Surgery最新文献

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109799","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109799","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109799"},"PeriodicalIF":2.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309210","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":"Multimodal prehabilitation in gastrointestinal surgery: Key risk factors for patient outcomes.","authors":"Braxton Goodnight, Jennifer Cook, Melanie Koenen, Christina Kasting, Dominic Sanford","doi":"10.1016/j.surg.2025.109777","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109777","url":null,"abstract":"<p><strong>Background: </strong>Surgical preconditioning initiatives, such as the Surgical Prehabilitation and Readiness program, have been shown to improve postoperative outcomes in older, high-risk patients. However, it remains unclear which patient subpopulations may experience reduced benefit with prehabilitation.</p><p><strong>Methods: </strong>Over 39 months, Surgical Prehabilitation and Readiness enrolled high-risk patients undergoing gastrointestinal surgery. The program addresses 4 domains: physical activity, pulmonary function, nutrition, and mindfulness. Multivariable analysis was used to identify independent predictors of nonideal outcome, defined as discharge to a facility, readmission within 30 days, or death within 30 days. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator was used to compare the observed-to-expected rates of 30-day mortality, 30-day readmission, and nonhome discharge to investigate drivers of nonideal outcome.</p><p><strong>Results: </strong>Surgical Prehabilitation and Readiness enrolled 300 participants who underwent gastrointestinal surgery. Compared with expected outcomes, participants demonstrated lower rates of 30-day mortality (observed-to-expected rate: 0.32), 30-day readmission (observed-to-expected rate: 0.93), and nonhome discharge (observed-to-expected rate: 0.61). Despite these improvements, 60 patients (20%) experienced nonideal outcomes. These patients were significantly more likely to have baseline dyspnea (46.7% vs 28.3%), congestive heart failure (16.7% vs 7.9%), and open surgical approach (81.7% vs 62.1%). Multivariable analysis, adjusted for surgery type and approach, identified dyspnea (adjusted odds ratio: 2.48, P < .05) and disseminated cancer (odds ratio: 3.41, P < .05) as independent risk factors for nonideal outcomes. Patients with dyspnea had higher 30-day readmission rates (observed-to-expected rate: 1.16), primarily driving nonideal outcomes in this subgroup.</p><p><strong>Conclusion: </strong>Patients with dyspnea have a potentially modifiable risk factor that may not be adequately addressed by prehabilitation interventions, contributing to higher readmission rates.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109777"},"PeriodicalIF":2.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303398","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":"Surgery or no surgery for pediatric uncomplicated appendicitis? A systematic review and meta-analysis to inform management.","authors":"Alyssa Stetson, Claudia Orlas, Raissa Li, Gabriella Smith, Cornelia L Griggs, David Chang, Cassandra M Kelleher, Peter T Masiakos","doi":"10.1016/j.surg.2025.109728","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109728","url":null,"abstract":"<p><strong>Background: </strong>Several studies have advocated for nonoperative management of uncomplicated acute appendicitis, given its favorable safety profile. However, the paucity of data regarding the long-term failure rates of nonoperative management imposes limitations on shared clinical decision-making with patients and families.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis comparing operative and nonoperative management of acute uncomplicated appendicitis in children (PROSPERO CRD42021270347). Single- or double-arm studies published in MEDLINE and EMBASE between 2000 and 2024 were included. Our primary outcome was nonoperative management failure rate at 1 year, defined as patients who returned with recurrent appendicitis, need for exploratory surgery for abdominal pain, or elective interval appendectomy. Secondary outcomes were rates of 30-day emergency department visits and 1-year readmissions.</p><p><strong>Results: </strong>Initial search yielded 2,249 articles, of which 48 articles were included. One-year mean failure rate was 22.3% (95% confidence interval, 21.7-23.0%), and beyond 1 year was 54.2% (95% confidence interval, 41.4-67.0%). Patients who underwent nonoperative management were more likely to visit the emergency department within 30 days and be readmitted within 1 year compared with those who underwent surgery.</p><p><strong>Conclusion: </strong>Our findings demonstrate a 1-year nonoperative management failure rate of more than 20% and more than 50% beyond 1 year. Patients undergoing nonoperative management returned to the emergency department and required readmission more frequently than patients whose acute uncomplicated appendicitis was treated operatively.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"109728"},"PeriodicalIF":2.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303462","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":"Postoperative infectious complications in gastric and colorectal cancer patients: A multicenter prospective cohort study from China.","authors":"Su Yan, Ziyu Li, Shuqin Zhang, Zhouqiao Wu","doi":"10.1016/j.surg.2025.109780","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109780","url":null,"abstract":"<p><strong>Background: </strong>Postoperative infectious complications are prevalent and associated with increased health care costs, prolonged hospitalization, and reduced quality of life. However, data characterizing these complications in patients with gastric and colorectal cancer remain limited. We used a multicenter database to evaluate infectious complications.</p><p><strong>Methods: </strong>This study was conducted using data from the Prevalence of Abdominal Complications After GastroEnterological surgery (PACAGE) registry. The study included cases from December 2018 to December 2020. The Clavien-Dindo grading system was used to categorize infectious complications based on severity, and the analysis was further refined by anatomic site. A generalized linear mixed-effects model was employed to identify infectious risk factors, with adjustment for multicenter hierarchical clustering effects.</p><p><strong>Results: </strong>Among 3,926 gastric and colorectal cancer surgeries, postoperative infectious complications occurred in 11.8% (462 of 3,926), with 2.2% (88 of 3,926) major infections. Intra-abdominal infections predominated (7.6%; 50.4% of all infections). Median hospitalization costs and postoperative stays increased with severity: $9,842.9 (interquartile range: $8,128.9-$12,415.5) and 8.0 days (7.0-10.0) for no complications; $13,298.0 ($10,574.7-$16,846.7) and 14.0 days (10.0-20.5) for minor infections; and $19,812.7 ($14,454.1-$27,374.6) and 25.0 days (19.0-37.8) for major infections. Major surgical incision infections incurred the highest incremental costs ($13,685.5, interquartile range: $5,676.5-22,610.8) and longest incremental postoperative stays (31.0 days, 13.0-52.0). Independent infectious risk factors included comorbidities, prolonged operative time, combine resection, intraoperative complications, and R1 resection margins.</p><p><strong>Conclusion: </strong>Major postoperative infections result in a 2-fold increase in hospitalization costs and a 3-fold prolongation of postoperative hospital stay. Intra-abdominal infections should be prioritized as a strategic focus for targeted prevention and control.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109780"},"PeriodicalIF":2.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293801","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 social vulnerability with a risk of readmission following cardiac surgery in a statewide collaborative.","authors":"Sidney Hinks, Esteban Aguayo, Sara Sakowitz, Nancy Satou, Richard J Shemin, Peyman Benharash","doi":"10.1016/j.surg.2025.109786","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109786","url":null,"abstract":"<p><strong>Background: </strong>The impact of neighborhood-level socioeconomic vulnerability remains to be elucidated within cardiac surgery. Using a multi-institutional database from a statewide collaborative, we analyzed the association of greater social vulnerability with 30-day readmission.</p><p><strong>Methods: </strong>The 2018-2023 University of California Cardiac Surgery Consortium database was queried to identify all adult patients (≥18 years) undergoing coronary artery bypass grafting and/or valve procedures. The Haversine formula was applied to compute the distance between patient residence and operating hospital. Structural vulnerability was assessed using the well-validated social vulnerability index. This index was stratified into quartiles, with least vulnerable and most vulnerable groups compared in a pairwise approach. Kaplan-Meier time-to-event analyses and Cox proportional hazard models were used to assess readmission within 30 days.</p><p><strong>Results: </strong>Among 5,704 patients, 680 (12.0%) were most vulnerable and 1,172 (31.2%) were least vulnerable. On average, when compared with least vulnerable patients, most vulnerable patients were similar in age, more often of female sex (33.0 vs 26.8%, P = .001), and Hispanic (39.0 vs 19.4%, P < .001). In addition, such patients traveled greater distances to the index hospital (87.2 ± 326.1 vs 113.7 ± 141.6 km, P < .001). After multivariable adjustment, most vulnerable patients were significantly associated with an increased odds of 30-day readmission (adjusted odds ratio: 1.5, 95% confidence interval: 1.0-2.1) and nonhome discharge (adjusted odds ratio: 1.4, 95% confidence interval: 1.0-2.0).</p><p><strong>Conclusion: </strong>A high social vulnerability index appears to be associated with inferior outcomes after cardiac surgery. The incorporation of social vulnerability index into risk stratification may improve perioperative outcomes.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"109786"},"PeriodicalIF":2.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293764","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":"Exploring the role of CA 19-9 dynamics in pancreatic cancer multidisciplinary treatment: Proposal of the PANC classification","authors":"Aya Maekawa MD, PhD ,&nbsp;Atsushi Oba MD, PhD ,&nbsp;Takafumi Mie MD ,&nbsp;Yui Sawa MD ,&nbsp;Hayato Baba MD, PhD ,&nbsp;Kosuke Kobayashi MD, PhD ,&nbsp;Yoshihiro Ono MD, PhD ,&nbsp;Takafumi Sato MD, PhD ,&nbsp;Hiromichi Ito MD, FACS ,&nbsp;Takashi Sasaki MD, PhD ,&nbsp;Masato Ozaka MD ,&nbsp;Naoki Sasahira MD, PhD ,&nbsp;Manabu Takamatsu MD, PhD ,&nbsp;Daisuke Ban MD, PhD ,&nbsp;Yosuke Inoue MD, PhD ,&nbsp;Yu Takahashi MD, PhD","doi":"10.1016/j.surg.2025.109783","DOIUrl":"10.1016/j.surg.2025.109783","url":null,"abstract":"<div><h3>Background</h3><div>Advancements in multiagent chemotherapy have transformed the management of pancreatic cancer as a systemic disease, with surgery playing a crucial role in determining prognosis. Serum carbohydrate antigen 19-9 remains the most critical biomarker for assessing treatment response and guiding clinical decisions. This study aimed to evaluate carbohydrate antigen 19-9 dynamics around chemotherapy and surgery to optimize treatment strategies and improve patient outcomes.</div></div><div><h3>Method</h3><div>We retrospectively analyzed pancreatic cancer patients who received preoperative chemotherapy followed by radical resection. Based on carbohydrate antigen 19-9 response patterns before and after chemotherapy, as well as after surgery, we established the PANC classification and assessed its prognostic significance.</div></div><div><h3>Results</h3><div>Among 283 patients, the median overall survival was 56.3 months, and recurrence-free survival was 26.0 months. The PANC classification categorized patients as follows: type 1 (Preoperative normalization), 148 patients (52.3%), type 2 (After-surgery normalization), 103 patients (36.4%), type 3 (Non-normalized Decline), 12 patients (4.2%), and type 4 (Complex dynamics), 20 patients (7.1%). Type 1 and 2 responses were associated with favorable overall survival (61.1 and 57.8 months) and recurrence-free survival (35.0 and 25.6 months), whereas type 3 and 4 responses were associated with poorer outcomes. A multivariate Cox proportional hazard model identified types 1 and 2 (versus types 3 and 4) as independent prognostic factors (hazard ratio = 3.20; 95% confidence interval, 1.99–5.16; <em>P</em> &lt; .001) along with other important factors.</div></div><div><h3>Conclusions</h3><div>The PANC classification provides a practical framework for categorizing carbohydrate antigen 19-9 dynamics. It can be easily aligned with diverse treatment strategies across various institutions and regions, ultimately improving patient outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109783"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269033","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":"Reviving Greek surgery: Toward competency, innovation, and global integration","authors":"Dimitrios Moris MD, MSc, PHD ,&nbsp;Nikolaos Dimitrokallis MD ,&nbsp;Emmanouil Giorgakis MD","doi":"10.1016/j.surg.2025.109768","DOIUrl":"10.1016/j.surg.2025.109768","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109768"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269036","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":"Modernizing surgical education in Greece: Bridging the gap to global standards","authors":"Dimitrios Moris MD, MSc, PhD ,&nbsp;Nikolaos Dimitrokallis MD ,&nbsp;Emmanouil Giorgakis MD","doi":"10.1016/j.surg.2025.109781","DOIUrl":"10.1016/j.surg.2025.109781","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109781"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269034","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":"Dedicated review of sarcoma pathology is necessary for corroborative diagnosis in nearly one half of referred patients","authors":"Mark A. Eckardt MD ,&nbsp;Nicholas M. Siena MD ,&nbsp;Amy R. Copeland MD ,&nbsp;Tyler R. McCaw MD, PhD ,&nbsp;Michael S. Shehata BS ,&nbsp;Serena Y. Lofftus MD ,&nbsp;Danielle S. Graham MD, PhD ,&nbsp;Hy B. Dao BS ,&nbsp;Arun S. Singh MD ,&nbsp;Bartosz Chmielowski MD, PhD ,&nbsp;Noah Federman MD ,&nbsp;Brian E. Kadera MD ,&nbsp;Anusha Kalbasi MD ,&nbsp;Nicholas M. Bernthal MD ,&nbsp;Fredrick R. Eilber MD ,&nbsp;Sarah M. Dry MD ,&nbsp;Scott D. Nelson MD, PhD ,&nbsp;Fritz C. Eilber MD ,&nbsp;Joseph G. Crompton MD, PhD","doi":"10.1016/j.surg.2025.109610","DOIUrl":"10.1016/j.surg.2025.109610","url":null,"abstract":"<div><h3>Background</h3><div>Specialized centers have been shown to improve survival and functional outcomes in patients with sarcoma. The objective of this study was to determine the rate and clinical impact of changes in pathologic diagnosis between high- and low-volume sarcoma centers.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of patients discussed at UCLA Multidisciplinary Sarcoma Conference over 1 year. Patients with a pathology report from an outside facility and subsequent formal UCLA pathology review were included. Of 1,350 cases and 877 unique patients presented, 196 patients were identified for analysis. The primary outcome was to assess concordance between pathologic diagnosis at high- and low-volume sarcoma centers. Concordance was defined as either full concordance, minor discordance, or major discordance between the original diagnosis and review by a sarcoma pathology specialist.</div></div><div><h3>Results</h3><div>Of the 196 patients who were included in this study, 44% had full concordance on review of their pathology, 12% had minor discordance, and 44% had major discordance. Major discordance included benign/malignant mismatch (<em>n</em> = 23/87, 26%), discrepancy in histologic subtype (<em>n</em> = 25/87, 29%), change from nondiagnostic to diagnostic (<em>n</em> = 34/87, 39%) and major grading discrepancy (<em>n</em> = 5/87, 6%). After excluding other high-volume centers (<em>n</em> = 18), the major discordance rate increased to 48% (n = 85/178).</div></div><div><h3>Conclusion</h3><div>Nearly one half (44%) of patients had a major change to their diagnosis that would affect prognosis or treatment plan after referral to a high-volume sarcoma center. A coordinated system for pathologic re-review for all potential sarcoma diagnoses could facilitate optimal management of patients with these rare malignancies.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109610"},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269035","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":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109774","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109774","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109774"},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275904","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}