship between self assessment and interview performance as a potential adjunct to discriminate between applicants. Methods: At the University of Ottawa in 2020, 55 applicants completed a 9-station interview circuit assessing different characteristics or skills important for a career in general surgery, followed by a self-assessment questionnaire evaluating their perceived performance at each station. Pearson's correlation was used to determine the relationship between self assessment scores (SASs) and interviewer scores (ISs). Results: There was a negative correlation between SASs and ISs for all interview stations. High performers underestimated their interview performance, and low performers overestimated their performance. Seven of the nine stations reached statistical significance (r = 0.60-0.73, P < 0.001). There was significant variability in the SAS of middle-ranked applicants, with a range three times greater than the range of ISs and demonstrating distinct self-assessment skills in candidates with very similar scores. Conclusions: Although we strive to select applicants who will succeed in residency to become competent physicians, self-assessment skills may be a useful adjunct during the interview process to assist in discriminating between applicants with similar scores. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Gastric Bypass Regulates Early Inflammatory Responses in High-Fat Diet-Induced Obese Mice

    Xu, RuiZhu, ChenyuLi, YuxinAndrade, Michael...
    11页
    查看更多>>摘要：Introduction: Obesity and diabetes are characterized by chronic inflammatory responses. Roux-en-Y gastric bypass (RYGB) is increasingly regarded as an effective approach for the improvement of glucose homeostasis. In this study, we examined the effects of RYGB on the regulation of early inflammatory responses in the liver and adipose tissue in high-fat diet (HFD)-induced obese (DIO) mice. Materials and Methods: RYGB was performed in DIO mice followed by analyses of adiposity, insulin sensitivity, plasma and tissue cytokines and adipokines, tissue NF-KB and JNK/c-Jun activation, and tissue macrophage and T-cell subsets. Results: We found that RYGB resulted in sustained improvement of adiposity and insulin sensitivity. Plasma insulin and leptin levels were increased in untreated DIO mice and reduced in RYGB mice. RYGB maintained plasma adiponectin levels and inhibited monocyte chemoattractant protein-1 and interleukin 6 in white adipose tissue (WAT) and liver. RYGB inhibited NF-KB activation in WAT and muscle, but not in the liver. However, RYGB attenuated the JNK/c-Jun signaling pathway in the liver and WAT at 1 wk after surgery, suggesting that RYGB regulates the tissue-specific inflammatory pathway. RYGB reduced M1-like (F4/80+/CD11c+) differentiation and enhanced M2-like population (F4/80+/CD206c+). RYGB also regulated CD4+ and CD8+ T-cell infiltration and increased Treg cells in the liver and WAT at the same time point. Conclusions: Our findings demonstrate that RYGB improves obesity and insulin resistance, which are associated with the regulation of early inflammatory reactions in the liver and WAT. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Assessing the Race, Ethnicity, and Gender Inequities in Blood Alcohol Testing After Trauma

    Jean, Raymond A.O'Neill, Kathleen M.Johnson, Dirk C.Becher, Robert D....
    9页
    查看更多>>摘要：Introduction: Alcohol use remains a significant contributing factor in traumatic injuries in the United States, resulting in substantial patient morbidity and societal cost. Because of this, the American College of Surgeons Verification, Review, and Consultation Program requires the screening of 80% of trauma admissions. Multiple studies suggest that patients who use alcohol are subject to stigma by health care providers and may ultimately face legal and financial ramifications of a positive alcohol screening test. There is also evidence that sociodemographic factors may dictate drug and alcohol screening patterns among patients. Because this screening target is often not uniformly achieved among all patients presenting with injury, we sought to investigate whether there are any discrepancies in screening across sociodemographic groups. Methods: We investigated the Trauma Quality Program Participant User File for all trauma cases admitted during 2017 and compared the rates of the serum alcohol screening test across different demographic factors, including race and ethnicity. We then performed an adjusted multivariable logistic regression to determine the odds ratio (OR) for receiving a test based on these demographic factors adjusted for hospital and clinical factors. Results: There were 729,174 traumas included in the study. Of this group, 345,315 (47.4%) were screened with a serum alcohol test. Screening rates varied by injury mechanism and were highest among motorcycle crashes (66.0% of patients screened) and lowest among falls (32.8% of patients screened). Overall, Asian and Pacific Islander (52.5% screened), Black (57.7% screened), and other race (58.4% screened) had higher rates of alcohol screening than White patients (43.7% screened, P < 0.001). Similarly, Hispanic patients were screened at higher rates than non-Hispanic patients (56.4% screening versus 46.2% screening, P < 0.001). These differences persisted across nearly all injury categories. In multivariable logistic regression, Asian and Pacific Islanders were associated with the highest odds of being screened (OR 1.34, P < 0.001) followed by other race (OR 1.25, P < 0.001) in comparison to White patients. Conclusions: There are consistent and significant differences in alcohol screening rates across race and ethnicity, despite accounting for injury mechanism and comorbidities. 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Impact of Gestational Age on Neuroprotective Function of Placenta-Derived Mesenchymal Stromal Cells

    Stokes, Sarah C.Kabagambe, Sandra K.Lee, Chelsey J.Wang, Aijun...
    10页
    查看更多>>摘要：Introduction: The Management of Myelomeningocele Study demonstrated that in utero repair of myelomeningocele improved motor outcomes compared with postnatal repair. However, even after in utero repair, many children were still unable to walk. We have previously demonstrated that augmentation of in utero repair with early-gestation placental mesenchymal stromal cells (PMSCs) improves motor outcomes in lambs compared with standard in utero repair. The neuroprotective potential of PMSCs of all gestational ages has not been evaluated previously. Methods: PMSCs were isolated from discarded first trimester (n = 3), second trimester (n = 3), and term (n = 3) placentas by explant culture. Cytokine array analysis was performed. Secretion of two neurotrophic factors, brain-derived neurotrophic factor and hepatocyte growth factor, was evaluated by enzyme-linked immunosorbent assay. An in vitro neuroprotective assay demonstrated to be associated with in vivo function was performed. Results: All cell lines secreted immunomodulatory and neuroprotective cytokines and secreted the neurotrophic factors evaluated. Increased neuroprotective capabilities relative to no PMSCs were demonstrated in two of the three first trimester cell lines (5.61, 4.96-6.85, P < 0.0001 and 2.67, 1.67-4.12, P = 0.0046), two of the three second trimester cell lines (2.82, 2.45-3.43, P = 0.0004 and 3.25, 2.62-3.93, P < 0.0001), and two of the three term cell lines (2.72, 2.32-2.92, P = 0.0033 and 2.57, 1.41-4.42, P = 0.0055). Conclusions: We demonstrated variation in neuroprotective function between cell lines and found that some cell lines from each trimester had neuroprotective properties. This potentially expands the donor pool of PMSCs for clinical use. Further in-depth studies are needed to understand potential subtle differences in cell function at different gestational ages. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Overutilization of Helicopter Emergency Medical Services in Central Gulf Coast Region Results in Unnecessary Expenditure

    Miles, Victoria P.Beasley, Justin R.Reed, Haylie E.Miles, Daniel T....
    7页
    查看更多>>摘要：Introduction: When appropriately used, helicopter emergency medical services (HEMSs) allow for timely delivery of severely injured patients to definitive care. Inappropriate uti-lization of HEMSs results in increased cost to the patient and trauma system. The purpose of this study was to review current HEMS criteria in the central Gulf Coast region and evaluate for potential areas of triage refinement and cost savings. We hypothesized that a significant number of patients received potentially unwarranted HEMS transport. Methods: A retrospective cohort study of all patients with trauma arriving to a level I trauma center by helicopter over 28 mo was performed; 381 patients with trauma and with HEMS transport from the scene were included. Data were collected from prehospital sources, as well as hospital chart review for each patient. The primary outcome was the rate of un-warranted HEMS transport. Results: A total of 381 adult patients with trauma transported by the HEMS were analyzed, of which 34% were deemed potentially nonwarranted transports. The significant factors correlating with warranted HEMS transport included age, multiple long bone fractures, penetrating mechanism, and vehicle ejection. Insurance demographics did not correlate to transport modality. Many of these patients were transported from a location within the same county or the county adjacent to the trauma center. When comparing patients transported by ground and HEMSs from the same scene, no time savings were identified. Unwarranted transports at the trauma center represented an estimated health care expenditure of over $3 million. Conclusions: HEMSs may be overused in the central Gulf Coast region, creating the risk for a substantial resource and financial burden to the trauma system. Further collaboration is needed to establish HEMS triage criteria, that is, more appropriate use of resources. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Surgical Outcomes in Patients With Preoperative Anemia Undergoing Colectomy for Colon Cancer

    El Ghouayel, MayaHamidi, MohammadMazis, ChristopherImam, Zaid...
    8页
    查看更多>>摘要：Introduction: Preoperative anemia is relatively common in colon cancer patients; however, its impact on short-term surgical outcomes is not well established. The aim of our study was to evaluate short-term surgical outcomes in colon cancer patients with preoperative anemia undergoing colectomy. Methods: We performed a 4-year analysis of the ACS-NSQIP and included all adult patients who underwent colectomy for colon cancer. Patients were stratified into two groups based on preoperative anemia (Preop Anemia, No Preop Anemia). Our outcome measures were 30-day complications, 30-day unplanned readmissions, and 30-day mortality. Results: A total of 35,243 colon cancer patients who underwent colectomy were included in the analysis, of whom 50.4% had preoperative anemia. The mean age was 65 +/- 13 years and the mean hemoglobin level was 12 +/- 2 g/dL. Patients in the anemia group were more likely to be African American, have higher ASA class >3, and were more likely to receive at least 1 unit of packed red blood cells preoperatively (7.1% versus 0.3%, P < 0.01). Patients in the anemia group had higher rates of 30-day complications (34.5% versus 16.6%, P < 0.01), 30-day readmission related to the principal procedure (11.7% versus 8.7%, P < 0.01), and 30-day mortality (3.1% versus 1%, P < 0.01). On regression analysis, preoperative anemia was independently associated with higher odds of 30-day complications (P < 0.01), but not 30-day readmission, or 30-day mortality (P = 0.464 and P = 0.362 respectively). Conclusions: Preoperative anemia appears to be associated with postoperative complications. Preoperatively optimizing hemoglobin levels may lead to improved outcomes. Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Association of Prehabilitation With Postoperative Opioid Use in Colorectal Surgery: An Observational Cohort Study

    Lee, AngelaShelton, ElizabethBidwell, SerenaShankar, Kreeti...
    7页
    查看更多>>摘要：Introduction: Preoperative optimization programs have demonstrated positive effects on perioperative physical function and surgical outcomes. In nonsurgical populations, physical activity and healthy diet may reduce pain and pain medication requirement, but this has not been studied in surgical patients. Our aim was to determine whether a preoperative diet and exercise intervention affects postoperative pain and pain medication use. Methods: Patients undergoing abdominal colorectal surgery were invited to participate in a web based patient engagement program. Those enrolling in the first and third time periods received information on the standard perioperative pathway (enhanced recovery after surgery [ERAS]). Those enrolling in the second time period also received reminders on nutrition and exercise (PREHAB + ERAS). The primary outcome was postoperative inpatient opioid use. The secondary outcomes were inpatient postoperative pain scores and nonopioid pain medication use. Results: The ERAS and PREHAB + ERAS groups were similar in demographic and operative characteristics. Subgroup analysis of patients who activated their accounts demonstrated that the two groups had similar average maximum daily pain scores, but the PREHAB + ERAS group (n = 158) used 15.9 fewer oral morphine equivalents per postoperative inpatient day than the ERAS group (n = 92), representing a 30% decrease (53 mg versus 37.1 mg, P = 0.04). The two groups used comparable amounts of acetaminophen, gabapentin, and ketorolac. Generalized linear models demonstrated that PREHAB + ERAS, minimally invasive surgery, and older age were associated with lower inpatient opioid use. Conclusions: Access to a web-based preoperative diet and exercise program may reduce inpatient opioid use after major elective colorectal surgery. Further studies are necessary to determine whether the degree of adherence to nutrition and physical activity recommendations has a dose-dependent effect on opioid use. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier