bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Outcomes After Laparoscopic, Robotic, and Open Pancreatoduodenectomy for Distal Cholangiocarcinoma
Authors: Uijterwijk Bas A. , Lemmers Daniël H.L. , Bolm Louisa , Luyer Misha , Koh Ye Xin , Mazzola Michele , Webber Laurence , Kazemier Geert , Bannone Elisa , Ramaekers Mark , Ielpo Benedetto , Wellner Ulrich , Koek Sharnice , Giani Alessandro , Besselink Marc G. , Abu Hilal Mohammed ,   for the ISGACA consortium, the International study group on non-pancreatic periampullary cancer
Published: February 2023

Objective:
This study aimed to compare surgical and oncological outcomes after minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) for distal cholangiocarcinoma (dCCA).

Background:
A dCCA might be a good indication for MIPD, as it is often diagnosed as primary resectable disease. However, multicenter series on MIPD for dCCA are lacking.

Methods:
This is an international multicenter propensity score-matched cohort study including patients after MIPD or OPD for dCCA in 8 centers from 5 countries (2010-2021). Primary outcomes included overall survival (OS) and disease-free interval (DFI). Secondary outcomes included perioperative and postoperative complications and predictors for OS or DFI. Subgroup analyses included robotic pancreatoduodenectomy (RPD) and laparoscopic pancreatoduodenectomy (LPD).

Results:
Overall, 478 patients after pancreatoduodenectomy for dCCA were included of which 97 after MIPD (37 RPD, 60 LPD) and 381 after OPD. MIPD was associated with less blood loss (300 vs 420 mL, P=0.025), longer operation time (453 vs 340 min; P<0.001), and less surgical site infections (7.8% vs 19.3%; P=0.042) compared with OPD. The median OS (30 vs 25 mo) and DFI (29 vs 18) for MIPD did not differ significantly between MIPD and OPD. Tumor stage (Hazard ratio: 2.939, P<0.001) and administration of adjuvant chemotherapy (Hazard ratio: 0.640, P=0.033) were individual predictors for OS. RPD was associated with a higher lymph node yield (18.0 vs 13.5; P=0.008) and less major morbidity (Clavien-Dindo 3b-5; 8.1% vs 32.1%; P=0.005) compared with LPD.

Discussion:
Both surgical and oncological outcomes of MIPD for dCCA are acceptable as compared with OPD. Surgical outcomes seem to favor RPD as compared with LPD but more data are needed. Randomized controlled trials should be performed to confirm these findings.
Health-related Quality of Life of Patients With Non–Intra-abdominal Desmoid-Type Fibromatosis During Active Surveillance
Authors: Schut Anne-Rose W. , Timbergen Milea J.M. , Nasserinejad Kazem , van Dalen Thijs , van Houdt Winan J. , Bonenkamp Johannes J. , Sleijfer Stefan , Grünhagen Dirk J. , Verhoef Cornelis , Husson Olga ,   on behalf of the Dutch Grafiti Group
Published: February 2023

Objective:
To examine the impact of an active surveillance (AS) approach on the health-related quality of life (HRQoL) of patients with desmoid-type fibromatosis (DTF).

Background Data:
AS is recommended as initial approach in DTF patients. AS might however negatively affect HRQoL due to physical symptoms or stress and anxiety.

Methods:
In a prospective observational study, the GRAFITI trial (NTR4714), DTF patients were followed during an initial AS approach for 3 years. HRQoL was assessed by the EORTC QLQ-C30 at baseline, 6, 12 and 24-month follow-up. Patients who completed questionnaires at≥1-time point were included in this analysis of the secondary endpoint. A multivariable linear mixed-effects model with random intercept was conducted to assess trends of HRQoL scores over time and to explore the effect of treatment strategy on HRQoL.

Results:
All 105 patients enrolled in the GRAFITI trial were eligible for the HRQoL analyses. During 24-month follow-up, 75 patients (71%) continued AS and 30 patients (29%) started an active treatment (AT). DTF patients who continued AS demonstrated relatively stable HRQoL scores during follow-up. HRQoL scores of patients who started AT worsened compared to patients who continued AS, although no significant changes in HRQoL score over time were found in the mixed-model analyses. Overall, DTF patients who started AT scored significantly worse on pain (β=10.08, P=0.039) compared to patients who continued AS.

Conclusions:
An initial AS approach did not impair HRQoL of DTF patients who continued AS over time, therefore providing further support for AS as the frontline approach in DTF patients. Longitudinal assessment of HRQoL should be part of clinical follow-up to identify patients who may need a change in treatment strategy.
Safety and Distribution of Opioid Prescribing by U.S. Surgeons
Authors: Waljee Jennifer F. , Gunaseelan Vidhya , Bicket Mark C. , Brummett Chad M. , Chua Kao-Ping 
Published: February 2023

Objective:
To estimate high-risk prescribing patterns among opioid prescriptions from U.S. surgeons; to characterize the distribution of high-risk prescribing among surgeons.

Background:
National data on the prevalence of opioid prescribing and high-risk opioid prescribing by U.S. surgeons are lacking.

Methods:
Using the IQVIA Prescription Database, which reports dispensing from 92% of U.S. pharmacies, we identified opioid prescriptions from surgeons dispensed in 2019 to patients ages ≥12 years. “High-risk” prescriptions were characterized by: days supplied >7, daily dosage ≥50 oral morphine equivalents (OMEs), opioid-benzodiazepine overlap, and extended-release/long-acting opioid. We determined the proportion of opioid prescriptions, total OMEs, and high-risk prescriptions accounted for by “high-volume surgeons” (those in the ≥95th percentile for prescription counts). We used linear regression to identify characteristics associated with being a high-volume surgeon.

Results:
Among 15,493,018 opioid prescriptions included, 7,036,481 (45.4%) were high-risk. Among 114,610 surgeons, 5753 were in the 95th percentile or above for prescription count, with ≥520 prescriptions dispensed in 2019. High-volume surgeons accounted for 33.5% of opioid prescriptions, 52.8% of total OMEs, and 44.2% of high-risk prescriptions. Among high-volume surgeons, 73.9% were orthopedic surgeons and 60.6% practiced in the South. Older age, male sex, specialty, region, and lack of affiliation with academic institutions or health systems were correlated with high-risk prescribing.

Conclusions:
The top 5% of surgeons account for 33.5% of opioid prescriptions and 45.4% of high-risk prescriptions. Quality improvement initiatives targeting these surgeons may have the greatest yield given their outsized role in high-risk prescribing.
Predictive Value of KLASS-02-QC Assessment Score on KLASS-02 Surgical Outcomes
Authors: Song Jeong Ho , Shin Hye Jung , Hyung Woo Jin , Yang Han-Kwang , Han Sang-Uk , Park Young-Kyu , Lee Hyuk-Joon , An Ji Yeong , Kim Wook , Kim Hyung-Ho , Ryu Seung Wan , Hur Hoon , Kim Min-Chan , Kong Seong-Ho , Kim Jin-Jo , Park Do Joong , Kim Young Woo , Ryu Keun Won , Kim Jong Won , Lee Joo-Ho , Kim Hyoung-Il 
Published: February 2023

Objective:
The aim of this study was to audit the 22 items and assessed each item's predictive value on surgical outcomes.

Background:
The KLASS-02 trial revealed that the oncologic outcomes of laparoscopic distal gastrectomy are not inferior to open distal gastrectomy in patients with advanced gastric cancer. The surgeons participating in this trial were chosen based on the assessment scores from the KLASS-02-QC trial, which used 22 items for standardization of D2 lymphadenectomy and quality control.

Methods:
We reviewed proficiency scores (PSs) for 22 items for 20 surgeons who participated in KLASS-02. The surgeons were divided into 2 groups according to PS, and the perioperative outcomes of 924 patients enrolled in KLASS-02 were compared between groups. Each item's predictive value for perioperative outcome was then assessed using multivariable regression models.

Results:
Of the total 924 patients, 529 were operated on by high-score surgeons (high PS) and 395 were operated on by low-score surgeons (low-PS). High-PS group had less intraoperative blood loss, longer operation times, and fewer complications, major complications, reoperations, and shorter first flatus and hospital stay than low-PS group (P=0.006, P<0.001, P<0.001, P<0.001, P=0.042, P=0.013, and P<0.001, respectively). Some items used in KLASS-02-QC predicted perioperative outcomes, such as intraoperative blood loss, major complications, reoperation, and hospital stay.

Conclusions:
Although this study only analyzed data associated with qualified surgeons, the 22 items effectively assessed the surgeons based on PS. A high score was associated with longer operation times, but better perioperative outcomes.
Evaluation of a Structured Female Pelvic Medicine and Reconstructive Surgery Resident Rotation Curriculum
Authors: Funfar Brenna , Godecker Amy , Spencer Ryan J. , Giles Dobie L. , Heisler Christine A. 
Published: February 2023

Importance
Residency education is moving toward competency-based learning, which requires novel educational methods. One solution is structured learning through a formalized curriculum.

Objective
The purpose of this study is to evaluate the educational aspects of a novel structured curriculum in female pelvic medicine and reconstructive surgery.

Study Design
This was a prospective cohort study of third-year obstetrics and gynecology residents who rotated on the female pelvic medicine and reconstructive surgery service. The curriculum was organized into 7 specific topics with weekly required reading, key specialty articles, and reviewed quizzes on subspecialty topics adapted from the American Board of Obstetrics and Gynecology Guide to Learning. A prerotation and postrotation self-assessment of pelvic anatomy and pelvic floor dysfunction content comprehension was assessed using a Likert scale (0–10) for each domain.

Results
Obstetrics and gynecology residents from 4 academic years resulted in a total of 17 paired assessments for analysis. Each of the 7 domains showed significant improvement among all academic years, with a mean increase of 4.9 ± 0.8 points (P < 0.001). The 2 domains that showed the greatest improvement were stress urinary incontinence (5.5 ± 1.3, P < 0.001) and pelvic organ prolapse (5.5 ± 1.9, P < 0.001). There was no significant association between score improvement and the number of previous surgical rotations or having the rotation in the first or second half of the academic year.

Conclusions
This study demonstrated that a structured curriculum in female pelvic medicine and reconstructive surgery was associated with significant improvement in self-assessed perceived resident knowledge during the subspecialty rotation. This approach could be applied to other rotations and direct education curriculum development.
Non-Surgical Management and Analgesia Strategies for Older Adults with Multiple Rib Fractures: a Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma
Authors: Mukherjee Kaushik , Schubl Sebastian D. , Tominaga Gail , Cantrell Sarah , Kim Brian , Haines Krista L. , Kaups Krista L. , Barraco Robert , Staudenmayer Kristan , Knowlton Lisa M. , Shiroff Adam M. , Bauman Zachary M. , Brooks Steven E. , Kaafarani Haytham , Crandall Marie , Nirula Raminder , Agarwal Suresh K. , Como John J. , Haut Elliott R. , Kasotakis George 
Published: February 2023

ABSTRACT

Background
Chest wall injury in older adults is a significant cause of morbidity and mortality. Optimal nonsurgical management strategies for these patients have not been fully defined regarding level of care, incentive spirometry, noninvasive positive pressure ventilation, and the use of ketamine, epidural and other locoregional approaches to analgesia.

Methods
Relevant questions regarding older patients with significant chest wall injury with patient Population(s), Intervention(s), Comparison(s), and appropriate selected Outcomes (PICO) were chosen. These focused on ICU admission, incentive spirometry, noninvasive positive pressure ventilation, and analgesia including ketamine, epidural analgesia, and locoregional nerve blocks. A systematic literature search and review was conducted, and our data were analyzed qualitatively and quantitatively and the quality of evidence assessed per the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. No funding was utilized.

Results
Our literature review (PROSPERO 2020-CRD42020201241,MEDLINE,EMBASE, Cochrane,Web of Science,1/15/2020) resulted in 151 studies. ICU admission was qualitatively not superior for any defined cohort other than by clinical assessment. Poor incentive spirometry performance was associated with prolonged hospital length of stay, pulmonary complications, and unplanned ICU admission. Noninvasive positive pressure ventilation was associated with 85% reduction in odds of pneumonia (p < 0.0001) and 81% reduction in odds of mortality (p = 0.03) in suitable patients without risk of airway loss. Ketamine use demonstrated no significant reduction in pain score but a trend toward reduced opioid use. Epidural and other locoregional analgesia techniques did not affect pneumonia, length of mechanical ventilation, hospital length of stay or mortality.

Conclusion
We do not recommend for or against routine ICU admission. We recommend use of incentive spirometry to inform ICU status and conditionally recommend use of noninvasive positive pressure ventilation in patients without risk of airway loss. We offer no recommendation for or against ketamine, epidural or other locoregional analgesia.

Level of Evidence
Guideline; systematic review/meta-analysis, level IV
Neighborhood deprivation and childhood opportunity indices are associated with violent injury among children in Los Angeles County
Authors: Sarnthiyakul Sasithorn , Ross Erin E. , Ourshalimian Shadassa , Spurrier Ryan G. , Chaudhari Pradip P. 
Published: February 2023

BACKGROUND
Previous research has demonstrated mixed relationships between individual neighborhood socioeconomic factors and incidences of violence, such as poverty level, population density, and income inequality. We used the Childhood Opportunity Index and Area Disadvantage Index to evaluate the relationship between neighborhood characteristics and the number of incidents of violence among children across the zip codes of Los Angeles (LA) County.

METHODS
We performed a retrospective cross-sectional study of children younger than 18 years from 2017 to 2019 who were entered in the LA County Trauma and Emergency Medicine Information System registry with violent mechanisms of injury, including gunshot, stabbing, or assault. Mechanisms classified as self-inflicted injuries were excluded from the study. The number of incidences of violent mechanism per 100,000 persons younger than 18 years for each zip code was calculated using population data from the US Census American Community Survey 5-Year estimates from 2019. The incidences of violence per capita younger than 18 years for each zip code was compared with the zip code Area Deprivation Index and Childhood Opportunity Index using logistic regression models.

RESULTS
There were 6,791 trauma activations in LA County over the study period, 12.8% (n = 866) of which were due to violence. The mean prevalence of pediatric violent mechanism of injury per zip code was 4 cases per 100,000 persons younger than 18 years. Most injuries were the result of firearms (n = 345 [60.4%]) and occurred among Hispanic/Latino children (n = 362 [57.1%]). There were significantly greater rates of violent injury among children from highest disadvantage (odds ratio, 8.84) and lowest opportunity (odds ratio, 42.48) zip codes.

CONCLUSION
Children living in high disadvantage or low opportunity zip codes had greater rates of violent injury. Further study of neighborhood factors is needed to develop targeted effective interventions to reduce violent injuries among children living in low opportunity areas.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Using the LASSI-L to Detect Robust Interference Effects in Premanifest Huntington Disease
Authors: Sierra Luis A. , Ullman Clementina J. , Frank Samuel A. , Laganiere Simon 
Published: February 2023

Background:
Diagnosis of manifest Huntington disease (HD) is based primarily on motor symptoms, but premanifest HD (preHD) is often associated with subtle cognitive decline. The Loewenstein–Acevedo Scales for Semantic Interference and Learning (LASSI–L) is a validated verbal learning test that can be used to detect early cognitive decline.

Objective:
To determine the utility of the LASSI–L for detecting early cognitive decline in individuals with preHD and to compare the results of the LASSI–L with those of commonly used neuropsychological tests in HD.

Method:
We administered the LASSI–L to 13 individuals with preHD and 13 healthy controls matched for age, sex, and education as part of a longitudinal study of disease progression. For comparison purposes, we administered the Mini-Mental State Examination; Stroop Color and Word Test; Symbol Digit Modalities Test; Trail-Making Test, Parts A and B; and category fluency (animals) task.

Results:
Five of the seven sections on the LASSI–L captured group differences: Proactive Semantic Interference (PSI; P < 0.001), Failure to Recover From PSI (P = 0.038), Retroactive Semantic interference (RSI; P = 0.013), Delayed Recall (P < 0.001), and B1 Cued Recall Intrusions (P = 0.036). Using a false discovery rate of <0.05, PSI, RSI, and Delayed Recall remained significant.

Conclusion:
The LASSI–L is a sensitive instrument for detecting early interference effects in individuals with preHD that outperforms commonly used neuropsychological tests. The LASSI–L could be a useful addition to clinical and research protocols involving individuals with preHD.
Influence of Tumor Characteristics on Visual Field Outcomes After Pituitary Adenoma Surgery
Authors: Ito Munekatsu , Suda Kenji , Nakano Eri , Tagawa Miho , Miyata Manabu , Kashii Satoshi , Tanji Masahiro , Miyamoto Susumu , Tsujikawa Akitaka 
Published: February 2023

Background:
There were few reports about the influence of tumor characteristics on the postoperative visual field outcomes after transsphenoidal surgery for pituitary adenoma. The purpose of this study was to explore the tumor characteristics that influenced perioperative visual field changes.

Method:
Patients who underwent transsphenoidal surgery under a diagnosis of pituitary adenoma at the Kyoto University Hospital between April 2012 and December 2018 were retrospectively enrolled. Correlations among circumpapillary retinal nerve fiber layer thickness, preoperative and postoperative mean deviation (MD) of visual field, MD change after the surgery, and maximum tumor diameter were evaluated by measuring Pearson correlation coefficient. We evaluated the influences on postoperative MD using a generalized estimating equation for univariate and multivariate regression analyses. We also compared the characteristics of cystic and solid tumors.

Results:
Thirty-two eyes of 18 patients were included in this study (9 male and 9 female patients). Postoperative MD positively correlated with maximum tumor diameter only in multivariate regression {β = 0.22 (95% confidence interval [CI], 0.004–0.43), P = 0.046}, although maximum tumor diameter negatively correlated with postoperative MD in univariate regression (β = −0.16 [95% CI, −0.58 to 0.26], P = 0.46). In the investigation of perioperative MD changes, eyes with cystic tumors showed significantly better improvement those with solid tumors (8.93 ± 7.85 vs 0.18 ± 6.56 dB, P = 0.007).

Conclusion:
Cystic and solid tumors show different characteristics of visual loss and visual field defects. The MD in eyes with cystic tumors improved significantly more than that in eyes with solid tumors.
Does the American College of Surgeons New Level I Children’s Surgery Center Verification Affect Treatment Efficiency and Narcotic Administration in Treating Pediatric Trauma Patients with Femur Fracture?
Authors: White Carter R , Leshikar Holly B , White Micaela R , White Spencer R , Semkiw Karen , Farmer Diana L , Haus Brian M 
Published: February 2023

Background:
In 2015, the American College of Surgeons (ACS) created a new hospital improvement program to enhance the performance of pediatric care in US hospitals. The Children’s Surgery Verification (CSV) Quality Improvement Program is predicated on the idea that pediatric surgical patients have improved outcomes when treated at children’s hospitals with optimal resources. Achieving ACS level I CSV designation at pediatric trauma centers may lead to greater benefits for pediatric trauma patients; however, the specific benefits have yet to be identified. We hypothesize that achieving the additional designation of ACS level I CSV is associated with decreased narcotic use perioperatively and improved efficiency when managing pediatric patients with femur fractures.

Study Design:
This study is a retrospective analysis of traumatic pediatric orthopaedic femur fractures treated at a verified level I pediatric trauma center before and after CSV designation (2010-2014 vs. 2015-2019). Efficiency parameters, defined as time from admission to surgery, duration of surgery, and duration of hospital stay, and narcotic administration in oral morphine equivalents (OME) were compared.

Results:
Of 185 traumatic femur fractures analyzed, 80 occurred before meeting ACS level I CSV criteria and 105 occurred after. Post-CSV, there was a significant decrease in mean wait time from admission to surgery (16.64hrs pre-CSV, 12.52hrs post-CSV (p<0.01)), and duration of hospital stay (103.49hrs pre-CSV, 71.61hrs post-CSV (p<0.01)). Narcotic usage was significantly decreased in both the preoperative period (40.61 OME pre-CSV, 23.77 OME post-CSV (p<0.01)), and postoperative period (126.67 OME pre-CSV, 45.72 OME post-CSV (p<0.01)).

Conclusion:
Achieving ACS level I CSV designation is associated with increased efficiency and decreased preoperative and postoperative narcotic use when treating pediatric trauma patients.
Impact of Rurality on Geriatric Emergency General Surgery Patients in New Hampshire
Authors: Burney Charles P , Baumann Laura , Carlos Heather A , Briggs Alexandra 
Published: February 2023

Background:
Geriatric patients requiring Emergency General Surgery (EGS) have significant risk of morbidity and mortality. Rural patients face decreased access to care. We sought to characterize the EGS needs and impact of rurality for geriatric residents of New Hampshire (NH).

Study Design:
A retrospective cohort study of the NH Uniform Healthcare Facility Discharge Dataset, including patients 65 years-old and older with urgent/emergent admission who underwent one of 7 EGS procedures, grouped by urban or rural county of residence, discharged between 2012-2015.

Results:
NH has 26 acute care hospitals of which 10 (38.5%) are in urban counties and 16 (61.5%) are in rural counties. 13 (50.0%) are critical access hospitals (1 urban and 12 rural). Of 2,445 geriatric patient discharges, 40% of patients were from rural counties and were demographically similar to urban patients. Rural patients were more likely to present as a hospital transfer (15.4% vs 2.5%, p<0.01), receive care at a critical access hospital (24.1% vs 1.0%, p<0.01), receive care outside their home county (32.5% vs 12.8%, p<0.01), and be transferred to another hospital after surgery. Rural and urban patients underwent similar procedures, with similar length of stay, cost of index hospitalization, and mortality.

Conclusion:
Rural geriatric patients in NH are more likely to receive care outside of their home county or be transferred to another hospital. Costs of care were similar but are likely underestimated for rural patients. There was no difference in unadjusted mortality. Further investigation is merited to determine the reasons for hospital transfer in the geriatric EGS population to evaluate which patients may benefit most from remaining close to home versus transferring to other facilities.