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Impact of parathyroidectomy on depression symptoms in patients with primary hyperparathyroidism: A systematic review and meta-analysis 甲状旁腺切除术对原发性甲状旁腺功能亢进患者抑郁症状的影响:系统回顾和荟萃分析
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-31 DOI: 10.1016/j.surg.2025.109461
Juan José Ruiz-Manzanera PhD , Beatriz Febrero PhD , José A. López-López PhD , Manuel J. Albaladejo-Sánchez MD , M. Isabel Jiménez-Mascuñán MD , Miriam Abellán PhD , José M. Rodríguez PhD
{"title":"Impact of parathyroidectomy on depression symptoms in patients with primary hyperparathyroidism: A systematic review and meta-analysis","authors":"Juan José Ruiz-Manzanera PhD ,&nbsp;Beatriz Febrero PhD ,&nbsp;José A. López-López PhD ,&nbsp;Manuel J. Albaladejo-Sánchez MD ,&nbsp;M. Isabel Jiménez-Mascuñán MD ,&nbsp;Miriam Abellán PhD ,&nbsp;José M. Rodríguez PhD","doi":"10.1016/j.surg.2025.109461","DOIUrl":"10.1016/j.surg.2025.109461","url":null,"abstract":"<div><h3>Background</h3><div>The presentation of primary hyperparathyroidism has evolved in recent years. At the moment, most patients are diagnosed incidentally through routine tests. However, these patients may present depressive symptoms and mood disturbances that may affect their quality of life. The objective of this study was to analyze published articles that evaluate depressive symptoms in patients with primary hyperparathyroidism and the changes produced in the short, mid, and long term after parathyroidectomy.</div></div><div><h3>Methods</h3><div>A systematic review of the literature on published articles that evaluated the role of parathyroidectomy on symptoms related to depression in primary hyperparathyroidism was carried out. A search was conducted in PubMed, Cochrane Library, and SciELO databases using terms specifically related to depression. All relevant literature published from the year 2000 to the present was included. The selection of studies was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses strategy. A meta-analysis was performed with studies that used the 2 most common depression-specific questionnaires.</div></div><div><h3>Results</h3><div>In total, 26 studies conducted in 11 different countries were included. A total population of 2,365 patients with hyperparathyroidism was collected and a total of 12 measurement instruments, specific and general, for depressive symptoms were used. The meta-analysis revealed a significant short-term (up to 3 months postoperatively) improvement in depression scores after surgery (effect estimate = 0.57; 95% confidence interval [CI], 0.33–0.81), though with notable heterogeneity among studies. Mid-term assessments (between 3 and 12 months postoperatively) did not show consistent evidence of improvement (effect estimate = 0.68; 95% CI, −0.32 to 1.69). However, long-term analysis (beyond 12 months postoperatively) demonstrated a significant and consistent reduction in depression scores (effect estimate = 0.46; 95% CI, 0.21–0.71) across studies.</div></div><div><h3>Conclusion</h3><div>Patients with primary hyperparathyroidism often present with depressive symptoms at diagnosis. Following parathyroidectomy, a significant improvement in these symptoms is observed. The meta-analysis confirms marked reductions in depression scores shortly after surgery, with these benefits sustained over the long term. Overall, the surgery provides lasting mental health benefits.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109461"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184363","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}
引用次数: 0
Appendiceal neuroendocrine tumors in children and adolescents: The European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) diagnostic and therapeutic recommendations 儿童和青少年阑尾神经内分泌肿瘤:欧洲儿科罕见肿瘤合作研究小组(专家)诊断和治疗建议
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-31 DOI: 10.1016/j.surg.2025.109451
Calogero Virgone MD, PhD , Jelena Roganovic MD, PhD , Guido Rindi MD, PhD , Michaela Kuhlen MD , Jan Jamsek MD , Paraskevi Panagopoulou MD , Viera Bajciova MD , Tal Ben-Ami MD , Martine F. Raphael MD , Guido Seitz MD , Patrizia Dall’Igna MD , Sheila C.E.J. Terwisscha van Scheltinga MD, PhD , Miranda P. Dierselhuis MD, PhD , Ramon R. Gorter MD, PhD , Said Bachiri MD, PhD , Ulrich-Frank Pape MD, PhD , Florent Guérin MD, PhD , Ines B. Brecht MD , Brice Fresneau MD, PhD , Daniel Orbach MD , Antje Redlich MD
{"title":"Appendiceal neuroendocrine tumors in children and adolescents: The European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) diagnostic and therapeutic recommendations","authors":"Calogero Virgone MD, PhD ,&nbsp;Jelena Roganovic MD, PhD ,&nbsp;Guido Rindi MD, PhD ,&nbsp;Michaela Kuhlen MD ,&nbsp;Jan Jamsek MD ,&nbsp;Paraskevi Panagopoulou MD ,&nbsp;Viera Bajciova MD ,&nbsp;Tal Ben-Ami MD ,&nbsp;Martine F. Raphael MD ,&nbsp;Guido Seitz MD ,&nbsp;Patrizia Dall’Igna MD ,&nbsp;Sheila C.E.J. Terwisscha van Scheltinga MD, PhD ,&nbsp;Miranda P. Dierselhuis MD, PhD ,&nbsp;Ramon R. Gorter MD, PhD ,&nbsp;Said Bachiri MD, PhD ,&nbsp;Ulrich-Frank Pape MD, PhD ,&nbsp;Florent Guérin MD, PhD ,&nbsp;Ines B. Brecht MD ,&nbsp;Brice Fresneau MD, PhD ,&nbsp;Daniel Orbach MD ,&nbsp;Antje Redlich MD","doi":"10.1016/j.surg.2025.109451","DOIUrl":"10.1016/j.surg.2025.109451","url":null,"abstract":"<div><div>Neuroendocrine tumors of the appendix, formerly known as carcinoid tumors, represent a rare entity. They are slow-growing tumors, characterized by an indolent clinical course. In pediatric patients, the 5-year overall survival is estimated to be 100% and the event-free survival slightly less than 100%, with only one reported case of local relapse to date. Nevertheless, a proportion of these patients still undergo a second surgery, mostly represented by right hemicolectomy with mesenteric lymphadenectomy, in consideration of the presence of certain risk factors (size &gt;1.5 or 2 cm; tumors of the appendiceal base with or without suspicious residuals, mesoappendiceal invasion, lymphovascular invasion, serosal breach). This approach represents an overtreatment of patients with a benign clinical course regardless of the presence of risk factors and/or whether a second surgery is performed. National recommendations for diagnosis, treatment, and follow-up of neuroendocrine tumors of the appendix in pediatric age are available in France, Italy, and Germany, but international consensus is lacking. This review presents the internationally harmonized recommendations for the diagnosis and treatment of neuroendocrine tumors of the appendix in children and adolescents, established by the European Cooperative Study Group for Pediatric Rare Tumors group.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109451"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184362","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}
引用次数: 0
Semisupervised home-based prehabilitation in patients undergoing pancreaticoduodenectomy: Impact on postoperative outcomes 半监督家庭康复对胰十二指肠切除术患者术后预后的影响
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-31 DOI: 10.1016/j.surg.2025.109455
Bikash Nepal MS , Rajesh Gupta MS, MCh , Thakur Deen Yadav MS , Nancy Sahni PhD , Sandeep Negi MPT , Chhewang Dorje MPT , Pankaj Gupta MD , Vishal Sharma MD, DM , Harjeet Singh MS, MCh
{"title":"Semisupervised home-based prehabilitation in patients undergoing pancreaticoduodenectomy: Impact on postoperative outcomes","authors":"Bikash Nepal MS ,&nbsp;Rajesh Gupta MS, MCh ,&nbsp;Thakur Deen Yadav MS ,&nbsp;Nancy Sahni PhD ,&nbsp;Sandeep Negi MPT ,&nbsp;Chhewang Dorje MPT ,&nbsp;Pankaj Gupta MD ,&nbsp;Vishal Sharma MD, DM ,&nbsp;Harjeet Singh MS, MCh","doi":"10.1016/j.surg.2025.109455","DOIUrl":"10.1016/j.surg.2025.109455","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation is a relatively newer concept of utilizing the preoperative period for patient optimization to enhance the patient's physiological reserve. We planned a study to see the impact of a structured, multidimensional prehabilitative intervention on postoperative outcomes in patients undergoing pancreaticoduodenectomy.</div></div><div><h3>Methodology</h3><div>All consecutive patients planned for pancreaticoduodenectomy from January 2023 to June 2024 were assessed for enrollment. At least 2 weeks of semisupervised home-based prehabilitative intervention was done that included physical exercises, nutritional optimization, smoking cessation, and comorbidity optimization. Postoperative outcomes were recorded that included postoperative pancreatic fistula (POPF), complications grade, delayed gastric emptying, postoperative hospital stay, readmission rate, and mortality. Postoperative outcomes were compared with a historical control group of 81 patients.</div></div><div><h3>Results</h3><div>Of the 85 patients who were assessed for inclusion, 58 patients completed the prehabilitation program and underwent pancreaticoduodenectomy and were finally analyzed. The median age of the study group was 58 (interquartile range 45, 63.2), and 29 (50%) were male. Prehabilitation intervention resulted in improved weight control (median 56.5 kg [interquartile range 51.2, 67] vs 55 kg [ 49.2, 67.5], <em>P</em> &lt; .001), increase in breath hold time (median 32 [interquartile range 28, 35] vs 28 [24, 33.5] seconds, <em>P</em> &lt; .001), higher prognostic nutritional index (median 45.5 [interquartile range 39.5, 49.6] vs 47.8 [42.4, 50.8], <em>P</em> = .003), and increased gait speed (median 0.66 [interquartile range 0.58, 0.75] vs 0.54 [0.50, 0.66] m/s, <em>P</em> = .001). Clinically relevant postoperative pancreatic fistula (18 [22.2%] vs 11 [19%], <em>P</em> = .64) and major complications were similar between the prehabilitation and control groups (17 [29.3%] vs 24 [29.6%], <em>P</em> = .96). The mortality in the control group was higher compared with that in the prehabilitation group (6.3% vs 1.7%).</div></div><div><h3>Conclusion</h3><div>Semisupervised home-based prehabilitation is effective in improving physiological parameters and functional capacity in pancreaticoduodenectomy. However, establishing the definite role of prehabilitation in pancreaticoduodenectomy to improve postoperative outcomes needs a large randomized study.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109455"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184364","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}
引用次数: 0
Minimally invasive surgery could be attempted with preoperatively predictable difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy: A large multicenter study 新辅助免疫化疗后的非小细胞肺癌可尝试微创手术,但术前可预测的困难:一项大型多中心研究
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-31 DOI: 10.1016/j.surg.2025.109458
Hanbo Pan MD , Hang Chen MD , Weicheng Kong MD , Zhen Ge MD , Jiaqi Zhang MD , Yu Tian MD , Junwei Ning MD , Ningyuan Zou MD , Zhiyuan Bao MD , Qiyang Qiu MD , Difan Zhang MD , Guomo Ruan MD , Zhichao Pang MD , Liang Fang MD , Zongxiang Duan MD , Weiqiu Jin MD , Zhongjie Chen MD , Min Zheng MD , Chengwei Zhou MD , Hui Wang MD , Qingquan Luo MD, FACS, FRCS
{"title":"Minimally invasive surgery could be attempted with preoperatively predictable difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy: A large multicenter study","authors":"Hanbo Pan MD ,&nbsp;Hang Chen MD ,&nbsp;Weicheng Kong MD ,&nbsp;Zhen Ge MD ,&nbsp;Jiaqi Zhang MD ,&nbsp;Yu Tian MD ,&nbsp;Junwei Ning MD ,&nbsp;Ningyuan Zou MD ,&nbsp;Zhiyuan Bao MD ,&nbsp;Qiyang Qiu MD ,&nbsp;Difan Zhang MD ,&nbsp;Guomo Ruan MD ,&nbsp;Zhichao Pang MD ,&nbsp;Liang Fang MD ,&nbsp;Zongxiang Duan MD ,&nbsp;Weiqiu Jin MD ,&nbsp;Zhongjie Chen MD ,&nbsp;Min Zheng MD ,&nbsp;Chengwei Zhou MD ,&nbsp;Hui Wang MD ,&nbsp;Qingquan Luo MD, FACS, FRCS","doi":"10.1016/j.surg.2025.109458","DOIUrl":"10.1016/j.surg.2025.109458","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant immunochemotherapy has revolutionized the treatment of non–small cell lung cancer. However, it presents significant surgical challenges, leading to controversy over the feasibility and safety of minimally invasive surgery. This study aims to assess the adequacy of minimally invasive surgery and preoperatively predict its difficulty for non–small cell lung cancer after neoadjuvant immunochemotherapy.</div></div><div><h3>Methods</h3><div>Initial stage IIA-IIIB (excluding stage T4N2) non–small cell lung cancer patients with neoadjuvant immunochemotherapy undergoing minimally invasive surgery or open thoracotomy at 12 institutions between 2019 and 2024 were retrospectively reviewed. Difficult minimally invasive surgery was defined by conversion to thoracotomy. Propensity score matching was applied to balance baseline characteristics.</div></div><div><h3>Results</h3><div>Of the 571 cases included, propensity score matching led to 240 patients per group. Minimally invasive surgery decreased intraoperative bleeding, shortened postoperative chest tube duration and hospitalization, ameliorated postoperative pain, and reduced postoperative complications compared to open thoracotomy. Moreover, minimally invasive surgery had an acceptable conversion rate of 15.8%, and notably, converted minimally invasive surgery achieved similar perioperative outcomes to open thoracotomy. Accumulated surgeons' experiences reduced minimally invasive surgery conversion rates and shortened surgical durations. Additionally, logistic regression identified squamous cell carcinoma, advanced preinduction N stage, preoperative tumor size &gt;5 cm, advanced preoperative stage, and extended resection as independent risk factors for conversion. A nomogram was further established with good performance (area under curve value = 0.804) and clinical utility to predict conversion probability preoperatively. Finally, minimally invasive surgery and open thoracotomy achieved comparable event-free survival and overall survival profiles.</div></div><div><h3>Conclusions</h3><div>Minimally invasive surgery achieved improved perioperative outcomes and similar oncologic efficacies to open thoracotomy. Moreover, minimally invasive surgery had an acceptable conversion rate, which would not compromise perioperative outcomes compared with open thoracotomy and could be effectively forecasted by a prediction model.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109458"},"PeriodicalIF":3.2,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184365","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}
引用次数: 0
Letter to the editor on "Development and validation of a nomogram to predict the need for bailout procedure in laparoscopic cholecystectomy: A multicenter study of 1,898 cases". 致编辑的信“发展和验证预测腹腔镜胆囊切除术中需要救助程序的nomogram:一项1898例的多中心研究”。
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-30 DOI: 10.1016/j.surg.2025.109465
Yuhang Zhou, Bang Wang, Minhui Xu
{"title":"Letter to the editor on \"Development and validation of a nomogram to predict the need for bailout procedure in laparoscopic cholecystectomy: A multicenter study of 1,898 cases\".","authors":"Yuhang Zhou, Bang Wang, Minhui Xu","doi":"10.1016/j.surg.2025.109465","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109465","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109465"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187969","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}
引用次数: 0
Comment on: "Association of mental health assessment with postoperative outcomes following major surgery in older individuals". 评论:“老年人大手术后心理健康评估与术后结果的关系”。
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-30 DOI: 10.1016/j.surg.2025.109435
Mohammadali Ranjbar, Hesam Nozari, Amirhossein Keshavarz
{"title":"Comment on: \"Association of mental health assessment with postoperative outcomes following major surgery in older individuals\".","authors":"Mohammadali Ranjbar, Hesam Nozari, Amirhossein Keshavarz","doi":"10.1016/j.surg.2025.109435","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109435","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109435"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187968","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}
引用次数: 0
Development and validation of a machine learning–based model for predicting intraoperative blood loss during burn surgery 基于机器学习的预测烧伤手术术中出血量模型的开发和验证
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-29 DOI: 10.1016/j.surg.2025.109445
Fangqing Zuo MD, MS , Jiaqing Su MD, MS , Yang Li MS , Haiming Xin MD, PhD , Chunhao Li BN , Lina Huang BE , Lijuan Zhang MD , Junda Li MD , Zhuo Zeng MD, MS , Yu Chen BSMT , Yali Gong MS , Jing Chen MD, PhD , Yingying Lan MS , Yajie Chen BSMT , Cheng Zhang BSMT , Yizhi Peng MD, PhD , Gaoxing Luo MD, PhD , Zhiqiang Yuan MD, PhD
{"title":"Development and validation of a machine learning–based model for predicting intraoperative blood loss during burn surgery","authors":"Fangqing Zuo MD, MS ,&nbsp;Jiaqing Su MD, MS ,&nbsp;Yang Li MS ,&nbsp;Haiming Xin MD, PhD ,&nbsp;Chunhao Li BN ,&nbsp;Lina Huang BE ,&nbsp;Lijuan Zhang MD ,&nbsp;Junda Li MD ,&nbsp;Zhuo Zeng MD, MS ,&nbsp;Yu Chen BSMT ,&nbsp;Yali Gong MS ,&nbsp;Jing Chen MD, PhD ,&nbsp;Yingying Lan MS ,&nbsp;Yajie Chen BSMT ,&nbsp;Cheng Zhang BSMT ,&nbsp;Yizhi Peng MD, PhD ,&nbsp;Gaoxing Luo MD, PhD ,&nbsp;Zhiqiang Yuan MD, PhD","doi":"10.1016/j.surg.2025.109445","DOIUrl":"10.1016/j.surg.2025.109445","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Intraoperative blood loss is a critical issue in the care of patients with burns. The timely identification of patients at elevated risk for substantial blood loss during surgical procedures is imperative.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Demographic data, laboratory test results, and surgical factors of patients were collected. For predicting intraoperative blood loss &gt;750 mL, the original cohort was randomly divided in an 8:2 ratio, with the larger group allocated for the model development and the smaller for internal validation. Six machine-learning algorithms, including logistic regression, decision tree, random forest, K-nearest neighbor, support vector machine, and extreme gradient boosting were used to develop the prediction models. The performance of the models was assessed by 8 metrics as well as density curve, calibration curve and decision curve. A scoring system was designed to assess the performance efficacy. Validation was conducted in another 2 cohorts. The optimal prediction model acquired. Ultimately, a web-based calculator to estimate the incidence of intraoperative blood loss &gt;750 mL was created.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 395 burn surgeries from 2 hospitals were analyzed, with 245 surgeries for modeling, 89 surgeries for the internal-external validation, and 61 surgeries for the external validation. The model features consist of 8 clinical variables. The random forest model gained the greatest total metrics score of 36, followed by the support vector machine, extreme gradient boosting, K-nearest neighbor, logistic regression, and decision tree models with total scores of 33, 32, 28, 24, and 18, respectively. Specifically, the random forest model performed superior in most metrics compared to the other models, achieving greater accuracy (0.776), recall (0.930), F1 score (0.868), as well as the lowest log loss (0.423), and Brier score (0.142). Meanwhile, the random forest model demonstrated strong performance with an area under the curve of 0.784 (95% confidence interval, 0.779–0.789), ranking second only slightly behind the extreme gradient boosting model, which achieved the greatest area under the curve of 0.785 (95% confidence interval, 0.780–0.790). Other models showed comparatively lower area under the curve values. The density curve, calibration plot, histogram with mean predicted probabilities against counts and decision curve of the random forest model also performed well. In the internal-external validation cohort, the random forest reached the greatest total metrics score of 35. In the external validation cohort, the random forest again secured the greatest composite metrics score, amounting to 38. Overall, the random forest model was found to be the optimal model for predictive accuracy. In addition initial hemoglobin, time to start surgery after burn injury, initial platelets, % total body surface area excised and grafted, and duration of surgery were the fi","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109445"},"PeriodicalIF":3.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170653","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}
引用次数: 0
Association of hospital volume with outcomes for reoperative coronary artery bypass grafting 医院容积与再手术冠状动脉搭桥术预后的关系
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-28 DOI: 10.1016/j.surg.2025.109441
Baran Khoraminejad BA , Sara Sakowitz MS, MPH , Troy Coaston BS , Giselle Porter BS , Saad Mallick MD , Esteban Aguayo MD , Peyman Benharash MD, MS
{"title":"Association of hospital volume with outcomes for reoperative coronary artery bypass grafting","authors":"Baran Khoraminejad BA ,&nbsp;Sara Sakowitz MS, MPH ,&nbsp;Troy Coaston BS ,&nbsp;Giselle Porter BS ,&nbsp;Saad Mallick MD ,&nbsp;Esteban Aguayo MD ,&nbsp;Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.109441","DOIUrl":"10.1016/j.surg.2025.109441","url":null,"abstract":"<div><h3>Introduction</h3><div>Outcomes following reoperative coronary artery bypass graft surgery are widely underexplored. Evaluating a contemporary national cohort, we assessed acute clinical and financial sequelae following reoperative coronary artery bypass graft surgery at the patient and hospital levels.</div></div><div><h3>Methods</h3><div>The 2016–2021 Nationwide Readmissions Database was queried to identify all adult (≥18 years) hospitalizations for elective isolated coronary artery bypass graft surgery. Patients with a history of coronary artery bypass graft surgery were categorized as ReOp (others: Non-ReOp). Centers in the highest quartile were considered high-volume centers. Multivariable regression models were built to assess the independent association of ReOp with clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of ∼470,546 patients, 5.0% were classified as ReOp. On average, ReOp was older (70 [63–76] vs 67 years [60–73], <em>P</em> &lt; .001), more often female (26.7 vs 21.7%, <em>P</em> &lt; .001), and of a higher Elixhauser comorbidity index (5 [4–7] vs 4 [3–5], <em>P</em> &lt; .001).</div><div>Following risk adjustment, ReOp was linked with comparable likelihood of in-hospital mortality (adjusted odds ratio 0.87, 95% confidence interval 0.74–1.03). However, ReOp faced greater odds of infection (adjusted odds ratio 1.72, 95% confidence interval 1.60–1.85), thromboembolism (1.85, 1.45–2.36), and stroke (1.35, 1.12–1.64). ReOp was also linked with greater costs (β +$9,845, 95% CI 8,888–0,802).</div><div>At high-volume centers, 5.1% of coronary artery bypass graft surgery recipients were ReOp. Reoperation was associated with greater adjusted odds of major complications (adjusted odds ratio 1.19, 95% confidence interval 1.12–1.27) and increased hospitalization expenditures (β +$6,782, 95% confidence interval 5,725–7,837).</div></div><div><h3>Conclusion</h3><div>The increased risk of facing major perioperative outcomes following reoperative coronary artery bypass graft surgery persists at centers despite case volume. Further studies are needed to develop optimal perioperative care pathways for these patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109441"},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170654","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}
引用次数: 0
Letter to the editor: "The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography-derived parameters as prognostic factors in patients undergoing resection for pancreatic ductal adenocarcinoma". 致编辑的信:“18f -氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描衍生参数作为胰腺导管腺癌切除术患者预后因素的作用”。
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-28 DOI: 10.1016/j.surg.2025.109438
Saad Ahmed Mughal, Aman Advani
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引用次数: 0
Rethinking turnover times: The right kind of wrong. 重新思考离职时间:正确的错误。
IF 3.2 2区 医学
Surgery Pub Date : 2025-05-28 DOI: 10.1016/j.surg.2025.109430
Javier A Blanco, Mitchell H Tsai, Justin S Routman
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引用次数: 0
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