Surgery最新文献

{"title":"Differences in histopathologic features and diagnostic performance of ^99mTc-methoxy-isobutyl-isonitrol single photon emission tomography-CT and ¹⁸F-fluorocholine positron emission tomography-CT in primary hyperparathyroidism.","authors":"Irene Osorio-Silla, Diego Meneses González, Hernán Darío Quiceno Arias, Paula Pastor Peinado, Jersy Jair Cárdenas Salas, María Miguélez González, Carlos Augusto Pestana Soares, Luisa Fernanda Martínez Ruiz, Laura Cristina Landaeta Kancev, Luis Martínez Dhier, Manuel Escanciano, María Luisa Sánchez de Molina, Amalia Paniagua Ruíz, Pedro Villarejo Campos","doi":"10.1016/j.surg.2025.109595","DOIUrl":"10.1016/j.surg.2025.109595","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism is a common endocrine disorder. Accurate preoperative localization is crucial for the success of minimally invasive parathyroidectomy. Although ⁹⁹mTc-methoxy-isobutyl-isonitrol single photon emission computed tomography-computed tomography remains the gold standard imaging technique, its diagnostic performance can be limited in certain clinical scenarios. In recent years, ¹⁸F-fluorocholine positron emission tomography-computed tomography has emerged as a promising alternative, especially in cases where first-line imaging results are inconclusive or negative. However, the mechanisms contributing to its superior diagnostic performance remain incompletely understood. The study aims to assess the diagnostic accuracy of ¹⁸F-fluorocholine positron emission tomography-computed tomography in patients with negative or discordant ⁹⁹mTc-methoxy-isobutyl-isonitrol single photon emission computed tomography-computed tomography results and to evaluate the biochemical and histopathologic characteristics of hyperfunctioning glands detected by each imaging modalities.</p><p><strong>Methods: </strong>A retrospective study was performed of 245 primary hyperparathyroidism patients who underwent parathyroid surgery between January 2021 and April 2024. Imaging findings were correlated with biochemical data, histopathology, and surgical outcomes. Semiquantitative positron emission tomography parameters were analyzed and statistical comparisons were made regarding gland size, weight, cellular composition, and growth patterns.</p><p><strong>Results: </strong>¹⁸F-Fluorocholine positron emission tomography-computed tomography presented a sensitivity of 93.1% and a diagnostic accuracy of 78.8%. This imaging modality identified smaller glands and was more frequently associated with chief-cell predominance. ⁹⁹mTc-methoxy-isobutyl-isonitrol single photon emission computed tomography-computed tomography demonstrated a sensitivity of 70.4% and an accuracy of 60.7%, with higher radiotracer uptake observed in oxyphilic and oncocytic adenomas. The maximum standardized uptake value correlated with parathyroid hormone levels and gland size but not with cellular composition or growth pattern.</p><p><strong>Conclusion: </strong>¹⁸F-fluorocholine positron emission tomography-computed tomography demonstrates high diagnostic performance in lesion localization, particularly in patients with negative or inconclusive first-line imaging. These findings suggest that radiotracer uptake may be influenced by biochemical and morphologic features, although further studies are warranted to clarify these mechanisms.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109595"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidrug-resistant bacterial colonization affects postoperative outcomes after pancreaticoduodenectomy.","authors":"Domenico Tamburrino, Giovanni Guarneri, Lorenzo Provinciali, Giuseppe Vanella, Matteo Tacelli, Livia Archibugi, Marcella Negri, Marco Ripa, Gabriele Capurso, Paolo Giorgio Arcidiacono, Antonella Castagna, Nicolò Pecorelli, Stefano Crippa, Stefano Partelli, Massimo Falconi","doi":"10.1016/j.surg.2025.109594","DOIUrl":"10.1016/j.surg.2025.109594","url":null,"abstract":"<p><strong>Background: </strong>Bile colonization after biliary drainage is associated with a greater rate of morbidity and mortality after pancreaticoduodenectomy. The increased use of antibiotics has led to a greater rate of bile colonization by multidrug-resistant microorganisms. This study aimed to analyze the correlation between multidrug-resistant microorganisms and the rate of postoperative complications.</p><p><strong>Methods: </strong>Data from patients who underwent pancreaticoduodenectomy between 2016 and 2022 were retrospectively analyzed, and biliary culture data were revised and collected. Microorganisms were defined as sensitive to antibiotics or multidrug-resistant according to the literature.</p><p><strong>Results: </strong>Overall, 460 patients with intraoperative biliary cultures were included in the study group. Multidrug-resistant microorganisms were isolated from 102 (22%) patients. The presence of multidrug resistance at biliary culture was an independent risk factor for clinically relevant postoperative pancreatic fistula (odds ratio, 2.590; 95% confidence interval, 1.49-4.48, P = .001) and infectious complications (odds ratio, 3.232; 95% confidence interval, 1.99-5.25, P < .001). The isolation of multidrug-resistant microorganisms also increased the final burden of complications. In patients with clinically relevant postoperative pancreatic fistula, the presence of multidrug-resistant microorganisms resulted in a median comprehensive complication index of 47.10 [interquartile range, 36.2-66.6] versus 39.53 [interquartile range, 29.6-54.2], P = .034. Among the different microorganisms, Escherichia coli multidrug resistance and Klebsiella pneumoniae multidrug resistance were significantly associated with pancreatic surgery-specific complications.</p><p><strong>Conclusion: </strong>Multidrug-resistance bile colonization is an independent risk factor for complications after pancreaticoduodenectomy, including clinically relevant postoperative pancreatic fistula. In case of the onset of pancreatic surgery-specific complications, the presence of these microorganisms increases the burden of complications.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109594"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term and long-term outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma and gallbladder carcinoma: A systematic review and meta-analysis with meta-regression.","authors":"Shahin Hajibandeh, Shahab Hajibandeh, Syed Soulat Raza, David C Bartlett, Nikolaos Chatzizacharias, Bobby V M Dasari, Keith J Roberts, Ravi Marudanayagam, Robert P Sutcliffe","doi":"10.1016/j.surg.2025.109593","DOIUrl":"10.1016/j.surg.2025.109593","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate short-term and long-term outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma and gallbladder cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting outcomes of hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma or gallbladder cancer were included, and their risk of bias were assessed. Effect sizes were determined for clinically relevant postoperative pancreatic fistula, clinically relevant posthepatectomy liver failure, bile leak, Clavien-Dindo classification III or greater complications, mortality, and 1- to 5-year survival using random-effects modeling followed by meta-regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-three retrospective studies (789 patients) conducted between 2007 and 2025 were included. Hepatopancreatoduodenectomy for extrahepatic cholangiocarcinoma was associated with clinically relevant postoperative pancreatic fistula: 52.1% (95% confidence interval, 38.8%-65.4%), CR-posthepatectomy liver failure: 31.5% (95% confidence interval, 14.5-48.4%), bile leak: 17.6% (95% confidence interval, 13.3-22.0%), Clavien-Dindo grade III or greater: 59.4% (95% confidence interval, 47.3-71.6%), mortality: 2.8% (95% confidence interval, 0.9-4.6%), and 1-year: 61.8% (95% confidence interval, 49.6-73.9%), 3-year: 30.2% (95% confidence interval, 23.5-36.9%) and 5-year survival: 23.7% (95% confidence interval, 17.3-30.2%). hepatopancreatoduodenectomy for gallbladder cancer was associated with clinically relevant postoperative pancreatic fistula: 48.7% (95% confidence interval, 19.9-77.5%), clinically relevant posthepatectomy liver failure: 15.7% (95% confidence interval, 0.2-31.2%), bile leak: 9.4% (95% confidence interval, 4.0-14.9%), Clavien-Dindo classification III or greater: 45.7% (95% confidence interval, 22.6-68.9%), mortality: 6.7% (95% confidence interval, 1.8-11.6%), and 1-year: 65.0% (95% confidence interval, 44.8-85.1%), 3-year: 19.9% (95% confidence interval, 10.8-29.0%), and 5-year survival: 14.0% (95% confidence interval, 5.2-22.9%). Portal vein resection was associated with clinically relevant postoperative pancreatic fistula (P = .003), clinically relevant posthepatectomy liver failure (P &lt; .001), and Clavien-Dindo grade III or greater (P &lt; .001) in extrahepatic cholangiocarcinoma, and clinically relevant postoperative pancreatic fistula (P &lt; .001) and clinically relevant posthepatectomy liver failure (P &lt; .001) in gallbladder cancer. Arterial resection was associated with clinically relevant posthepatectomy liver failure (P &lt; .001), and Clavien-Dindo classification III or greater (P &lt; .001) in extrahepatic cholangiocarcinoma. Portal vein embolization predicted posthepatectomy liver failure in both extrahepatic cholangiocarcinoma (P &lt; .001) and gallbladder cancer (P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Hepatopancreatoduodenectomy f","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"109593"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drowning in the silver tsunami: Geriatric patient proportion impact on trauma outcomes","authors":"Sebastian Boland MD, MBA ,&nbsp;Liling Lu MS ,&nbsp;Tamara Byrd MD, MPH ,&nbsp;David Silver MD, MPH ,&nbsp;Joshua B. Brown MD, MSc","doi":"10.1016/j.surg.2025.109651","DOIUrl":"10.1016/j.surg.2025.109651","url":null,"abstract":"<div><h3>Background</h3><div>The volume-outcome relationship in trauma centers is well established, including geriatric volume. With an increasing geriatric population, it remains unclear whether a tipping point exists for these complex patients who overwhelm centers. Our objective was to evaluate whether the proportion of geriatric patients relative to total volume impacts outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed patients aged &gt;15 years from the Trauma Quality Program Patient Use File dataset between the years 2017 and 2021. We calculated the center-level annual geriatric proportion of total adult patient volume. Generalized additive mixed models evaluated nonlinear effects between geriatric proportion and mortality for geriatric and nongeriatric patients adjusted for demographics, vitals, injury characteristics, center characteristics, frailty, and comorbidities.</div></div><div><h3>Results</h3><div>We included 3,989,267 patients from 605 centers. Increasing geriatric proportion was associated with improving mortality for geriatric patients until reaching thresholds of 65% of total volume, where mortality plateaued. Importantly, at a geriatric proportion of 61%, mortality for nongeriatric adults began to increase (adjusted odds ratio per 5% increase: 1.04; 95% confidence interval: 1.01–1.08). Geriatric Charlson Comorbidity Index was related to nongeriatric mortality in the highest quartile of geriatric proportion (adjusted odds ratio: 1.18, 95% confidence interval: 1.11–1.25).</div></div><div><h3>Conclusion</h3><div>Center-level geriatric proportion is an important predictor of both geriatric and nongeriatric trauma outcomes. At higher proportions of geriatric patients, the loss of the volume-outcome benefit and even increase in mortality suggests the medically complex geriatric population may overwhelm centers, leading to worse outcomes among all patients. These findings may inform trauma system planning to optimize care of our geriatric and nongeriatric patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"187 ","pages":"Article 109651"},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of breast reconstruction compared with no reconstruction on breast cancer-related lymphedema: A systematic review and meta-analysis","authors":"Cecilie Mullerup Laustsen-Kiel MD ,&nbsp;Laura Hansen MD ,&nbsp;Mathias Ørholt MD ,&nbsp;Sofie Meng Zhang ,&nbsp;Nicco Krezdorn MD, PhD ,&nbsp;Peter Viktor Vester-Glowinski MD, PhD ,&nbsp;Tine Engberg Damsgaard MD, PhD, MRBS","doi":"10.1016/j.surg.2025.109649","DOIUrl":"10.1016/j.surg.2025.109649","url":null,"abstract":"<div><h3>Introduction</h3><div>Breast cancer-related lymphedema affects 21.9% of patients. The role of breast reconstruction in lymphedema prevention remains unclear. This review aimed to assess the relative risk of breast cancer–related lymphedema after breast reconstruction compared with mastectomy and breast-conserving surgery, which has thus far been inconclusively assessed.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EMBASE, Cochrane Central, and gray literature searches identified studies reporting lymphedema outcomes after mastectomy, breast-conserving surgery, and breast reconstruction. We calculated incidence rate ratios using random-effects models. Subgroup analyses compared reconstruction timing (immediate compared with delayed), types (autologous compared with implant-based), and immediate implant stages (1-stage compared with 2-stage).</div></div><div><h3>Results</h3><div>Twenty-three studies with 15,670 patients were included in the qualitative analysis, and 14 were included in the meta-analysis. Patients with breast reconstruction had a significantly lower risk of lymphedema than those without reconstruction (incidence rate ratio, 0.58; 95% confidence interval, 0.38–0.87, <em>P</em> &lt; .001). However, this effect was less pronounced when only studies with baseline lymphedema measurements were included. We found no significant differences between autologous and implant-based reconstructions, immediate and delayed reconstruction, or 1- and 2-stage implant-based reconstruction.</div></div><div><h3>Conclusion</h3><div>Breast reconstruction does not increase the risk for breast cancer-related lymphedema, and the risk of lymphedema is similar across different types of breast reconstruction. Breast reconstruction may reduce the risk of breast cancer-related lymphedema compared with mastectomy alone. The lack of baseline lymphedema measurements in most studies and studies with follow-up less than 4 years limits the strength of these findings.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"187 ","pages":"Article 109649"},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and practices surrounding primary care firearm safety counseling before and after a single pragmatic mixed-methods education session","authors":"Surina Khurana BA,&nbsp;Avneet Bhullar BS, MSc,&nbsp;Sydney Burger BS,&nbsp;Areg Grigorian MD,&nbsp;Jeffry Nahmias MD, MHPE","doi":"10.1016/j.surg.2025.109654","DOIUrl":"10.1016/j.surg.2025.109654","url":null,"abstract":"<div><h3>Background</h3><div>Firearm violence is the leading cause of death among young adults and children. It is unclear whether primary care providers have adequate training in firearm safety counseling or incorporate it into routine care. This study aimed to address this gap by surveying primary care providers before and after a mixed-methods educational session on firearm safety counseling. We hypothesized this would increase firearm safety counseling at primary care provider well-being visits.</div></div><div><h3>Methods</h3><div>A 10-minute didactic/video-based educational session was adapted from existing resources from the BulletPoints Project's curriculum on firearm safety counseling. This was delivered to participants recruited through departmental faculty meetings (2023–2024). A 22-question anonymous survey, adapted from previously validated questionnaires assessing firearm safety counseling among primary care providers, was performed immediately prior to this education via REDCap. Follow-up surveys were sent 3 months later with bivariate pre-/post- comparisons.</div></div><div><h3>Results</h3><div>Of 71 primary care providers who attended the educational session, 47 (55% response rate) consented to participate and completed prestudy surveys (57% family medicine, 17% pediatrics, 17% internal medicine, 9% other). Of these, 21 of 47 (44.7%) completed follow-up surveys. The reported frequency of firearm safety counseling at well-being visits increased in the post- compared with prestudy responses (33% vs 13% reported counseling &gt;75% of their wellness visits, <em>P</em> = .014) and fewer primary care providers reported not knowing what to tell families to prevent firearm injuries in the poststudy cohort (13% vs 36%, <em>P</em> = .018).</div></div><div><h3>Conclusions</h3><div>A brief educational session for primary care providers improved the 3-month post education rate of firearm safety counseling at primary care provider well-being visits. Future research is needed to evaluate continued retention and whether this is an effective form of primary firearm injury prevention.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"187 ","pages":"Article 109654"},"PeriodicalIF":2.7,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical health service research on single-incision laparoscopic colon and rectal surgery: results of 1,170 patients in a 7-year registry analysis","authors":"Maik Sahm PhD ,&nbsp;Marcia Fricke ,&nbsp;Victoria Stirn ,&nbsp;Richard Hunger ,&nbsp;Roland Croner PhD ,&nbsp;Hans Lippert PhD ,&nbsp;Rene Mantke PhD","doi":"10.1016/j.surg.2025.109672","DOIUrl":"10.1016/j.surg.2025.109672","url":null,"abstract":"<div><h3>Background</h3><div>The clinical impact of single-incision laparoscopic surgery for the colon and rectum remains unclear despite its undeniable advantages. The European Association for Endoscopic Surgery consensus statement in 2019 highlights limitations concerning body mass index, tumor size, and previous surgery based on randomized studies, but many patients fall outside the recommended European Association for Endoscopic Surgery limits. Our study aimed to analyze patient care in routine clinical practice beyond randomized trials to assess its real-world relevance. The development of new robotic platforms for single-port techniques necessitates a reassessment of single-incision laparoscopic surgery applicability in clinics.</div></div><div><h3>Methods</h3><div>This analysis is based on a prospectively established multicenter registry database covering data collected over 7 years. Primary endpoints were overall morbidity and mortality; regression analyses identified significant variables.</div></div><div><h3>Results</h3><div>The registry analysis included 1,170 patients from 26 German hospitals performing single-incision laparoscopic colon and/or rectum surgery. Mean operative time was 157.7 minutes; additional trocars were required in 28.3% of cases. The conversion rate was 6.2%. The mean intraoperative complication rate was 1.8%; postoperative complications occurred in 14.9% of cases, and the mortality rate was 0.51%. In multivariate regression analyses, no variable was found to influence intraoperative complications. However, postoperative complications were significantly associated with sex (<em>P</em> &lt; .001) and rectal surgery (<em>P</em> = .028).</div></div><div><h3>Conclusion</h3><div>This registry analysis demonstrates that single-incision laparoscopic surgery for the colon and rectum can be safely performed in routine clinical practice, even outside the selection criteria of European Association for Endoscopic Surgery recommendations. Male sex and rectal surgery significantly increase postoperative complications.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109672"},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminating Surgery Content in 2025","authors":"Steven D. Wexner MD, PhD,&nbsp;Caitlin W. Hicks MD, MS","doi":"10.1016/j.surg.2025.109690","DOIUrl":"10.1016/j.surg.2025.109690","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"Article 109690"},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for readers","authors":"","doi":"10.1016/S0039-6060(25)00538-0","DOIUrl":"10.1016/S0039-6060(25)00538-0","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"186 ","pages":"Article 109686"},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared decision-making within acute care surgery and surgical residency: Identifying deficiencies to increase use","authors":"V. Christian Sanderfer MD ,&nbsp;Kathryn Muir MD ,&nbsp;Buddy Marterre MD, MDiv ,&nbsp;Hannah Wang PhD ,&nbsp;Samuel W. Ross MD ,&nbsp;Bradley W. Thomas MD ,&nbsp;Caroline E. Reinke MD","doi":"10.1016/j.surg.2025.109648","DOIUrl":"10.1016/j.surg.2025.109648","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision-making is integral to patient-centered, goal concordant health care. In this model clinicians and patients work together to make care plans balancing clinical evidence regarding risks, benefits, and expected outcomes with patient preferences and values. While this is an ideal approach to patient care shared decision-making is inconsistently applied. Our aim was to identify surgery attendings', fellows', and residents' perceived barriers to, comfort with, and training experience in shared decision-making.</div></div><div><h3>Methods</h3><div>Surgery attendings (attendings/fellows) and residents across a health care market were surveyed regarding perceived barriers towards performing shared decision-making (August-October 2023). Provider demographics, perceived patient/family and time barriers, as well as surgeon comfort in utilizing shared decision-making were queried using a 5-point Likert scale. The survey was administered via REDCap and results were compared between resident and attending (fellow/attending) physicians. Univariate analysis was used to compare the difference between groups.</div></div><div><h3>Results</h3><div>Over the survey period 40 residents and 44 attendings responded (53% response). Residents were more likely to have had prior shared decision-making simulation-based education (<em>P</em> = .002). Significant barriers to residents using shared decision-making included lack of time (<em>P</em> = .01) and the fear of being perceived as being less knowledgeable when discussing different treatment options (<em>P</em> &lt; .0001) compared to attending physicians. Residents were less comfortable in discussing “Big Picture” prognosis (<em>P</em> &lt; .0001), addressing unrealistic patient/family expectations (<em>P</em> = .01), and clarifying patient preferences (<em>P</em> = .04) compared with attendings.</div></div><div><h3>Conclusion</h3><div>While multiple barriers to shared decision-making were identified, the greatest need for further training was noted in the resident responses. Future training for residents should focus on the identified barriers toward implementing shared decision-making.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"187 ","pages":"Article 109648"},"PeriodicalIF":2.7,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}