Surgery最新文献

{"title":"Predicting biochemical hypothyroidism after thyroid lobectomy using ultrasound elastography.","authors":"Wei-Che Chen, Chung-Hsin Tsai, Yi-Shing Leu, Chi-Yu Kuo, Shih-Ping Cheng","doi":"10.1016/j.surg.2026.110530","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110530","url":null,"abstract":"<p><strong>Background: </strong>Predicting hypothyroidism after thyroid lobectomy is important for treatment selection, patient counseling, and postoperative management. Although thyroiditis is a recognized risk factor, the predictive value of ultrasound strain elastography remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study based on prospectively collected elastography data from consecutive adults undergoing thyroid lobectomy between January 2023 and December 2024. Biochemical hypothyroidism was defined as an elevated thyroid-stimulating hormone level at the final assessment within 1 year after surgery or before initiation of levothyroxine therapy. Multivariable logistic regression, restricted cubic spline analysis, and 3 machine learning models were used to identify predictors of postoperative hypothyroidism.</p><p><strong>Results: </strong>Among the 269 patients included, 86 (32%) developed biochemical hypothyroidism. In multivariable logistic regression, preoperative thyroid-stimulating hormone level and thyroid parenchymal strain ratio were independent predictors of postoperative hypothyroidism (both P < .001). Restricted cubic spline analysis demonstrated a positive nonlinear association between strain ratio and predicted risk without an apparent threshold. Across all machine learning models, preoperative thyroid-stimulating hormone level and strain ratio consistently ranked as the 2 most influential predictors based on SHapley Additive exPlanations. The elastic net model achieved the highest discrimination (area under the receiver operating characteristic curve, 0.800), whereas the random forest model demonstrated the best calibration.</p><p><strong>Conclusion: </strong>Thyroid parenchymal strain ratio measured by ultrasound elastography and preoperative thyroid-stimulating hormone level are independent predictors of biochemical hypothyroidism after thyroid lobectomy. Incorporating quantitative assessment of thyroid stiffness into preoperative risk stratification may provide incremental predictive value beyond conventional clinicopathologic factors and facilitate individualized surgical counseling, treatment selection, and postoperative surveillance.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110530"},"PeriodicalIF":3.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888425","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":"Perioperative immunocircadian recovery and its association with circulating tumor DNA-based minimal residual disease and long-term survival after colorectal cancer surgery.","authors":"Shengjie Pan, Gang Wang","doi":"10.1016/j.surg.2026.110539","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110539","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative outcomes after curative colorectal cancer surgery vary widely, even among patients with comparable tumor characteristics and treatment pathways. Conventional clinicopathologic factors and circulating tumor DNA predominantly characterize tumor-related risk but provide limited information regarding the dynamic host response to surgical stress. We investigated whether distinct perioperative immunocircadian recovery trajectories could be identified and whether these trajectories were associated with postoperative circulating tumor DNA-based minimal residual disease and long-term oncologic outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective observational cohort study included 1,000 patients with stage II-III colorectal cancer who underwent curative-intent resection between June 2017 and December 2019 and were scheduled for oncologic follow-up through 60 months. Perioperative immunocircadian recovery phenotypes were derived by integrating longitudinal wearable-based sleep, rest-activity rhythm, and heart-rate measures with serial inflammatory and immune markers collected from the preoperative period through postoperative day 30. Associations with postoperative circulating tumor DNA-minimal residual disease positivity were assessed using multivariable logistic regression, whereas associations with disease-free survival and overall survival were assessed using multivariable Cox regression and a postoperative day 30 landmark analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three distinct recovery phenotypes were identified: rapid recovery (382/1,000; 38.2%), intermediate recovery (401/1,000; 40.1%), and delayed immunocircadian recovery (217/1,000; 21.7%). Postoperative circulating tumor DNA-minimal residual disease positivity increased from 8.9% (34/382) in the rapid-recovery group to 17.0% (68/401) in the intermediate-recovery group and 30.0% (65/217) in the delayed-recovery group. Compared with rapid recovery, delayed recovery was associated with greater odds of postoperative circulating tumor DNA-minimal residual disease positivity (adjusted odds ratio, 3.94; 95% confidence interval, 2.45-6.33). At 60 months, estimated disease-free survival was 82.1%, 76.4%, and 63.8%, respectively, and estimated overall survival was 90.0%, 86.9%, and 77.2%, respectively. In models adjusted for clinicopathologic factors but not circulating tumor DNA-minimal residual disease, delayed recovery was associated with worse disease-free survival (adjusted hazard ratio, 2.21; 95% confidence interval, 1.64-2.98) and overall survival (adjusted hazard ratio, 2.03; 95% confidence interval, 1.45-2.85). After additional adjustment for postoperative circulating tumor DNA-minimal residual disease, the corresponding adjusted HRs were 1.90 (95% confidence interval, 1.40-2.57) and 1.80 (95% confidence interval, 1.28-2.53), respectively. Addition of the recovery phenotype to a clinicopathologic model that included circulating tumor DNA-minimal","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110539"},"PeriodicalIF":3.2,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892127","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":"Invited commentary on \"Economic reporting and conflicts of interest in randomized trials comparing robot assisted with laparoscopic colorectal surgery: A meta-epidemiological systematic review\".","authors":"Sameh Hany Emile","doi":"10.1016/j.surg.2026.110529","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110529","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110529"},"PeriodicalIF":3.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888417","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":"All physicians lead: The importance of integrating leadership as a core clinical competency across the profession of medicine.","authors":"Leon E Moores","doi":"10.1016/j.surg.2026.110527","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110527","url":null,"abstract":"<p><strong>Background: </strong>Leadership can be succinctly defined as influencing behavior to achieve desired results. Physicians influence the behavior of patients, team members, and colleagues many times each day to achieve desired outcomes, yet leadership is rarely framed or taught as a core clinical competency. In practice, physicians routinely lead patients through complex decisions, guide interprofessional teams, support families during times of uncertainty, and model professional behavior for trainees.</p><p><strong>Methods: </strong>This article reframes physician leadership as an essential function of clinical care and presents a practical, longitudinal framework for leadership development across the medical profession. A concentric circles model describes leadership growth across four interdependent domains: leading self, leading another, leading teams, and leading organizations. Complementing this individual framework, four institutional lines of effort are proposed: developing interest, providing foundational education, refining leadership through apprenticeship, mentorship, and coaching, and building a pipeline of future leaders.</p><p><strong>Results: </strong>The proposed framework provides a scalable approach for embedding leadership development across medical education, clinical practice, and health care systems. Recognizing leadership as a core clinical competency aligns with existing accreditation standards and creates a unifying framework for strengthening communication, professionalism, teamwork, and systems-based practice. The model also links individual leadership development with institutional strategies that can support progressive growth across the continuum of a physician's career.</p><p><strong>Conclusion: </strong>Leadership is an essential component of everyday clinical practice rather than a competency reserved for physicians in formal administrative roles. It is a fact that all physicians are leading every day; the question is whether we recognize it and train for it. Integrating structured leadership development throughout medical training and professional practice represents a meaningful opportunity to strengthen physician effectiveness, enhance team performance, and improve patient outcomes.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110527"},"PeriodicalIF":3.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888477","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":"Direct lymphangiography-guided cervical thoracic duct exploration for isolated primary chylopericardium: Abnormal reflux patterns and long-term outcomes.","authors":"Jianfeng Xin, Chao Dong, Song Xia, Yuguang Sun, Kun Chang, Ke Xu, Wenxiang Jiang, Peilin Li, Wenbin Shen","doi":"10.1016/j.surg.2026.110520","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110520","url":null,"abstract":"<p><strong>Background: </strong>Primary chylopericardium is a rare lymphatic disorder with poorly defined pathophysiology and limited treatment options. This study aimed to characterize lymphangiographic reflux patterns and evaluate the long-term outcomes and predictors of success of direct lymphangiography-guided cervical thoracic duct exploration.</p><p><strong>Methods: </strong>We retrospectively reviewed 67 patients with isolated primary chylopericardium who underwent direct lymphangiography between June 2007 and December 2020. A novel 4-type classification of abnormal reflux pathways was proposed based on direct lymphangiography findings. Treatment success was defined as resolution or marked reduction of pericardial effusion, relief of symptoms, and no need for reintervention. Median follow-up was 10.2 years (range, 7.5-19.5 years). Multivariable logistic regression was performed to identify independent predictors of success.</p><p><strong>Results: </strong>Direct lymphangiography demonstrated distinct reflux patterns: type I (bronchomediastinal trunk, 55.2%), type II (thoracic segment, 11.9%), type III (combined, 7.5%), and type IV (no identifiable pathway, 28.4%). Compensatory drainage was present in 25.4% of patients. Among 65 patients who underwent cervical thoracic duct exploration, the clinical success rate was 66.2% (43/65), with no major complications. Multivariable analysis showed that the absence of compensatory drainage pathways was the strongest independent predictor of success (adjusted odds ratio, 7.85; 95% confidence interval, 1.48-41.6; P = .016). Reflux pathway type was also independently associated with outcome (P = .012), with type I demonstrating better results than types II-IV. Conservative dietary management alone was ineffective in the 2 patients who did not undergo surgery.</p><p><strong>Conclusion: </strong>Direct lymphangiography-guided cervical thoracic duct exploration is associated with favorable long-term outcomes in selected patients with primary chylopericardium. The proposed reflux classification and the absence of compensatory drainage pathways were strong predictors of success. These findings are preliminary and require prospective multicenter validation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110520"},"PeriodicalIF":3.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857691","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 evaluation of the Cystic Echinococcosis Complication Score for preoperative risk stratification and surgical planning in hepatic cystic echinococcosis: A retrospective derivation and comparative cohort study.","authors":"D S Sapaev, F R Yakubov, D S Khodjiev, H N Bekchanov, S K Yigitaliev, A U Sharipova, K K Khayitboeva, N O Matkurbonov","doi":"10.1016/j.surg.2026.110491","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110491","url":null,"abstract":"<p><strong>Background: </strong>Surgical management of hepatic cystic echinococcosis is frequently associated with substantial postoperative morbidity. The absence of a validated, disease-specific risk stratification tool hinders optimal patient referral, surgical planning, and perioperative resource allocation. This study evaluates the clinical utility of the Cystic Echinococcosis Complication Score for preoperative risk assessment and its association with postoperative outcomes.</p><p><strong>Methods: </strong>The Cystic Echinococcosis Complication Score was derived from a retrospective cohort of 746 patients who underwent echinococcectomy between January 2015 and December 2020. Multivariable logistic regression identified 12 independent predictors of postoperative complications, which were weighted to construct the Cystic Echinococcosis Complication Score. To evaluate its clinical impact, we conducted a retrospective comparative analysis of 2 sequential cohorts: a historical control group managed without formal risk stratification (n = 106, January 2018-December 2020) and a Cystic Echinococcosis Complication Score-guided group where preoperative assessment and surgical planning were systematically informed by the score (n = 110, January 2021-December 2023). Primary outcomes included the incidence and severity of postoperative complications (Clavien-Dindo classification) and preoperative tactical modifications.</p><p><strong>Results: </strong>Implementation of Cystic Echinococcosis Complication Score-guided risk stratification was associated with a significant reduction in overall postoperative complications (12.7% vs 31.1%; χ² = 10.741; P = .001) and a decrease in clinically significant complications (Clavien-Dindo III-V: 0.9% vs 5.7%; P = .031). Preoperative management was modified in 29 patients (26.4%) in the Cystic Echinococcosis Complication Score cohort, including referral to higher-level centers (n = 11), involvement of senior surgeons (n = 14), and short-course preoperative optimization (n = 4). Median hospital stay was shorter in the Cystic Echinococcosis Complication Score group (6.2 vs 7.5 days; P = .0002).</p><p><strong>Conclusion: </strong>The Cystic Echinococcosis Complication Score is a feasible, clinically applicable tool for preoperative risk stratification in hepatic cystic echinococcosis. Its systematic use was associated with improved perioperative decision-making and a lower burden of postoperative complications. Given the historical control design, causal inference is limited, and observed improvements may also reflect evolving institutional expertise. Prospective, multicenter external validation is warranted to confirm the score's generalizability and predictive performance.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110491"},"PeriodicalIF":3.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881677","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":"Economic reporting and conflicts of interest in randomized trials comparing robot-assisted with laparoscopic colorectal surgery: A metaepidemiological systematic review.","authors":"Sang-Ji Choi, Gibong Chae","doi":"10.1016/j.surg.2026.110509","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110509","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted colorectal surgery carries a substantial cost premium, yet how consistently randomized trials of these platforms report economic outcomes-and whether reporting relates to industry funding or conflicts of interest-is unclear.</p><p><strong>Methods: </strong>We conducted a metaepidemiological systematic review (PROSPERO: CRD420261411610), searching PubMed, Embase, and Cochrane CENTRAL for randomized controlled trials comparing robot-assisted with conventional laparoscopic colorectal surgery. Reports were classified by cost-reporting tier (tier 1, none; tier 2, cost data without a formal economic evaluation; and tier 3, formal economic evaluation with an incremental cost-effectiveness ratio or quality-adjusted life-years); registries and protocols were checked for prespecified economic outcomes. The trial was the primary unit; proportions were estimated with exact 95% confidence intervals, and funding-reporting relationships were described.</p><p><strong>Results: </strong>Twenty-three reports of 15 trials were included. Any cost data were reported by 7 of 15 trials (46.7%; 95% confidence interval, 21.3-73.4) and a formal economic evaluation by 2 of 15 (13.3%); neither cited the Consolidated Health Economic Evaluation Reporting Standards. Four trials had a registered or protocol-documented economic outcome (2 reported, 2 deferred); most reporting no cost had not planned one. Robotic surgery was costlier in every trial reporting cost, although the scope and evidentiary strength of these comparisons varied substantially; the 2 formal evaluations reached opposite conclusions. Two trials were manufacturer funded, and 4 trials had author conflicts of interest; associations were too imprecise for inference.</p><p><strong>Conclusion: </strong>Within these platform trials, economic outcomes were reported inconsistently. When an economic evaluation is intended, prespecifying a cost outcome and following a standard such as Consolidated Health Economic Evaluation Reporting Standards would improve its usefulness for decision-makers.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110509"},"PeriodicalIF":3.2,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819468","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":"Surgical palliative care: A 5-hour resident curriculum to improve attitudes, knowledge, and behaviors.","authors":"Shruti Koti, Rachel Harvey, Lyudmyla Demyan, Mark Butler, Gary Deutsch, Danielle DePeralta, Sophia Tam","doi":"10.1016/j.surg.2026.110501","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110501","url":null,"abstract":"<p><strong>Background: </strong>Palliative care skills are essential in surgical practice, but time constraints and lack of faculty expertise are barriers to implementing palliative care education in surgical training. This study describes and assesses a 5-hour palliative care curriculum designed to fit within demanding residency programs.</p><p><strong>Methods: </strong>The palliative care curriculum was delivered to general surgery residents at a single institution by faculty surgeons over the course of five 1-hour sessions. Palliative care competence was assessed by a palliative care competence survey completed by residents at baseline and after completion of the palliative care curriculum. The palliative care curriculum survey assessed 3 domains (attitudes, knowledge, and behavior) on a 5-point Likert scale to create a composite score and domain subscores reported as mean (standard deviation).</p><p><strong>Results: </strong>The study included 62 survey respondents, most of whom were in their first year of training (n = 32, 59.7%). Overall survey scores were significantly higher after palliative care curriculum participation (3.92 [0.43]) when compared with baseline (3.56 [0.61]), P = .008; this was also demonstrated in the knowledge domain (3.73 [0.55] vs 3.32 [0.69], P = .011) and the behavior domain (3.44 [0.7] vs 3.28 [0.78], P = .023). The improvement in scores was demonstrated in both univariate and multivariate analyses (P < .05).</p><p><strong>Conclusion: </strong>Participation in this 5-hour palliative care curriculum for surgical residents is associated with improved attitudes, knowledge, and behaviors in palliative care. This palliative care curriculum provides a framework for palliative care education across a variety of residency programs based on available time and faculty resources.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110501"},"PeriodicalIF":3.2,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881718","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":"Rural advocacy: Meeting the challenge.","authors":"David J Welsh","doi":"10.1016/j.surg.2026.110504","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110504","url":null,"abstract":"<p><p>Rural settings can be challenging with regard to the level of resources and general support of surgery. Effective advocacy is the means to deal with barriers to good surgical care. While advocating for more support for rural health care can appear daunting, it can be accomplished. This article gives concrete examples of tools for rural surgeons to participate in strong advocacy as well as success stories. This article can serve as a primer to begin or amplify a surgeon's advocacy journey.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110504"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866949","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":"Final thoughts: A value-based vision for safety and quality innovation in surgery.","authors":"Gregory Glauser, Toms Augustin","doi":"10.1016/j.surg.2026.110507","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110507","url":null,"abstract":"<p><strong>Background: </strong>Surgical innovation is rapidly evolving through artificial intelligence, digital health, robotics, advanced imaging, and precision diagnostics. However, technological advancement alone does not ensure improved safety, quality, equity, or responsible resource use.</p><p><strong>Methods: </strong>This article presents a narrative perspective on value-based surgical innovation, alignment of patient-centered outcomes, safety, cost-conscious care, ethical implementation, equity, and continuous quality improvement.</p><p><strong>Results: </strong>Value-based care provides a framework for integrating new technologies into surgical practice by prioritizing outcomes that matter to patients relative to the resources required to achieve them. Established quality programs, enhanced recovery pathways, transitional care models, and outpatient access initiatives demonstrate that improved outcomes and resource stewardship can be complementary. Emerging technologies may improve precision, efficiency, and access to less invasive care, but they also risk increasing costs or worsening disparities if adopted without rigorous outcome evaluation and equitable implementation strategies.</p><p><strong>Conclusion: </strong>The future of surgical quality will depend not only on the sophistication of new tools but also on the value they deliver to patients and society. Clinicians, institutions, payers, and policymakers must collaborate to align incentives, strengthen data infrastructure, promote equitable access, and ensure that innovation meaningfully improves safety, outcomes, and sustainable care delivery.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"199 ","pages":"110507"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891501","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}