Surgery最新文献

{"title":"Discussion.","authors":"","doi":"10.1016/j.surg.2025.109755","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109755","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109755"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182242","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.2025.109800","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109800","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109800"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182181","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":"Prevalence and correlates of spiritual distress in adult patients facing elective surgery: A cross-sectional analysis","authors":"Katelyn G. Makar MD ,&nbsp;Allison M. Worden BS ,&nbsp;Melissa R. Thomas BSPH ,&nbsp;Shelley E. Varner-Perez MDiv ,&nbsp;Mengyu Di MSPH ,&nbsp;Alexia M. Torke MD","doi":"10.1016/j.surg.2025.109724","DOIUrl":"10.1016/j.surg.2025.109724","url":null,"abstract":"<div><h3>Background</h3><div>Patients with terminal disease, leading to existential concerns, commonly experience spiritual distress. Despite the uniqueness of the surgical encounter, which evokes major life disruption, the prevalence of spiritual distress in patients undergoing elective surgery remains unknown.</div></div><div><h3>Methods</h3><div>We surveyed patients ≥18 years of age scheduled within 4 weeks for elective surgery requiring overnight admission. Scores &lt;36 on the validated Functional Assessment of Chronic Illness Therapy—Spiritual Well-being 12, Non-Illness Version or &gt;52 on the Religious and Spiritual Struggles scale indicated spiritual distress. Pearson χ², Welch 2-sample <em>t</em> tests, and logistic regression were used to evaluate associations.</div></div><div><h3>Results</h3><div>Of 140 patients (response rate 31%), 49 were spiritually distressed (35%; mean [standard deviation] Functional Assessment of Chronic Illness Therapy—Spiritual Well-being 12: 37 [9], median [interquartile range] Religious and Spiritual Struggles: 5 [13]). Those with distress had significantly lower intrinsic religiosity scores (<em>P</em> &lt; .001) and lower levels of organizational and nonorganizational religious activity (<em>P</em> &lt; .001 for both) than those without distress. Depression (<em>P</em> &lt; .001), anxiety (<em>P</em> &lt; .001), being unmarried (<em>P</em> &lt; .001), frequent financial worry (<em>P</em> &lt; .001), fair/poor health (<em>P</em> &lt; .001), and no identified religion (<em>P</em> &lt; .001) were associated with spiritual distress. On adjusted analysis, intrinsic religiosity (odds ratio, 0.71; 95% confidence interval, 0.53–0.92, <em>P</em> = .013), identified religion (odds ratio, 0.04; 95% confidence interval, 0.00–0.57; <em>P</em> = .038), and good/excellent health (odds ratio, 0.09; 95% confidence interval, 0.01–0.39; <em>P</em> = .003) were associated with lower odds of spiritual distress.</div></div><div><h3>Conclusion</h3><div>More than one-third of patients experienced spiritual distress preoperatively, suggesting an unmet need to facilitate spiritual care in the preoperative period. Although the surgical encounter is an isolated event, patients with surgical disease navigate serious concerns related to health, meaning, and purpose.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109724"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159374","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":"Insurer market competition and negotiated prices for elective hospital-based procedures","authors":"Mitchell Mead BSA ,&nbsp;Clifford Sheckter MD, MS ,&nbsp;Andrew M. Ibrahim MD, MSc","doi":"10.1016/j.surg.2025.109714","DOIUrl":"10.1016/j.surg.2025.109714","url":null,"abstract":"<div><h3>Background</h3><div>Rapid consolidation of insurers and decreasing competitiveness of insurance markets has raised concerns for potential impacts on the prices for surgery.</div></div><div><h3>Methods</h3><div>This was a 2024 cross-sectional study using mandatory reported data for 9 hospital-based procedures under the Hospital Price Transparency Rule, which documents negotiated prices for procedures between a hospital and insurer. These data were linked to the Kaiser Family Foundation Insurer Market Share data set, which documents insurer market competition. The primary outcomes were risk-adjusted (1) insurer price variation and (2) price differences across insurer market competition.</div></div><div><h3>Results</h3><div>Prices varied significantly for hospital-based procedures within and across insurers. For example, negotiated prices for joint replacement (hip or knee) varied by insurer: Aetna (interquartile range: $11,161–$16,975; 1.52-fold variation), Anthem (interquartile range: $13,003–$19,346; 1.49-fold variation), BCBS (interquartile range: $13,170–$20,358; 1.55-fold variation), Kaiser (interquartile range: $22,318–$24,874; 1.11-fold variation), and United (interquartile range: $13,003–$18,693; 1.44-fold variation). As an insurer dominated a market, it negotiated lower prices for procedures. For example, in low-competition markets, the average negotiated price for procedures were $6,683 (21.1%) less when negotiated by the leading insurer versus nonleading insurers ($24,882 vs $31,565; <em>P</em> &lt; .001). In contrast, high-competition insurer markets demonstrated a relatively smaller difference in negotiated prices between leading and nonleading insurers ($26,155 vs $25,368; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>In high-competition insurer markets, insurers negotiated similar prices for procedures. However, in low-competition markets, the dominant insurer negotiated significantly lower prices. These findings suggest increasing insurer market competition may decrease price variability and lower prices in particular markets.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109714"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159287","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":"Use of a Best Practice Advisory to increase the detection rate of hyperparathyroidism.","authors":"Rebecca S Gates, Kristin McCoy, Jonathan Stewart, Andrew J Behnke, Adegbenga Bankole, Theresa Vallia, Michael S Nussbaum, Daniel Tershak","doi":"10.1016/j.surg.2025.109706","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109706","url":null,"abstract":"<p><strong>Background: </strong>Timely diagnosis and treatment of primary hyperparathyroidism requires a high index of suspicion and collaboration across specialties. The diagnosis often is overlooked. This study aimed to determine whether the introduction of a screening algorithm for primary hyperparathyroidism would increase diagnosis and treatment rates.</p><p><strong>Methods: </strong>An electronic health record Best Practice Advisory was launched in 2022, encouraging parathyroid hormone testing for patients with hypercalcemia (calcium ≥11 mg/dL). Parathyroid hormone testing, specialist referrals, and parathyroidectomy were examined pre- and postintervention.</p><p><strong>Results: </strong>There were 902 and 893 patients with hypercalcemia in the pre- and postintervention groups, respectively. Parathyroid hormone testing increased from 24.61% to 38.75% after the Best Practice Advisory was implemented (P < .01). Specialist referrals and rates of parathyroidectomy were unchanged between the pre- and postintervention groups (referrals in 41.44% vs 41.04% of those with parathyroid hormone testing, P = .93; parathyroidectomy in 27.17% vs 26.76% of those referred, P = 1.00). Parathyroid hormone testing was performed more commonly in older patients (69.63 vs 59.01 years, P < .01). Patients referred to a specialist were younger (67.59 vs 71.05 years, P = .04). Patients with primary hyperparathyroidism-associated comorbidities were more likely to undergo parathyroid hormone testing, with no differences in rates of specialist referrals (P = .11) or parathyroidectomy (P = .60).</p><p><strong>Conclusion: </strong>An electronic health record Best Practice Advisory was effective in increasing primary hyperparathyroidism screening, but did not result in a higher rate of specialist referrals or parathyroidectomies. Reflex parathyroid hormone testing as well as increased education about primary hyperparathyroidism may further improve screening, referrals, and treatment.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109706"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178636","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":"Effectiveness of artificial intelligence–based visualization for surgical anatomy education: A cluster quasirandomized controlled trial","authors":"Eiichiro Nakao MD, PhD ,&nbsp;Masataka Igeta PhD ,&nbsp;Nao Kobayashi MD ,&nbsp;Yuta Kumazu MD, PhD ,&nbsp;Yuhi Otani ME ,&nbsp;Motoki Murakami MD ,&nbsp;Shugo Kohno MD ,&nbsp;Yudai Hojo MD, PhD ,&nbsp;Tatsuro Nakamura MD, PhD ,&nbsp;Yasunori Kurahashi MD, PhD ,&nbsp;Yoshinori Ishida MD, PhD ,&nbsp;Hisashi Shinohara MD, PhD","doi":"10.1016/j.surg.2025.109723","DOIUrl":"10.1016/j.surg.2025.109723","url":null,"abstract":"<div><h3>Background</h3><div>Although surgical techniques have advanced markedly, surgical education for medical students has remained largely traditional. Because of the importance of accurate recognition of intraoperative anatomy, passive observation is insufficient for novice learners. This study evaluated the educational effectiveness of an artificial intelligence–based visualization system that highlights anatomical structures during surgery in real time.</div></div><div><h3>Methods</h3><div>We conducted a cluster quasi-randomized controlled trial involving fifth-year medical students assigned to receive either conventional intraoperative teaching (cohort C) or instruction augmented by artificial intelligence–based visualization (cohort A). Each student annotated the pancreatic regions on 6 static laparoscopic or robotic images before and after clinical observation training. Performance was assessed using 3 image segmentation metrics: recall (minimizing false negatives), precision (avoiding false positives), and the Dice coefficient, which integrates recall and precision. The Dice coefficient served as the primary outcome, whereas recall and precision served as secondary outcomes.</div></div><div><h3>Results</h3><div>Both cohorts showed similar baseline performance and improved across all metrics after training. However, cohort A exhibited a significantly greater improvement in recall than cohort C (ΔRecall: 0.112 vs 0.013, <em>P</em> = .020), indicating enhanced sensitivity in identifying pancreatic regions. Precision did not differ significantly between the groups (<em>P</em> = .746). The Dice coefficient improved more in cohort A than in cohort C (ΔDice: 0.087 vs 0.028), although the between-group difference did not reach statistical significance (<em>P</em> = .097). Scatter plot analysis showed that many cohort A students exhibited increased recall without loss of precision, suggesting improved recognition accuracy.</div></div><div><h3>Conclusion</h3><div>Incorporating artificial intelligence–based visualization into surgical anatomy education may enhance medical students' recognition of intraoperative anatomy, particularly for visually complex structures such as the pancreas.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109723"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159353","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":"Patient preferences in papillary thyroid microcarcinoma management are driven by aversion toward complications rather than treatment pathway.","authors":"Rebecca Kowalski, Kendyl Carlisle, Aprill N Park, Salome Ricci, Reuben Don, Carrie Cunningham, Julia F Slejko, C Daniel Mullins, Yinin Hu","doi":"10.1016/j.surg.2025.109694","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109694","url":null,"abstract":"<p><strong>Background: </strong>Papillary thyroid microcarcinomas carry an excellent prognosis, making patient preferences and cost-effectiveness important determinants of treatment selection. To conduct cost-effectiveness analyses, quality-adjusted life year weights for papillary thyroid microcarcinoma treatments must be derived. Our objective was to estimate the quality-adjusted life year weights of common papillary thyroid microcarcinoma treatment scenarios.</p><p><strong>Methods: </strong>This study used 10 previously published papillary thyroid microcarcinoma clinical vignettes describing active surveillance, radiofrequency ablation, partial thyroidectomy, and total thyroidectomy, along with potential complications (progression, vocal cord palsy, hypocalcemia). Quality-adjusted life year weights were derived using a time trade-off instrument administered to thyroid cancer survivors. Quality-adjusted life year weights were compared using within-subjects repeated measures analysis of variance and paired Wilcoxon rank-sum tests. The cohort was powered to detect a minimal important difference with an effect size of 0.5 (ie, 0.04 quality-adjusted life year).</p><p><strong>Results: </strong>Data from 101 thyroid cancer survivors were collected. Median quality-adjusted life year weights for uncomplicated treatment scenarios ranged from 0.975 to 0.992 and were not significantly different between treatments (P = .15). Treatment complications resulted in significantly lower quality-adjusted life year weights across all treatment strategies (P < .01) except active surveillance (P = .72).</p><p><strong>Conclusion: </strong>Quality-adjusted life year weights were comparable between the uncomplicated versions all 4 treatment pathways, suggesting that patient treatment preferences for papillary thyroid microcarcinoma are driven by aversion to treatment complications, rather than an inclination toward the experience of the treatments themselves. These quality-adjusted life year weights may be readily incorporated into value assessments for papillary thyroid microcarcinoma treatments.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109694"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178629","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.2025.109798","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109798","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109798"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178618","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.2025.109744","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109744","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109744"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178668","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 management of metastatic adrenocortical carcinoma: Is there a role for multivisceral resection?","authors":"Omair A Shariq, Benjamin Kensing, Jace P Landry, Ching-Wei D Tzeng, Mouhammad Amir Habra, Matthew T Campbell, Sarah B Fisher, Nancy D Perrier, Jeffrey E Lee, Paul H Graham","doi":"10.1016/j.surg.2025.109696","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109696","url":null,"abstract":"<p><strong>Background: </strong>Recent data suggest that cytoreductive surgery in metastatic adrenocortical carcinoma) may improve survival. However, successful removal of locally invasive primary tumors in such patients may require complex en bloc and/or multivisceral resection, for which the survival benefits remain unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 153 patients with metastatic adrenocortical carcinoma treated at our institution from 1998 to 2024. Patients were categorized into 3 groups based on treatment approach: multivisceral resection, adrenalectomy alone, and nonoperative management. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate overall survival across these groups.</p><p><strong>Results: </strong>Among 153 patients (52% female; median age 49 years, interquartile range: 36-59 years), 24% underwent multivisceral resection, 18% had adrenalectomy alone, and 58% were managed nonoperatively. Overall, 68% of tumors were functional. The most frequent metastatic sites were the lung (71%) and liver (66%). The most frequent en bloc procedures included radical nephrectomy (64%) and partial hepatectomy (47%). The median overall survival was 33 months after multivisceral resection, 22 months after adrenalectomy alone, and 7 months with nonoperative management (P < .0001). On multivariable analysis, multivisceral resection (hazards ratio = 0.31, 95% confidence interval: 0.18-0.50, P < .0001) and adrenalectomy alone (hazards ratio = 0.50, 95% confidence interval: 0.28-0.88, P = .017) were independently associated with longer overall survival compared with nonoperative management.</p><p><strong>Conclusion: </strong>Cytoreductive surgery, including multivisceral resection, may be associated with improved survival in metastatic adrenocortical carcinoma compared with nonoperative management. However, given the potential risks of these complex operations, they should be judiciously performed in select patients by experienced multidisciplinary teams.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109696"},"PeriodicalIF":2.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145178601","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}