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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.
正式出版
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    Telemedicine During COVID-19 Pandemic: Endocrine Surgery Patient Perspective

    Jeraq, Mohammed W.Mulder, Michelle B.Kaplan, DinaLew, John I....
    11页
    查看更多>>摘要：Introduction: In response to the COVID-19 pandemic, many medical providers have turned to telemedicine as an alternative method to provide ambulatory patient care. Perspectives of endocrine surgery patients regarding this mode of healthcare delivery remains unclear. The purpose of this study is to evaluate the opinions and perspectives of endocrine surgery patients regarding telemedicine. Methods: The first 100 adult patients who had their initial telemedicine appointment with two endocrine surgeons were contacted at the conclusion of their visit. The survey administered assessed satisfaction with telemedicine, the provider, and whether attire or video background played a role in their perception of the quality of care received using a 5-point Likert scale. Differences in responses between new and returning patients were also evaluated. Results: Telemedicine endocrine surgery patients stated excellent satisfaction with their visit (4.89 out of 5) and their provider (4.96 out of 5). Although there was less consensus that telemedicine was equivalent to in-person or face-to-face clinic visits (4.15 out of 5), patients would recommend a telemedicine visit to others and most agreed that this modality made it easier to obtain healthcare (4.7 out of 5). Attire of the provider and video background did not influence patient opinion in regard to the quality of care they received. Returning patients were more likely to be satisfied with this modality (4.94 versus 4.73, P = 0.02) compared to new patients. Conclusions: This study shows that telemedicine does not compromise patient satisfaction or healthcare delivery for patients and is a viable clinic option for endocrine surgery. (C) 2021 Published by Elsevier Inc.
      原文链接:
    • NSTL
    • Elsevier

    Show Me the Money, I'll Show You My Complications: Impacts of Incentivized Incident Self-Reporting Among Surgeons

    Cook-Richardson, SharmaAddo, AlexKim, PaulTurcotte, Justin...
    9页
    查看更多>>摘要：Introduction: Trial and error have the propensity to generate knowledge. Near misses and adverse event reporting can improve patient care. Professional ridicule or litigation risks after an incident may lead to decreased reporting by physicians; however, the lack of incident reporting can negatively affect patient safety and halt scientific advancements. This study compares reporting patterns after distribution of financial incentives to surgeons for self-reporting quality incidents. Methods: Retrospective review of an internal incident reporting system, RL6, from September 2018 to September 2019 was performed. Incident reporting patterns after incentive distributions across professional classifications and surgical specialties were evaluated. Engagement surveys on incident reporting were completed by physicians. The primary outcomes were changes in reporting patterns and perceptions after distribution of incentives. Results: Two hundred and eighteen surgical patients were identified in the incidents reported. Financial incentives significantly increased incidents reported (35 to 183) by physicians (37.1% to 67.8%; P < 0.001) and physician assistants (2.9% to 18.6%; P < 0.001). Acute care surgery displayed the largest increase in incidents reported among surgical specialties (5.7% to 20.2%; P = 0.040). Surgeons exhibited an increase in reporting (60.0% to 94.5%; P < 0.001) compared with witnesses after incentivization (2.9% to 1.6%). Conclusions: Financial incentives were associated with increased incident reporting. After the establishment of incentives, physicians were more likely to report their incidents, which may dispel professional embarrassment and display incident ownership. Institutions must encourage reporting while supporting providers. Future quality-improvement studies targeting reporting should incorporate incentives aimed to engage and empower health-care providers. (C) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Protective Effect of Casticin on Experimental Skin Wound of Rats

    Sun, ChaoYan, HongmeiJiang, KejiaoHuang, Lei...
    8页
    查看更多>>摘要：Introduction: The wound is known as damage to the skin structure by external stimuli, such as cut, bruises, and burn, which typically leaves the internal tissue exposed. The wound repair process when hampered leads to an excessive burden on the healthcare setting. Therefore, there is an urgent need to develop effective agents that can promote the wound healing process. In the present study, we intended to investigate the pharmacological benefit of Casticin (CST), a polymethylflavone against wound. Methods: The wound in Wistar rats was induced by a surgical procedure. After surgery, the wound was examined for wound size over a period and for the expression of cyclooxygenase-2 and induced collagen III expressions. The effect of CST was examined on tumor necrosis factor a, interferon gamma, interleukin (IL)-10, transforming growth factor beta, and IL-7 by real-time polymerase chain reaction. The expression of matrix metalloproteinases (MMP)-2 and MMP-9 and its natural inhibitor (tissue inhibitors of metalloproteinases, TIMP1), level of macrophages, and lymphocytes were also quantified. The effect of CST was determined also on apoptosis of rats' splenocytes. Results: CST significantly enhances wound healing of rat postsurgery, with maximum activity achieved in the case of a 60 mM treated group. The expression of cyclooxygenase-2 was found reduced together with an increase in collagen III, tumor necrosis factor a, interferon gamma, IL-10, transforming growth factor beta, and IL-7 in the CST group. The levels of MMP-2 and MMP-9 were also found reduced together with an increase in TIMP1 level in CST-treated group. The levels of CD4+, CD8+, and CD11b+ cells at the wound site 24 and 120 h postsurgery was also found reduced in CST-treated group. However, it showed no apoptosis in murine splenocytes. Conclusions: Collectively, CST can promote the wound healing process by modulation of inflammation and immune response, which induces tissue remodeling. (c) 2021 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The Case for Integrating Medical-Legal Partnerships Into Trauma Care

    Hall, Erin C.Current, J. J.Sava, Jack A.Rosen, Jennifer E....
    7页
    查看更多>>摘要：Introduction: Medical-legal needs are health-harming adverse social conditions with a legal remedy. Medical-legal partnerships in primary care settings have been proposed to address these needs for at-risk patients already seeking medical care. Our hypothesis is that trauma patients represent a unique population that may be more likely to have baseline medical-legal needs. Methods: A trauma-specific medical-legal needs survey was developed. Adult trauma patients who were able to give consent and were admitted to our urban Level I hospital were surveyed. Medical-legal needs were tabulated from the surveys. Those patients in the top decile of medical-legal needs were categorized as having a High Burden of medical-legal needs. Multivariate logistic regression was used to identify those independent risk factors for having a High Burden of medical-legal needs. Results: A total of 566 participants completed the survey (78.2% response rate). The mean number of medical-legal needs for our population was 2.5 (SD = 3.1). 73% of our respondents had at least one medical-legal need. The most common needs were Housing (n = 229, 40%) and Education/Employment (n = 223, 39%). Older age (aOR = 3.01, 95% CI 1.2-8.1, P = 0.02), being separated or divorced (aOR = 4.25, 95% CI 1.2-14.0, P = 0.02), self perceived poor health (aOR = 8.4, 95% CI 2.61-26.86, P < 0.001), penetrating mechanism of injury (aOR = 2.52, 95% CI 1.22-5.2, P = 0.01), and having been admitted to the hospital for a longer period of time (aOR = 5.48, 95% CI 1.55-19.4, P = 0.008) were all independently associated with a High Burden of medical-legal needs. Conclusions: Trauma patients have a high baseline burden of medical-legal needs. Medicallegal partnerships embedded in trauma teams may offer an innovative strategy to help address long-term health outcomes in a highly vulnerable population that would not otherwise have contact with the healthcare system. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Postoperative Respiratory Failure After Elective Abdominal Surgery: A Case-Control Study

    Orabi, DannyNaples, RobertBrundidge, DominiqueSnyder, Karen...
    9页
    查看更多>>摘要：Introduction: Postoperative respiratory failure (PRF) contributes significantly to morbidity and mortality. We sought to identify patient characteristics and perioperative risk factors associated with PRF in patients undergoing elective abdominal surgery to improve patient outcomes. Methods: We retrospectively reviewed patients undergoing elective abdominal surgery from 2011 to 2016 at our institution. An experimental group consisting of adult patients with the Patient Safety Indicator 11 diagnosis of PRF was compared with a time-matched control group. Results: Each group consisted of 233 patients. Comorbidities associated with PRF included ascites, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus type II, hypertension, and hypoalbuminemia (P < 0.05). American Society of Anesthesiologists score IV (20.2% versus 3.95%; P < 0.001), operative time (4.13 versus 2.55 h; P < 0.001), laparotomy with open operation (77.7% versus 45.5%; P < 0.001), and net intraoperative fluid balance (3635 versus 2410 mL; P < 0.001) were higher in patients with PRF. On multivariate analysis, age, American Society of Anesthesiologists score, chronic obstructive pulmonary disease, diabetes mellitus type II, laparotomy, and net intraoperative fluid balance maintained significance (P < 0.05). Conclusions: We identified contributing pre- and intra-operative risk factors for PRF undergoing elective abdominal surgery. These findings may help identify those at increased risk for respiratory failure and mitigate complications. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Enhancing Patient-Centered Surgical Care With Mobile Health Technology

    Panda, NikhilPerez, NumaTsangaris, ElenaEdelen, Maria...
    7页
    查看更多>>摘要：From smartphones or wearables to portable physiologic sensors and apps, healthcare is witnessing an exponential growth in mHealthddigital health tools used to support medical and surgical care, as well as public health. In surgery, there is interest in harnessing the capabilities of mHealth to improve the quality of patient-centered care delivery. Digitally delivered surveys have enhanced patient-reported outcome measurement and patient engagement throughout care. Wearable devices and sensors have allowed for the assessment of physical fitness before surgery and during recovery. Smartphone-based digital phenotyping has introduced novel methods of integrating multiple data streams (accelerometer, global positioning system, call and text logs) to create multidimensional digital health footprints for patients following surgery. Yet, with all the technological sophistication and 'big data' mHealth provides, widespread implementation has been elusive. Do clinicians and patients find these data valuable or clinically actionable? How can mHealth become integrated into the day-to-day workflows of surgical systems? Do these data represent opportunities to address disparities of care or worsen them? In this review, we discuss experiences and future opportunities to use mHealth to enhance patient-centered surgical care. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Intraoperative Deaths: Who, Why, and Can We Prevent Them?

    Pian-Smith, MayMikdad, SarahKapoen, CarolijnBreen, Kerry A....
    11页
    查看更多>>摘要：Introduction: Intraoperative deaths (IODs) are rare but catastrophic. We systematically analyzed IODs to identify clinical and patient safety patterns. Methods: IODs in a large academic center between 2015 and 2019 were included. Perioperative details were systematically reviewed, focusing on (1) identifying phenotypes of IOD, (2) describing emerging themes immediately preceding cardiac arrest, and (3) suggesting interventions to mitigate IOD in each phenotype. Results: Forty-one patients were included. Three IOD phenotypes were identified: trauma (T), nontrauma emergency (NT), and elective (EL) surgery patients, each with 2 sub-phenotypes (e.g., ELm and ELv for elective surgery with medical arrests or vascular injury and bleeding, respectively). In phenotype T, cardiopulmonary resuscitation was initiated before incision in 42%, resuscitative thoracotomy was performed in 33%, and transient return of spontaneous circulation was achieved in 30% of patients. In phenotype NT, ruptured aortic aneurysms accounted for half the cases, and median blood product utilization was 2,694 mL. In phenotype ELm, preoperative evaluation did not include electrocardiogram in 12%, cardiac consultation in 62%, stress test in 87%, and chest x-ray in 37% of patients. In phenotype ELv, 83% had a single peripheral intravenous line, and vascular injury was almost always followed by escalation in monitoring (e.g., central/arterial line), alert to the blood bank, and call for surgical backup. Conclusions: We have created a framework for IOD that can help with intraoperative safety and quality analysis. Focusing on interventions that address appropriateness versus futility in care in phenotypes T and NT, and on prevention and mitigation of intraoperative vessel injury (e.g., intraoperative rescue team) or preoperative optimization in phenotype EL may help prevent IODs. 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Effects of Sarcopenia on Postoperative Outcomes in Patients Who Underwent Gastrectomy for Gastric Cancer

    Cekic, Arif BurakErkul, OguzCansu, AysegulYildirim, Reyyan...
    11页
    查看更多>>摘要：Background: The relationship between sarcopenia and postoperative outcomes in patients with gastric cancer remains controversial. This study aimed to investigate the impact of sarcopenia on short-term outcomes after surgery for gastric cancer. Methods: Patients who underwent surgical treatment for gastric cancer were evaluated in this prospective observational study. Muscle strength, muscle mass, and physical performance were measured before surgery. Diagnosis of sarcopenia was based on the revised European Working Group on Sarcopenia criteria. Postoperative 30-day outcomes, including complications, reoperation, readmission, and operative mortality, were recorded. Results: Sarcopenia was observed in 31 out of 146 patients (21.2%). The overall complication incidence was 31.5%. The postoperative complication rate was higher in the sarcopenic patients compared to the nonsarcopenic patients (54.8% versus 25.2%, P = 0.003). There was no statistically significant difference in terms of surgical complication rates (25.8% versus 14.8%, P = 0.239), although the sarcopenic group had a significantly higher systemic complication rate (38.7% versus 13%, P = 0.003). No statistically significant difference was observed in terms of major complications (3.2% versus 5.2%, P = 1.000). Muscle strength, muscle mass, and physical performance were not identified as independent factors when tested alone at adjusted multivariable analysis. Sarcopenia (Odds ratio: 2.73, 95% CI 1.027.52, P = 0.047) and severe sarcopenia (Odds ratio: 4.44, 95% CI 1.57-13.34, P = 0.006) were identified as independent prognostic factors for postoperative complications. Conclusions: Sarcopenia was associated with postoperative complications after gastrectomy for gastric cancer. Severe sarcopenia may serve as a more robust prognostic indicator. The variation in the complication rates between sarcopenic and nonsarcopenic patients was mainly due to difference in systemic complications rather than surgical complications. (c) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Provider Perception of Time During Trauma Resuscitation: A Prospective Quantitative Trauma Video Review Analysis

    Dumas, Ryan P.Kuhlenschmidt, Kali M.Choi, EliasMoonmoon, Kazi...
    6页
    查看更多>>摘要：Introduction: Delays in transition to the next phase of care result in increased mortality. Prehospital literature suggests emergency medical service technicians underestimate transport times by as much as 20%. What remains unknown is clinician perception of time during the trauma resuscitation. We sought to determine if clinicians have an altered perception of time. We hypothesized that clinicians underestimate time, resulting in delay of care. Methods: Clinicians at a large level 1 trauma center completed a post-trauma activation survey on the perceived elapsed time to complete three specific resuscitation endpoints. The primary study endpoint was the time to the next phase of care, defined as leaving the trauma bay to go to the operating room, interventional radiology, computerized tomography or time of death. The data from the surveys were linked and compared with recorded videos of the resuscitations. The difference in perceived versus actual time, along with confounding variables, was used to assess the impact of perception of time on the time to the next phase of care using a stepwise multivariate linear model. Results: There were 284 complete surveys and videos, culminating in 543 time points. The median perceived versus actual time (minutes [interquartile range]) to the next phase of care was 20 [10-25] versus 26 [19-40] (P < 0.001). Overall, clinicians underestimated time by 28%, such that if the resuscitation lasted 20 min, the clinician's perception was that 14.4 min elapsed. Differences in the perceived versus actual time in the procedure group impacted time to the next phase of care (P = 0.01). Conclusions: Clinicians have significant gaps in the perception of time during trauma resuscitations. This misperception occurs during procedures and correlates with an increase in the length of time to the next phase of care. (C) 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Pre-COVID-19 National Mortality Trends in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancer

    Hirji, SameerShah, RohanDezube, Aaron R.Axtell, Andrea...
    11页
    查看更多>>摘要：Introduction: In the current era of episode-based hospital reimbursements, it is important to determine the impact of hospital size on contemporary national trends in surgical technique and outcomes of lobectomy. Methods: Patients aged >18 y undergoing open and video-assisted thoracoscopic surgery (VATS) lobectomy from 2008 to 2014 were identified using insurance claims data from the National Inpatient Sample. The impact of hospital size on surgical approach and outcomes for both open and VATS lobectomy were analyzed. Results: Over the 7-y period, 202,668 lobectomies were performed nationally, including 71,638 VATS and 131,030 open. Although the overall number of lobectomies decreased (30,058 in 2008 versus 27,340 in 2014, P < 0.01), the proportion of VATS lobectomies increased (24.0% versus 46.9%), and open lobectomies decreased (76.0% versus 53.0%, all P < 0.01). When stratified by hospital size, small hospitals had a significant increase in the proportion of open lobectomies (6.4%-12.2%; P 1/4 0.01) and trend toward increased number of VATS lobectomies (2.7%-12.2%). Annual mortality rates for VATS (range: 1.0%-1.9%) and open (range: 1.9%-2.4%) lobectomy did not significantly differ over time (all P > 0.05) but did decrease among small hospitals (4.1%-1.3% and 5.1%-1.1% for VATS and open, respectively; both P < 0.05). After adjusting for confounders, hospital bed size was not a predictor of in-hospital mortality. Conclusions: Utilization of VATS lobectomies has increased over time, more so among small hospitals. Mortality rates for open lobectomy remain consistently higher than VATS lo bectomy (range 0.4%-1.4%) but did not significantly differ over time. This data can help benchmark hospital performance in the future. 2022 Elsevier Inc. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier