Surgery最新文献

{"title":"Author's Reply to the Letter regarding our manuscript: \"Impact of biliary drainage method before pancreaticoduodenectomy on short- and long-term outcomes in patients with periampullary carcinoma and obstructive jaundice: A multicenter retrospective analysis\".","authors":"Yusuke Yamamoto, Teiichi Sugiura, Minoru Esaki, Yu Takahashi, Junichi Arita, Masaji Hashimoto, Yoshihiro Sakamoto, Masaru Konishi, Tsuyoshi Sano, Akifumi Notsu, Katsuhiko Uesaka, Kazuaki Shimada","doi":"10.1016/j.surg.2025.109486","DOIUrl":"10.1016/j.surg.2025.109486","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109486"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337018","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":"High superficial resemblance versus high functional task alignment simulation for central venous catheterization training: A randomized crossover trial","authors":"Ibrahim A. Gomaa MD ,&nbsp;Rosa Anna Chorro MD ,&nbsp;Andres Climent RN, CFRN ,&nbsp;Jeffrey Huang MD ,&nbsp;Aaron Damon BS ,&nbsp;David A. Cook MD ,&nbsp;Alex Finch MD ,&nbsp;Mark Morrey MD ,&nbsp;Mariela Rivera MD ,&nbsp;Diana Kelm MD","doi":"10.1016/j.surg.2025.109487","DOIUrl":"10.1016/j.surg.2025.109487","url":null,"abstract":"<div><h3>Introduction</h3><div>Fidelity in procedural skills simulation can be classified as superficial resemblance (simulator approximates real tissue appearance) or functional task alignment (key steps of simulation approximate those of real procedure). We hypothesized that resident physicians would prefer a simulation model with high functional task alignment over a model with higher superficial resemblance and lower functional task alignment in central venous catheter placement training.</div></div><div><h3>Methods</h3><div>We conducted a randomized crossover trial, enrolling residents from multiple specialties. We compared an Appearance-focused model with high superficial resemblance (head, neck, and upper torso) and low functional task alignment vs a function-focused model with high functional task alignment (replicates the process central venous catheter using ultrasound guidance including vascular identification, dilation, and catheter introduction in a single model) and lower superficial resemblance. Participants used each model once (crossover), with sequence randomly assigned. After using each model, they rated the superficial resemblance (ultrasonographic image, tissue feel, needle and transducer functionality, model as a whole) and functional task alignment (movements, steps sequence, continuity between steps, task as a whole) using a 5-point scale. Finally, participants rated their preference after using both simulators.</div></div><div><h3>Results</h3><div>Eighty residents were invited to participate, with 53 (66%) completing the study. Immediate post simulator assessments comparing Function-focused and Appearance-focused models demonstrated significantly higher mean scores for the Function-focused model across several domains, including tissue feels (2.9 ± 1.04 vs 2.4 ± 0.95, <em>P</em> = .027), needle and transducer functionality (3.3 ± 1.11 vs 2.8 ± 1.05, <em>P</em> = .007), model as a whole (3.4 ± 0.98 vs 2.6 ± 0.93, <em>P</em> &lt; .001), and task continuity (4.0 ± 1.04 vs 2.7 ± 1.25, <em>P</em> &lt; .001). Furthermore, the Function-focused model notably outperformed the Appearance-focused model regarding the overall task alignment (3.6 ± 0.95 vs 2.8 ± 1.0, <em>P</em> &lt; .001). The overall preference for the simulators indicated a clear inclination toward the Function-focused model with participants preferring it for future training (87%, <em>n</em> = 46).</div></div><div><h3>Conclusion</h3><div>Resident physicians rated the function-focused simulator higher for both overall superficial resemblance and for all measures of functional task alignment, and preferred this model overall, in comparison with the appearance-focused simulator. Additionally, they demonstrated a strong preference for functional task alignment.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109487"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313225","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":"Revisiting surgical decisions: The choice between laparotomy and laparoscopy for traumatic small bowel injuries","authors":"Han-Hsi Chiu MD,&nbsp;Shih-Ching Kang MD,&nbsp;Chih-Yuan Fu MD","doi":"10.1016/j.surg.2025.109477","DOIUrl":"10.1016/j.surg.2025.109477","url":null,"abstract":"<div><h3>Background</h3><div>Although laparoscopy has gained popularity in abdominal trauma management, its role in treating traumatic small bowel injuries remains controversial, particularly in critically ill patients. The present study aimed to assess the feasibility and outcomes of laparoscopic surgery in comparison with laparotomy for traumatic small bowel injuries, especially among high-risk subgroups.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study based on data from the Trauma Quality Improvement Program database between 2021 and 2022. Patients with small bowel injury who underwent operative management were included. Clinical data of patients who underwent laparotomy were compared with those who underwent laparoscopic surgeries. Subgroup analyses were performed on the older patients, severely injured patients, and patients with unstable hemodynamics. Factors associated with poor outcomes in patients who underwent laparoscopy were also analyzed using logistic regression.</div></div><div><h3>Results</h3><div>Of the 9,593 patients, 234 (2.4%) underwent laparoscopic surgery for small bowel injuries. No differences in the injury site or surgical procedure performed were observed between the patients who underwent laparotomy and those who underwent laparoscopy. No significant differences were found between elderly or hemodynamically unstable patients who underwent laparotomy or laparoscopy in terms of hospital stay, mortality rate, or surgery-associated complications. Among patients who underwent laparoscopic surgery, those with unstable hemodynamics (odds = 5.846, <em>P</em> &lt; .001) and severe injuries (odds = 3.322, <em>P</em> = .010) had higher risks of surgical complications.</div></div><div><h3>Conclusion</h3><div>Despite traditional concerns, surgeons may consider a more assertive use of laparoscopy in trauma settings.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109477"},"PeriodicalIF":3.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306949","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":"State family support policies and their impact on women's representation and productivity in surgical research: A web-scraping comparative analysis","authors":"Georgios Karamitros MD, MS ,&nbsp;Heather J. Furnas MD ,&nbsp;Michael P. Grant MD, PhD ,&nbsp;Sofoklis Goulas PhD","doi":"10.1016/j.surg.2025.109478","DOIUrl":"10.1016/j.surg.2025.109478","url":null,"abstract":"<div><h3>Background</h3><div>Gender disparities in academic surgery persist, with women underrepresented as first authors and facing significant barriers to research productivity. Family-supportive policies, including paid family leave and reproductive rights protections, have been suggested as potential solutions to mitigate these disparities. However, their impact on women representation in surgical research has not been comprehensively evaluated.</div></div><div><h3>Study Design</h3><div>This cross-sectional analysis, using a web-scraping methodology, examined 198,542 first-author publications from 388 PubMed-indexed surgery journals published between 2010 and 2022. Gender differences in research output and representation were assessed across US states with and without family-supportive policies, specifically mandatory paid family leave and protective reproductive rights. We compared women representation among first authors and analyzed the average publication count for women authors, examining gender disparities at publication thresholds of 1, 2, and 5 papers.</div></div><div><h3>Results</h3><div>Women comprised 33.0% of all first authors, with representation decreasing at higher publication thresholds. States with paid family leave showed higher women representation among first authors compared with non–paid family leave states (34.2% vs 32.3%; <em>P</em> &lt; .001), and similarly, protective reproductive rights states had more women representation than restrictive states (33.9% vs 32.0%; <em>P</em> &lt; .001). Among authors with 5 or more publications, women represented 25.1% in paid family leave states versus 22.6% in non–paid family leave states (<em>P</em> = .005), and 24.6% in reproductive rights states versus 22.3% in restrictive states (<em>P</em> = .010). Women in states with these policies also saw significantly higher average publication counts (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>State-level paid family leave and reproductive rights policies are associated with improved women representation and reduced gender disparities in surgical research. Our results indicate a statistically significant association between family-supportive policies and increased women's authorship, suggesting that such policies may play a role in shaping the academic trajectories of women in surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109478"},"PeriodicalIF":3.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of patient-reported outcome measures in recurrent diverticulitis","authors":"Megan Shroder MD ,&nbsp;Thomas Ueland BS ,&nbsp;Liping Du PhD ,&nbsp;Ashley Spann MD, MSACI ,&nbsp;Samuel A. Younan MD ,&nbsp;Allison McCoy PhD ,&nbsp;Fei Ye PhD ,&nbsp;Alexander T. Hawkins MD, MPH","doi":"10.1016/j.surg.2025.109492","DOIUrl":"10.1016/j.surg.2025.109492","url":null,"abstract":"<div><h3>Background</h3><div>National guidelines for elective colectomy for uncomplicated diverticulitis have changed to a patient-centered approach. Patient-reported outcome measures, such as the Diverticulitis Quality of Life Instrument, may be helpful to determine who will benefit from elective colectomy for diverticulitis.</div></div><div><h3>Methods</h3><div>We performed a prospective observational cohort study to investigate whether greater Diverticulitis Quality of Life Instrument scores (indicating more severe disease burden) would be associated with increased likelihood of electing to undergo colectomy for recurrent diverticulitis. Adult patients ≥18 year old seen in consultation for uncomplicated diverticulitis at a tertiary referral medical center from March 2021 to August 2023 were included for analysis. The primary outcome of interest was the decision to proceed with elective colectomy vs. continued medical management.</div></div><div><h3>Results</h3><div>Of the 70 patients included, 48 (68.6%) elected for medical management and 22 (31.4%) had elective surgery planned or completed during the study period. The mean overall Diverticulitis Quality of Life Instrument scores were 4.6 (standard deviation, 1.8) for the medical management group and 5.3 (standard deviation, 1.2) for the elective colectomy group. An adjusted multivariable analysis showed an odds ratio of 1.39 (confidence interval, 1.03–1.89, <em>P</em> = .04) for electing surgical management with one-unit greater baseline Diverticulitis Quality of Life Instrument overall score and an odds ratio of 1.36 (confidence interval, 1.03–1.78, <em>P</em> = .03) for one-unit greater baseline Diverticulitis Quality of Life Instrument score in the subdomain of behavior.</div></div><div><h3>Conclusion</h3><div>We observed significantly greater baseline overall Diverticulitis Quality of Life Instrument scores and scores in the subdomain of behavior in patients who chose to pursue elective colectomy after consultation for recurrent diverticulitis.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109492"},"PeriodicalIF":3.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297460","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":"Response to letter to the editor re: Assessing the role of immunonutrition in Enhanced Recovery After Surgery programs for colorectal surgery: Insights and methodologic considerations.","authors":"Samuel A Younan, Danish Ali, Aimal Khan","doi":"10.1016/j.surg.2025.109470","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109470","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109470"},"PeriodicalIF":3.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317887","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":"Comprehensive assessment of genomic heterogeneity, coalterations, and outcomes of patients with colorectal cancer: An AACR GENIE project analysis","authors":"Hunter Stecko BSE, BA ,&nbsp;Diamantis I. Tsilimigras MD, PhD, MS ,&nbsp;Sidharth Iyer BS ,&nbsp;Jad Daw BS ,&nbsp;Hua Zhu PhD ,&nbsp;Emily Huang MD ,&nbsp;Matthew Kalady MD ,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS","doi":"10.1016/j.surg.2025.109475","DOIUrl":"10.1016/j.surg.2025.109475","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal cancer remains a leading cause of cancer mortality in the United States and can be characterized by racial and sex-based disparities. The objective of the current study was to characterize the genomic heterogeneity of colorectal cancer among diverse demographic groups, assess coalteration patterns and their impact on long-term outcomes among patients with colorectal cancer.</div></div><div><h3>Methods</h3><div>Data from the American Association for Cancer Research GENIE registry were analyzed to assess genomic alterations in colorectal cancer. The cohort included 20,542 samples from 19,542 patients, stratified by race or ethnicity, sex, and age of onset (&lt;50 years for early-onset colorectal cancer). Genomic alterations and coalterations among the 48 most prevalent loci were evaluated for any association with overall survival in an external Memorial Sloan Kettering Cancer Center cohort.</div></div><div><h3>Results</h3><div>Among 19,542 patients, <em>KRAS</em> mutations were more prevalent among Black patients (57.1%) compared with White (41.8%) and Asian (43.4%) patients (<em>P</em> &lt; .001), whereas <em>TP53</em> alterations were more frequent among Asian (75.6%) than White (69.9%) or Black (71.9%) patients (<em>P</em> &lt; .001). Coalterations with <em>KRAS</em> were associated with improved survival over <em>KRAS</em> alteration alone, a pattern less-frequently observed among Black patients. Sex-based differences were also observed, with <em>BRAF</em> mutations more prevalent among females (14.6% vs 9.7%; <em>P</em> &lt; .001) and <em>TP53</em> mutations more common among males (73% vs 70.5%;<em>P</em> = .009). Although <em>KRAS</em> alterations tended to co-occur with alterations in <em>ATM</em>, <em>ARID1A</em>, <em>CREBBP</em>, <em>FAT1</em>, <em>KMT2B</em>, and <em>KMT2D</em> genes among patients with “early onset” colorectal cancer (all p &amp; q &lt; 0.05), alterations of these gene pairs were mutually exclusive among individuals with late onset colorectal cancer.</div></div><div><h3>Conclusion</h3><div>Genomic alterations and coalteration patterns varied relative to race/ethnicity, sex, and age at disease onset. Differences in genomic alteration patterns of colorectal cancer somatic tumor cells are an important consideration to help address disparities among different demographic groups.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109475"},"PeriodicalIF":3.2,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279815","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":"Serum carbohydrate antigen 19-9 greater than 100 and risk of invasive carcinoma in pancreatic intraductal papillary mucinous neoplasms: Worrisome feature or high-risk stigmata?","authors":"Maximiliano Servin-Rojas MD,&nbsp;Carlos Fernández-Del Castillo MD,&nbsp;Marwa Mohamed MD,&nbsp;Raja R. Narayan MD, MPH,&nbsp;Zhi Ven Fong MD, MPH, DrPH,&nbsp;Dario M. Rocha-Castellanos MD,&nbsp;Cristina R. Ferrone MD,&nbsp;Keith D. Lillemoe MD,&nbsp;Motaz Qadan MD, PhD","doi":"10.1016/j.surg.2025.109481","DOIUrl":"10.1016/j.surg.2025.109481","url":null,"abstract":"<div><h3>Background</h3><div>Elevated serum carbohydrate antigen 19-9 was incorporated as a worrisome feature in the International Association of Pancreatology 2017 Fukuoka guidelines and is associated with an increased risk of invasive carcinoma. We compared the independent predictive value of carbohydrate antigen 19-9 &gt;100 U/mL with other worrisome feature and high-risk stigmata to better delineate its utility and importance.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of all patients who underwent pancreatic resection for intraductal papillary mucinous neoplasms at a high-volume tertiary center in the United States. Clinicopathologic and radiologic variables were compared by the final pathologic status. Multivariable logistic regression was used to adjust for worrisome feature and high-risk stigmata.</div></div><div><h3>Results</h3><div>Of 645 patients who underwent pancreatectomy, 49% had low-grade dysplasia, 23% had high-grade dysplasia, and 28% had invasive carcinoma. A greater proportion of patients with invasive carcinoma had serum carbohydrate antigen 19-9 levels &gt;100 U/mL (30% vs 5% vs 4%, <em>P</em> &lt; .001). Multivariable analysis revealed that serum carbohydrate antigen 19-9 &gt;100 U/mL (odds ratio, 7.24, <em>P</em> &lt; .001), jaundice (odds ratio, 6.04, <em>P</em> &lt; .001), main pancreatic duct diameter &gt;10 mm (odds ratio, 4.05, <em>P</em> &lt; .001), and mural nodules &gt;5 mm (odds ratio, 3.12, <em>P</em> &lt; .001) were significant predictors of invasive carcinoma. Serum carbohydrate antigen 19-9 was not predictive of high-grade dysplasia.</div></div><div><h3>Conclusion</h3><div>Serum carbohydrate antigen 19-9 &gt;100 U/mL performed more similarly to other high-risk stigmata and appeared to be the strongest predictor of invasive carcinoma. Serum carbohydrate antigen 19-9 &gt;100 U/mL is a concerning finding that warrants consideration of surgical resection.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109481"},"PeriodicalIF":3.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The benefits of a department-wide prehabilitation program: A propensity score match analysis","authors":"Shaleen V. Sathe MD ,&nbsp;Yijin Huang BS ,&nbsp;Jorge G. Zarate Rodriguez MD ,&nbsp;Heidy Cos MD ,&nbsp;Jennifer Cook MA ,&nbsp;Melanie Koenen RN ,&nbsp;William C. Chapman MD ,&nbsp;Benjamin D. Kozower MD, MPH ,&nbsp;Ryan C. Fields MD, FACS ,&nbsp;Dominic E. Sanford MD, MBA, MPHS, FACS","doi":"10.1016/j.surg.2025.109489","DOIUrl":"10.1016/j.surg.2025.109489","url":null,"abstract":"<div><h3>Background</h3><div>Despite increasing use of prehabilitation in aging surgical patients, large studies demonstrating benefits on postoperative outcomes are lacking. This study aimed to determine if a department-wide prehabilitation program (Surgical Prehabilitation and Readiness) improves 30-day mortality, discharge to post-acute care facilities, and postoperative length of stay in high-risk surgical patients compared to historical controls, and to examine age's influence on these outcomes.</div></div><div><h3>Methods</h3><div>Surgical Prehabilitation and Readiness patients with 30 days of postoperative follow-up were compared to patients from the National Surgical Quality Improvement Program database undergoing procedures at the same institution during the 5 years before Surgical Prehabilitation and Readiness implementation (pre–Surgical Prehabilitation and Readiness). Surgical Prehabilitation and Readiness patients were propensity score matched to pre–Surgical Prehabilitation and Readiness patients in a 1:3 ratio, and outcomes were compared.</div></div><div><h3>Results</h3><div>Over 40 months, 424 patients completed Surgical Prehabilitation and Readiness and underwent surgery with 30 days of follow-up. Compared with pre–Surgical Prehabilitation and Readiness patients, Surgical Prehabilitation and Readiness patients were significantly older (median: 69.9 vs 60.7 years, <em>P</em> &lt; .001) with higher American Society of Anesthesiologists class (≥3: 84.7% vs 54.4%, <em>P</em> &lt; .001) and more comorbidities. Compared to propensity score–matched pre–Surgical Prehabilitation and Readiness patients (<em>n</em> = 1,161), Surgical Prehabilitation and Readiness patients (<em>n</em> = 387) had significantly decreased 30-day mortality (0.8% vs 2.8%, <em>P</em> = .023), discharge to post-acute care facility (8.8% vs 12.9%, <em>P</em> = .030), and length of stay (7.2 vs 8.0 days, <em>P</em> = .039). Older Surgical Prehabilitation and Readiness patients (age &gt; median) exhibited significantly decreased 30-day mortality (0.6% vs 3.3%, <em>P</em> = .044) and discharge to post-acute care facility (11.6% vs 19.3%, <em>P</em> = .017), whereas younger Surgical Prehabilitation and Readiness patients (age ≤ median) exhibited decreased length of stay (6.9 vs 8.2 days, <em>P</em> = .021).</div></div><div><h3>Conclusions</h3><div>Prehabilitation reduces postoperative mortality, loss of functional independence, and hospital recovery time, and the benefits vary by age. These findings support the implementation of prehabilitation programs in clinical practice.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109489"},"PeriodicalIF":3.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271616","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":"Validation and modification of the PAncreatic surgery Composite Endpoint (PACE) model: A single-institution study from Southeast Asia","authors":"Hwee Leong Tan MBBS, MMed, FRCS ,&nbsp;Yun Zhao PhD ,&nbsp;Darren Weiquan Chua MBBS, MMed, FRCS ,&nbsp;Jin Yao Teo MBBS, MMed, FRCS ,&nbsp;Peng Chung Cheow MBBS, MMed, FRCS, FAMS, FACS ,&nbsp;Alexander Yaw Fui Chung MBBS, FRCS ,&nbsp;Ivan En-Howe Tan MBA ,&nbsp;Marianne Kit Har Au BSc ,&nbsp;Brian Kim Poh Goh MBBS, MMed, FRCS, FAMS ,&nbsp;Ye Xin Koh MBBS, MMed, FRCS","doi":"10.1016/j.surg.2025.109482","DOIUrl":"10.1016/j.surg.2025.109482","url":null,"abstract":"<div><h3>Background</h3><div>The PAncreatic surgery Composite Endpoint was developed as a standardized, clinically relevant outcome measure for pancreatectomies, and it has been shown to correlate with prolonged length of stay and 90-day mortality. Although the PAncreatic surgery Composite Endpoint combines key complications of postoperative pancreatic fistula, postpancreatectomy hemorrhage, and reoperation/reintervention into a single measure, delayed gastric emptying has not been integrated. We aimed to validate PAncreatic surgery Composite Endpoint and assess whether adding delayed gastric emptying (modified PAncreatic surgery Composite Endpoint) enhances its predictive performance in a Southeast Asian cohort.</div></div><div><h3>Methods</h3><div>Prolonged length of stay was defined as ≥20 days (the 75th percentile of length of stay). PAncreatic surgery Composite Endpoint and modified PAncreatic surgery Composite Endpoint were evaluated as binary indicators using logistic regression analyses to assess their associations with prolonged length of stay and 90-day mortality. Model performance was evaluated using the area under the receiver operating characteristic curve, sensitivity, specificity, and calibration curves.</div></div><div><h3>Results</h3><div>A total of 575 patients underwent pancreatectomy at Singapore General Hospital between 2018 and 2023. When predicting prolonged length of stay, modified PAncreatic surgery Composite Endpoint (area under the receiver operating characteristic curve, 0.781; sensitivity, 79.2%; specificity, 77.0%) outperformed PAncreatic surgery Composite Endpoint (area under the receiver operating characteristic curve, 0.669; sensitivity, 53.0%; specificity, 80.8%), demonstrating stronger discrimination in both pancreatoduodenectomy and distal pancreatectomy subcohorts and retaining good calibration. For postoperative 90-day mortality, PAncreatic surgery Composite Endpoint and modified PAncreatic surgery Composite Endpoint demonstrated moderate, comparable performance (area under the receiver operating characteristic curves of 0.682 and 0.679, respectively) and exhibited good calibration.</div></div><div><h3>Conclusion</h3><div>The PAncreatic surgery Composite Endpoint and modified PAncreatic surgery Composite Endpoint models are robust and clinically relevant tools for predicting prolonged length of stay and 90-day mortality after pancreatectomy. Adding delayed gastric emptying to the modified PAncreatic surgery Composite Endpoint model enhances its predictive performance for prolonged length of stay.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109482"},"PeriodicalIF":3.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271628","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}