Surgery最新文献

{"title":"Outcomes of neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma","authors":"Kelong Shao MM ,&nbsp;Yening Du MM ,&nbsp;Liwei Xu MD ,&nbsp;Youhua Jiang MD ,&nbsp;Qixun Chen MD ,&nbsp;Jian Zeng MD ,&nbsp;Lei Cai MD ,&nbsp;Yujin Xu MD ,&nbsp;Xiaojiang Sun MD ,&nbsp;Weimin Mao MD ,&nbsp;Changchun Wang MD","doi":"10.1016/j.surg.2025.109383","DOIUrl":"10.1016/j.surg.2025.109383","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal squamous carcinoma is a prevalent cancer worldwide, particularly in China. Few studies have compared the treatment effects of neoadjuvant immunochemotherapy and neoadjuvant chemoradiotherapy on the long-term prognosis of patients with esophageal squamous carcinoma. This study analyzed the 3-year overall survival rate of patients with locally advanced esophageal squamous carcinoma treated with esophagectomy after neoadjuvant immunochemotherapy or neoadjuvant chemoradiotherapy.</div></div><div><h3>Methods</h3><div>A total of 309 patients with esophageal squamous carcinoma who underwent neoadjuvant chemoradiotherapy between 2010 and 2020 and 88 who underwent neoadjuvant immunochemotherapy between 2019 and 2020 at Zhejiang Cancer Hospital were included in this study. Propensity score matching with a 1:1 ratio and a caliper of 0.02 was used to balance the baseline characteristics.</div></div><div><h3>Results</h3><div>The study included 397 patients with locally advanced thoracic segmental esophageal squamous carcinoma, including 88 who received neoadjuvant immunochemotherapy and 309 who received neoadjuvant chemoradiotherapy. After propensity score matching, there were no significant differences in pathologic complete response between the 2 groups (21.3% vs 33.3%, χ² = 2.148, <em>P</em> = .143), and the neoadjuvant immunochemotherapy group demonstrated a greater 3-year overall survival rate (73.8% vs 54.8%, <em>P</em> = .003), particularly for patients with a primary stage Ⅲ diagnosis (T₃N₁M₀, T_1–3N₂M₀) or an initial suspicion of lymph node metastases. Pathologic complete response emerged as a reliable predictor of long-term outcomes in patients receiving neoadjuvant chemoradiotherapy, but not in those receiving neoadjuvant immunochemotherapy.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant immunochemotherapy was associated with improved long-term prognosis in patients with a primary stage Ⅲ diagnosis or an initial suspicion of lymph node metastases. Neoadjuvant immunochemotherapy plus surgery emerged as an effective therapeutic strategy for treating locally advanced thoracic segmental esophageal squamous carcinoma.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109383"},"PeriodicalIF":3.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902140","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":"Model of End-Stage Liver Disease–alpha-fetoprotein–tumor burden (MELD-AFP-TBS) score to stratify prognosis after liver resection for hepatocellular carcinoma","authors":"Jun Kawashima MD ,&nbsp;Miho Akabane MD ,&nbsp;Mujtaba Khalil MD ,&nbsp;Selamawit Woldesenbet MD ,&nbsp;Yutaka Endo MD ,&nbsp;Kota Sahara MD ,&nbsp;Andrea Ruzzenente MD ,&nbsp;Francesca Ratti MD ,&nbsp;Hugo P. Marques MD ,&nbsp;Sara Oliveira MD ,&nbsp;Jorge Balaia MD ,&nbsp;François Cauchy MD ,&nbsp;Vincent Lam MD ,&nbsp;George A. Poultsides MD ,&nbsp;Minoru Kitago MD ,&nbsp;Irinel Popescu MD ,&nbsp;Guillaume Martel MD ,&nbsp;Ana Gleisner MD ,&nbsp;Tom Hugh MD ,&nbsp;Matthew Weiss MD ,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon.)","doi":"10.1016/j.surg.2025.109388","DOIUrl":"10.1016/j.surg.2025.109388","url":null,"abstract":"<div><h3>Introduction</h3><div>Morphologic criteria, such as the Barcelona Clinic Liver Cancer staging system often fail to accurately predict long-term survival among patients undergoing liver resection for hepatocellular carcinoma. We sought to develop a continuous risk score that incorporates established markers of tumor biology and liver function to improve the prediction of overall survival.</div></div><div><h3>Methods</h3><div>Data from a multi-institutional database were used to identify patients who underwent curative-intent hepatectomy for hepatocellular carcinoma. A predictive score for overall survival was developed using weighted beta-coefficients from a multivariable Cox regression model.</div></div><div><h3>Results</h3><div>Among 850 patients, 595 (70.0%) were assigned to the training cohort, and 255 (30.0%) to the test cohort. In the training cohort, multivariable analysis identified the Model of End-Stage Liver Disease (hazard ratio, 1.04; 95% confidence interval, 1.01–1.07), log-transformed alpha-fetoprotein (hazard ratio, 1.07; 95% confidence interval, 1.02–1.13), and tumor burden score (hazard ratio, 1.07; 95% confidence interval, 1.03–1.11) as independent predictors of worse overall survival. The Model of End-Stage Liver Disease–alpha-fetoprotein–tumor burden score, based on the Cox model, stratified patients into low-risk (<em>n</em> = 466, 78.3%) with a 5-year OS of 70.5% and high-risk (<em>n</em> = 129, 21.7%) with a 5-year OS of 47.0% (<em>P</em> &lt; .001). In the test cohort, the Model of End-Stage Liver Disease–alpha-fetoprotein–tumor burden score demonstrated superior discriminative accuracy (C-index: 0.72, time-dependent area under the curve 1-year: 0.80, 3-year 0.76, 5-year 0.70) compared with the Barcelona Clinic Liver Cancer staging system (C-index: 0.53, time-dependent area under the curve 1-year: 0.61, 3-year 0.55, 5-year 0.56). An online tool was made accessible at <span><span>https://jk-osu.shinyapps.io/MELD_AFP_TBS/</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>The Model of End-Stage Liver Disease–alpha-fetoprotein–tumor burden score provides a novel, accurate tool for prognostic stratification of patients with hepatocellular carcinoma, identifying high-risk patients who may benefit from alternative treatments to improve outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109388"},"PeriodicalIF":3.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891840","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":"Is preoperative smoking status a predictor of postoperative outcomes after esophagectomy for squamous cell carcinoma in a high-volume centre?","authors":"Alexandre Lintis MD ,&nbsp;Thibault Voron MD, PhD ,&nbsp;Guillaume Passot MD, PhD ,&nbsp;Sebastien Degisors MD ,&nbsp;Marguerite Messier MD ,&nbsp;Clarisse Eveno MD, PhD ,&nbsp;Guillaume Piessen MD, PhD ,&nbsp;Julie Veziant MD, PhD","doi":"10.1016/j.surg.2025.109379","DOIUrl":"10.1016/j.surg.2025.109379","url":null,"abstract":"<div><h3>Background</h3><div>Smoking is a major risk factor for esophageal squamous cell carcinoma (ESCC) and is linked to increased postoperative morbidity. However, its impact on long-term survival remains unclear. This study evaluated the influence of preoperative smoking status on postoperative complications and survival following esophagectomy for ESCC in a high-volume center.</div></div><div><h3>Methods</h3><div>Patients who underwent surgery for ESCC between 1996 and 2019 were retrospectively categorized as smokers (S-group) or non-smokers (NS-group). A subgroup analysis was performed to compare active and former smokers. Primary outcomes included major postoperative complications (Clavien-Dindo ≥ III), pulmonary complications, and postoperative mortality at 30 and 90 days. Long-term outcomes included overall survival (OS) and recurrence-free survival (RFS).</div></div><div><h3>Results</h3><div>Among 694 patients, 97 (14%) were in the NS-group and 597 (86%) in the S-group. Smokers had significantly higher major morbidity rates (37% vs 23%, <em>P</em> = .002), including major pulmonary complications (29% vs 21%, <em>P</em> = .03). Active smoking was associated with increased 30-day mortality (<em>P</em> = .006) and higher rates of acute respiratory distress syndrome (<em>P</em> = .012) compared to former smokers. OS and RFS did not differ significantly between groups. The absence of post-operative smoking data limits long-term outcome interpretation.</div></div><div><h3>Conclusion</h3><div>Smoking was associated with increased perioperative morbidity, particularly pulmonary complications, but its effect on long-term survival remains uncertain. Structured smoking cessation programs should be integrated into perioperative care. Future studies should incorporate postoperative smoking status to better assess its impact on survival.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109379"},"PeriodicalIF":3.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881397","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":"Patterns of care and surgical outcomes for early-stage rectal cancer in the United States","authors":"Julia Kohn MD ,&nbsp;Anthony I. Squillaro MD ,&nbsp;Alexander Troester MD ,&nbsp;Sarah L. Mott MS ,&nbsp;Melanie Quick BS ,&nbsp;Lindsay Welton MD ,&nbsp;Christine Jensen MD ,&nbsp;Imran Hassan MD ,&nbsp;Paolo Goffredo MD","doi":"10.1016/j.surg.2025.109374","DOIUrl":"10.1016/j.surg.2025.109374","url":null,"abstract":"<div><h3>Background</h3><div>Although limited trials have demonstrated the feasibility of rectal-preserving approaches in clinical T1-3N0 adenocarcinoma, local excision after neoadjuvant therapy has been associated with high rates of morbidity. We hypothesized that this strategy would be comparable to the standard, total mesorectal excision. The aim of this study was to describe trends of early-stage rectal cancer management.</div></div><div><h3>Methods</h3><div>cT1-3N0 rectal cancers in the National Cancer Database (2006–2018) were grouped into 5 treatments: total mesorectal excision, total neoadjuvant therapy + local excision, neoadjuvant chemoradiotherapy + local excision, total neoadjuvant therapy + total mesorectal excision, and neoadjuvant chemoradiotherapy + total mesorectal excision. Morbidity was defined as a combination of readmissions and 30- and 90-day mortality.</div></div><div><h3>Results</h3><div>We identified 22,793 patients. Neoadjuvant chemoradiotherapy + local excision had the highest proportion of patients ≥70 years (41%) and those with comorbidities (Charlson-Deyo score ≥2, 9%). Median stay was 1 day for local excision and 5 days for total mesorectal excision. Overall composite morbidity was 9%, which, after adjustment, was not statistically different between local excision and total mesorectal excision (odds ratio = 0.45, 95% confidence interval: 0.17–1.19). Among local excision patients, 56% had pathologic complete response, 33% were pStage I, and 12% pStage II-III. In multivariable analysis, all strategies had similar overall survival compared with total mesorectal excision, except for neoadjuvant chemoradiotherapy + local excision, which was associated with worse prognosis (hazard ratio = 1.57, 95% confidence interval: 1.21–2.03).</div></div><div><h3>Conclusion</h3><div>Although infrequent, neoadjuvant chemoradiotherapy/total neoadjuvant therapy + local excision were associated with high rates of tumor downstaging, suggesting that rectal-preserving strategies are feasible. However, 1 in 8 patients had more advanced disease, which may have compromised future total mesorectal excision planes. Together with the similar morbidity and relatively worse prognosis of neoadjuvant chemoradiotherapy + local excision, these observations should prompt careful patient selection for this approach, while cautioning against its widespread use.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109374"},"PeriodicalIF":3.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881402","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":"Cover 1(with editorial board)","authors":"","doi":"10.1016/S0039-6060(25)00211-9","DOIUrl":"10.1016/S0039-6060(25)00211-9","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109359"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870802","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)00213-2","DOIUrl":"10.1016/S0039-6060(25)00213-2","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109361"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870803","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":"Editors' note","authors":"Caitlin W. Hicks MD, MS, FACS, FAHA, DFSVS,&nbsp;Steven D. Wexner MD, PhD","doi":"10.1016/j.surg.2025.109356","DOIUrl":"10.1016/j.surg.2025.109356","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109356"},"PeriodicalIF":3.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870805","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":"Association of psychosocial risk factors with acute outcomes of elective cancer resection in the United States","authors":"Konmal Ali,&nbsp;Amulya Vadlakonda BS,&nbsp;Sara Sakowitz MPH, MS,&nbsp;Adedunmola P. Adewale BS,&nbsp;Syed Shaheer Ali,&nbsp;Melissa Justo MD,&nbsp;Ayesha Ng MPH,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.109354","DOIUrl":"10.1016/j.surg.2025.109354","url":null,"abstract":"<div><h3>Background</h3><div>Psychosocial risk factors, including psychiatric disorders, substance use, limited cognitive comprehension, and low socioeconomic or uninsured status, are increasingly recognized in cancer care. However, their independent effects on acute postoperative outcomes after elective cancer surgery remain unclear. This study evaluates the association between psychosocial risk factors and clinical and financial outcomes in patients undergoing cancer resections.</div></div><div><h3>Methods</h3><div>All adult (≥18 years) records entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, and colon cancer were tabulated from the 2016–2021 Nationwide Readmissions Database. After entropy balancing, multivariable regression models were developed to ascertain the independent association of psychosocial risk factors. with mortality, complications, length of stay, and nonhome discharge.</div></div><div><h3>Results</h3><div>Of ∼655,376 patients, 223,035 (34.2%) were considered to comprise psychosocial risk factors. Relative to others, the psychosocial risk factors cohort was more commonly female (51.9 vs 47.1%, <em>P</em> &lt; .001), and had a greater Elixhauser Comorbidity Index (4 [3–5] vs 3 [2–4], <em>P</em> &lt; .001). Both groups most frequently underwent resection for colectomy (51.9% vs 51.1%%, <em>P</em> &lt; .001), yet those with psychosocial risk factors had greater rates of lobectomy (27.8% vs 25.8%, <em>P</em> &lt; .001), compared with their counterparts. After entropy balancing, psychosocial risk factors were linked to greater odds of mortality (adjusted odds ratio, 1.43, 95% confidence interval, 1.31–1.57), respiratory (adjusted odds ratio, 1.25; 95% confidence interval, 1.21–1.31) and infectious (adjusted odds ratio, 1.17; 95% confidence interval, 1.12–1.21) complications. Furthermore, patients with psychosocial risk factors faced incrementally increased resource use.</div></div><div><h3>Conclusion</h3><div>Psychosocial risk factors independently predict adverse clinical and financial outcomes after elective cancer operations. Systematic screening for psychosocial risk factors may facilitate targeted interventions to improve care for high-risk patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109354"},"PeriodicalIF":3.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864139","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":"Isolated surgical valve replacement for tricuspid regurgitation: An international multicenter study","authors":"Massimo Baudo MD ,&nbsp;Besart Cuko MD ,&nbsp;Julien Ternacle MD ,&nbsp;Elena Magrini MS ,&nbsp;Olivier Busuttil MD ,&nbsp;Nabil Dib MD ,&nbsp;Serge Sicouri MD ,&nbsp;Louis Labrousse MD, PhD ,&nbsp;Thomas Modine MD, PhD ,&nbsp;Basel Ramlawi MD","doi":"10.1016/j.surg.2025.109370","DOIUrl":"10.1016/j.surg.2025.109370","url":null,"abstract":"<div><h3>Background</h3><div>Although the management of tricuspid regurgitation during mitral surgery is standardized, the approach to patients with isolated tricuspid regurgitation is less clearly defined. This study examined the surgical outcomes of patients who underwent isolated surgical tricuspid valve replacement at 2 medical centers, providing insights into the postoperative and midterm outcomes.</div></div><div><h3>Methods</h3><div>This retrospective observational study analyzed data from 2 tertiary cardiac surgery centers. All patients underwent isolated surgical tricuspid valve replacement between 2010 and 2023. The primary end point included 30-day and midterm survival. The secondary end points included postoperative and valve-related complications.</div></div><div><h3>Results</h3><div>A total of 64 patients were included. The mean age was 58 ± 17 years, and 51.6% (33/64) were male patients. The median European System for Cardiac Operative Risk Evaluation II, TRISCORE, and Model for End-Stage Liver Disease scores were 2.16 [1.38–3.42], 3.00 [1.00–4.00], and 10.50 [9.00–16.25], respectively. More than 60% of the procedures were conducted on a beating heart. Thirty-day mortality was 7.8%. European System for Cardiac Operative Risk Evaluation II underestimated mortality, whereas the Model for End-Stage Liver Disease score was a more reliable predictor. Ten patients finally received a permanent pacemaker upon discharge. The overall survival rates at 1 and 6 years were 88.8 ± 4.0% and 80.3 ± 7.3%, respectively. Freedom from tricuspid valve reintervention rates at 1 and 6 years were 96.2 ± 2.6% and 75.0 ± 9.6%, respectively.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that isolated surgical tricuspid valve replacement can be undertaken without exposing patients to an excessively high mortality risk. Risk assessment using specific scores may be useful in this regard. Nevertheless, these patients are at risk of postoperative complications, particularly permanent pacemaker implantation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109370"},"PeriodicalIF":3.2,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860451","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 smallest suffer stroke: Understanding stroke and treatment patterns in children with blunt cerebrovascular injury within the Trauma Quality Improvement Program database","authors":"Catherine C. Dawson-Gore MD, MSc ,&nbsp;Emily K. Myers MD ,&nbsp;Emily H. Cooper MS ,&nbsp;Lauren L. Evans MD ,&nbsp;Steven G. Schauer DO ,&nbsp;Shannon Acker MD","doi":"10.1016/j.surg.2025.109353","DOIUrl":"10.1016/j.surg.2025.109353","url":null,"abstract":"<div><h3>Background</h3><div>Stroke rate and treatment patterns for children with blunt cerebrovascular injury are not well-described. There exists a gap in knowledge of how children with blunt cerebrovascular injury are treated, the stroke rate associated with antithrombotic therapy, and the optimal time to start treatment.</div></div><div><h3>Methods</h3><div>A retrospective review of the Trauma Quality Improvement Program database was conducted from 2016 to 2022 for children with blunt injury (&lt;18 years) with blunt cerebrovascular injury. Analysis of all children with blunt cerebrovascular injury and subgroups of children without traumatic brain injury, as well as those without contraindications to antithrombotic therapy (no traumatic brain injury, solid-organ injury, or blood transfusion within 24 hours) was performed. Stroke rate and treatment patterns were compared between age groups (0–6, 7–11, 12–14, 15–17 years) and injury grades.</div></div><div><h3>Results</h3><div>Among 685,631 blunt injured children, 2,336 incurred blunt cerebrovascular injury (0.34%). Stroke rate was greatest in the youngest patients (6.2% 0–6 years; 2.0% 7–11 years) who had the lowest rates of antithrombotic therapy. Fifty-two percent of patients received no antithrombotic therapy during their hospitalization. Children who received antithrombotic therapy had greater rates of stroke compared with those untreated (6.1% vs 2.1%, <em>P</em> &lt; .001) regardless of age group. Low-molecular weight heparin was the most common antithrombotic therapy (28.2%) followed by heparin (14.2%), and aspirin (5.1%).</div></div><div><h3>Conclusion</h3><div>Children aged 0–11 years had the greatest rates of stroke and were least likely to receive antithrombotic therapy. More than one half of children did not receive antithrombotic therapy. Patients who received antithrombotic therapy had greater stroke rates than untreated patients, which may reflect antithrombotic therapy given after stroke occurred. Treatment guidelines are needed for children with blunt cerebrovascular injury.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"183 ","pages":"Article 109353"},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855097","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}