Surgery最新文献

{"title":"Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis","authors":"Patrick Goldhawk-White BSc ,&nbsp;Kevin White MD, PhD ,&nbsp;Manish Chand MBA, PhD ,&nbsp;Danny A. Sherwinter MD ,&nbsp;Steven Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.110072","DOIUrl":"10.1016/j.surg.2025.110072","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.</div></div><div><h3>Methods</h3><div>Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.</div></div><div><h3>Results</h3><div>Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.</div></div><div><h3>Conclusion</h3><div>For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110072"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078888","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":"Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue","authors":"Océane Lelièvre MD ,&nbsp;Solafah Abdalla MD, PhD ,&nbsp;Aurélien Amiot MD, PhD ,&nbsp;Antoine Meyer MD, PhD ,&nbsp;Franck Carbonnel MD, PhD ,&nbsp;Christophe Penna MD, PhD ,&nbsp;Stéphane Benoist MD, PhD ,&nbsp;Antoine Brouquet MD, PhD","doi":"10.1016/j.surg.2026.110082","DOIUrl":"10.1016/j.surg.2026.110082","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.</div></div><div><h3>Methods</h3><div>All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m², and permanent stoma retained for multivariate analysis.</div></div><div><h3>Results</h3><div>One hundred nine patients underwent surgery for refractory colitis (<em>n</em> = 32; 29%), severe acute colitis (<em>n</em> = 58; 54%), and dysplasia (<em>n</em> = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; <em>P</em> = .022).</div></div><div><h3>Conclusion</h3><div>Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110082"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078889","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":"National trends in conduit selection for redo coronary arterial bypass grafting","authors":"Bennet S. Cho MD ,&nbsp;Nguyen K. Le MD, MS ,&nbsp;Troy Coaston BS ,&nbsp;Esteban Z. Aguayo MD ,&nbsp;Oh Jin Kwon MD ,&nbsp;Saad Mallick MD ,&nbsp;Giselle Porter BS ,&nbsp;Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.110043","DOIUrl":"10.1016/j.surg.2025.110043","url":null,"abstract":"<div><h3>Background</h3><div>Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.</div></div><div><h3>Methods</h3><div>Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into <em>F</em><em>irst-time</em> and <em>R</em><em>edo</em> cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.</div></div><div><h3>Results</h3><div>Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (<em>P</em> &lt; .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).</div></div><div><h3>Conclusion</h3><div>Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110043"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941375","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":"Calcium and vitamin D reduce hypoparathyroidism and hospital stay after thyroidectomy: A randomized controlled trial","authors":"Vasileios Gkanis MD, MSc ,&nbsp;Konstantinos Nastos MD, PhD ,&nbsp;Konstantinos Ntalaperas MD ,&nbsp;Evangelia Agianni MD ,&nbsp;Spyridon Lainas MD ,&nbsp;Panagiota Raikou MD ,&nbsp;Nikolaos Dafnios MD, PhD ,&nbsp;Ioannis Papakonstantinou MD, PhD ,&nbsp;Sophocles Lanitis MD, PhD","doi":"10.1016/j.surg.2025.110071","DOIUrl":"10.1016/j.surg.2025.110071","url":null,"abstract":"<div><h3>Background</h3><div>Transient hypoparathyroidism is a common complication after total thyroidectomy, prolonging hospitalization and necessitating calcium and/or vitamin D replacement. Evidence from prospective randomized trials on preventive supplementation remains limited. This study aimed to evaluate whether prophylactic calcium and vitamin D supplementation reduces transient hypoparathyroidism and shortens hospital stay after total thyroidectomy.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, randomized, controlled, open-label trial, 600 patients undergoing total thyroidectomy without central neck dissection were randomized to receive prophylactic oral calcium carbonate/gluconate and alfacalcidol (group A, <em>n</em> = 300) or standard postoperative care (group B, <em>n</em> = 300). Primary outcomes were biochemical and symptomatic hypocalcemia and the need for intravenous calcium. Secondary outcomes included postoperative serum calcium levels and length of hospital stay. Statistical analyses used χ², Student’s <em>t</em> test, Mann-Whitney <em>U</em> test, and odds ratio and 95% confidence interval.</div></div><div><h3>Results</h3><div>Laboratory hypocalcemia (serum calcium &lt;8.5 mg/dL) occurred significantly less often in group A (16.9% vs 39.9%; odds ratio 0.305, 95% confidence interval 0.207–0.451, <em>P</em> &lt; .001). Symptomatic hypocalcemia was also reduced (5.6% vs 12.3%; odds ratio 0.427, 95% confidence interval 0.232–0.785, <em>P</em> &lt; .005), as was the need for intravenous calcium (1.8% vs 9.3%; odds ratio 0.175, 95% confidence interval 0.070–0.441, <em>P</em> &lt; .001). Group A demonstrated higher mean serum calcium levels on postoperative days 1 and 2 (<em>P</em> &lt; .001) and a shorter hospital stay (1.25 days vs 1.7 days, <em>P</em> &lt; .001). Supplementation benefits were consistent across subgroups stratified by malignancy status and preoperative vitamin D levels.</div></div><div><h3>Conclusion</h3><div>Routine calcium and vitamin D supplementation after total thyroidectomy significantly reduces transient hypoparathyroidism and shortens hospitalization. These findings support its use as a standard postoperative strategy to enhance recovery and reduce health care resource utilization.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110071"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078863","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":"Beyond the no-show: A case study highlighting the hidden scope of barriers to radiotherapy adherence in cancer care","authors":"Camille A. Biggins MHA,&nbsp;Laurie J. Kirstein MD, FACS,&nbsp;Eileen Reilly MSW,&nbsp;Kathryn Swingle MSW, LICSW,&nbsp;Kelly Christensen MSW, LICSW,&nbsp;Laura Marquez MSW, LSWAIC,&nbsp;Mark Daniels BS","doi":"10.1016/j.surg.2026.110087","DOIUrl":"10.1016/j.surg.2026.110087","url":null,"abstract":"<div><h3>Background</h3><div>Despite prevalent systemic barriers to accessing healthcare services, Virginia Mason Medical Center’s Floyd &amp; Delores Jones Cancer Institute has historically taken a piecemeal approach in responding to barriers. To uphold the organization’s mission, they participated in the Commission on Cancer’s “Breaking Barriers” national quality improvement collaborative in 2023 to investigate the predictable and modifiable reasons for radiotherapy nonadherence among their patients with cancer.</div></div><div><h3>Methods</h3><div>From March 1 to December 15, 2023, a multidisciplinary quality improvement team prospectively collected data on patients aged 18–99 years scheduled to receive 14–15 fractions of radiotherapy, excluding palliative care and ultrafractionation regimens. The team employed REDCap for bimonthly reporting and used multiple investigative methods including community assessments, patient chart reviews, patient narratives, and stakeholder input sessions. Environmental and community factors affecting transportation access were systematically evaluated using established quality improvement frameworks. Social work activity data were also collected to quantify institutional resource allocation.</div></div><div><h3>Results</h3><div>Among 104 eligible patients during the initial study period, 85.6% completed all scheduled appointments, 14.4% missed at least 1 appointment, and 3.8% met the no-show threshold of missing at least 3 appointments. By the end of 2023, the total institutional no-show rate was 5.2%, with transportation accounting for only 5.3% of all missed radiotherapy appointments. However, oncology social workers spent 14.8% of their time addressing transportation needs. Transportation-related missed appointments decreased to 3.7% by December 2023, while social work interventions prevented numerous potential no-shows from being recorded.</div></div><div><h3>Conclusion</h3><div>This project reveals an “iceberg problem” where transportation insecurity’s true magnitude remains hidden beneath outcome-oriented no-show metrics. The substantial discrepancy between low rates of transportation-related missed appointments (5.3%) and high social work time allocation (14.8%) demonstrates that no-show rates mask significant institutional workload required to maintain treatment adherence. Social work time emerges as a more sensitive, novel indicator of barrier vulnerability that reframes the problem from patient-centric failure to system-level resource demands. Health care organizations should implement proactive, data-driven barrier management systems that account for hidden workloads while developing sustainable, multilevel interventions to ensure equitable cancer care access.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110087"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137781","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":"Utilization of thyroid ultrasound and surgery after glucagon-like peptide-1 receptor agonist prescription","authors":"Lia D. Delaney MD, MS ,&nbsp;Heather Day MS ,&nbsp;Katherine Arnow MS ,&nbsp;Robin M. Cisco MD ,&nbsp;Dan Eisenberg MD, MS ,&nbsp;Manjula Kurella Tamura MD, MPH ,&nbsp;Insoo Suh MD ,&nbsp;Electron Kebebew MD ,&nbsp;Carolyn D. Seib MD, MAS","doi":"10.1016/j.surg.2025.110042","DOIUrl":"10.1016/j.surg.2025.110042","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110042"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941431","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":"Implementation of a robotic pancreatoduodenectomy program: Navigating the learning curve with a liberal patient selection and conversion strategy","authors":"Zhi Ven Fong MD, MPH, DrPH ,&nbsp;Chee-Chee Stucky MD ,&nbsp;Po Hong Tan MBBS ,&nbsp;Dillon Cheung MD ,&nbsp;Stephanie Yu MD ,&nbsp;Anita M. Moyer RN, OCN ,&nbsp;Julie L. Hildebrand PA-C, MS ,&nbsp;Hoe Yan Hor MBBS ,&nbsp;Melody Tu MBBS ,&nbsp;Rick Bold MD, MBA ,&nbsp;Yu-Hui Chang MS, PhD ,&nbsp;Nabil Wasif MD, MPH","doi":"10.1016/j.surg.2025.110070","DOIUrl":"10.1016/j.surg.2025.110070","url":null,"abstract":"<div><h3>Background</h3><div>The robotic platform is being increasingly utilized to perform pancreatoduodenectomy, but implementation can be associated with a steep learning curve, and large number of cases is required to surmount it. We detail an approach for implementation of a robotic pancreatoduodenectomy program that incorporates a liberal patient selection and conversion strategy to achieve proficiency while maintaining outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing pancreatoduodenectomy from January 2018 to June 2025 were identified. A robotic pancreatoduodenectomy program was implemented in October 2023. Difference-in-difference models with patients identified in the National Surgical Quality Improvement Program during the same period as a control cohort were used.</div></div><div><h3>Results</h3><div>A total of 205 patients underwent pancreatoduodenectomy, 127 in the preimplementation period and 78 in the postimplementation period. Of the 78 pancreatoduodenectomies performed in the postimplementation period, 62 (79.5%) were performed robotically with a conversion rate of 19.4%. Compared with the preimplementation cohort, the postimplementation cohort had similar complication and mortality rates but shorter median length of stay (5 days vs 8 days, <em>P</em> &lt; .0001). On difference-in-difference analyses, the institutional cohort was associated with an increase in robotic use after program implementation (+74.8%, <em>P</em> &lt; .001) compared with the National Surgical Quality Improvement Program control cohort. The institutional cohort was also associated with fewer pancreatic fistulas (−12.3%, <em>P</em> = .02), shorter length of stay (−2.0 days, <em>P</em> &lt; .001), and similar 30-day major morbidity (−9.3%, <em>P</em> = .14) and readmission (+7.3%, <em>P</em> = .13), as well as mortality rates (−1.7%, <em>P</em> = .45) after program implementation.</div></div><div><h3>Conclusion</h3><div>A robotic pancreatoduodenectomy program with a liberal patient selection and conversion strategy can be safely implemented while preserving overall outcomes compared with National Surgical Quality Improvement Program benchmarks.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110070"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078867","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":"Local infiltration of liposomal bupivacaine is associated with reduced postoperative admission in anterior abdominal hernia repair","authors":"Johnathan V. Torikashvili BS,&nbsp;Rachel L. Wolansky MD,&nbsp;Emily A. Grimsley MD,&nbsp;Tyler Zander MD,&nbsp;Joseph Sujka MD,&nbsp;Paul C. Kuo MD, MS, MBA,&nbsp;Melissa A. Kendall MD","doi":"10.1016/j.surg.2025.110069","DOIUrl":"10.1016/j.surg.2025.110069","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110069"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980615","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":"Effect of a preoperative coating agent on postoperative skin tears in pancreatectomy","authors":"Masahiko Kubo MD, PhD ,&nbsp;Eri Iwai RN ,&nbsp;Hirofumi Akita MD, PhD ,&nbsp;Kunihito Gotoh MD, PhD ,&nbsp;Yasunari Fukuda MD, PhD ,&nbsp;Hisateru Komatsu MD, PhD ,&nbsp;Kei Yamamoto MD, PhD ,&nbsp;Ryota Mori MD ,&nbsp;Masatoshi Kitakaze MD, PhD ,&nbsp;Norihiro Matsuura MD, PhD ,&nbsp;Yasunori Masuike MD, PhD ,&nbsp;Takahito Sugase MD, PhD ,&nbsp;Yuki Ushimaru MD, PhD ,&nbsp;Masaaki Mio MD, PhD ,&nbsp;Yoshitomo Yanagimoto MD, PhD ,&nbsp;Takashi Kanemura MD, PhD ,&nbsp;Toshinori Sueda MD, PhD ,&nbsp;Yoshinori Kagawa MD, PhD ,&nbsp;Kazuyoshi Yamamoto MD, PhD ,&nbsp;Junichi Nishimura MD, PhD ,&nbsp;Shogo Kobayashi MD, PhD","doi":"10.1016/j.surg.2025.110039","DOIUrl":"10.1016/j.surg.2025.110039","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative skin tears are an underrecognized complication following pancreatectomy and often result from the removal of adhesive surgical drapes. Despite a negative impact on recovery, limited strategies are available for their prevention.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data for 348 patients who underwent pancreatectomy at our institution from April 2019 to December 2021. In this cohort, 71 patients had received a preoperative sterile coating agent (intervention group), and 277 patients had not (control group). The incidence, severity, and treatment duration of postoperative skin tears were compared between these 2 groups, and univariate and multivariate analyses were performed to identify risk factors. Propensity score matching also was conducted, and receiver operating characteristic curve analysis was used to evaluate operative time thresholds.</div></div><div><h3>Results</h3><div>Skin tears occurred in 19.0% of patients. The incidence was significantly lower in the intervention group compared with the control group (9.9% vs 21.3%, <em>P</em> = .02). Multivariate and propensity score matching analyses identified a prolonged operative time and absence of coating agent as independent risk factors for tears. Treatment duration was significantly shorter in the intervention group (<em>P</em> = .03). Receiver operating characteristic analysis identified a longer threshold operative time for skin tear occurrence in the intervention group (673 minutes versus 656 minutes in the control group), suggesting improved skin tolerance.</div></div><div><h3>Conclusion</h3><div>A sterile preoperative coating agent significantly reduces the risk of postoperative skin tears following pancreatectomy and may improve skin tolerance during prolonged procedures. Clinical use of this agent should be considered in high-risk surgical patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110039"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908847","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 surgeon advocate's role in shaping state and federal policy","authors":"Ross F. Goldberg MD","doi":"10.1016/j.surg.2025.110068","DOIUrl":"10.1016/j.surg.2025.110068","url":null,"abstract":"<div><div>Although most surgeons dedicate their careers to clinical excellence, education, and research, many overlook a critical fourth pillar of the profession, advocacy. Surgeons already advocate daily, whether guiding patients through care plans, performing technically complex operations, or navigating insurance barriers. However, few recognize their potential to influence broader health policies that directly affect their surgical practices. This article emphasizes the urgent need for surgeons to engage in both legislative and regulatory processes. Policy decisions, ranging from scope of practice laws to Medicare reimbursement rates, have profound and often immediate impacts on how surgeons deliver care. Although surgeons may be familiar with legislative processes, many underestimate the influence of regulatory bodies such as the Centers for Medicare &amp; Medicaid Services, Food and Drug Administration, and state health departments. These agencies interpret and implement laws, often through unilateral decisions, without direct votes and with minimal physician input. Surgeons are often absent from critical discussions at both state and federal levels, allowing other stakeholders such as the insurers, hospitals, and device manufacturers to shape the narrative and outcome. To counteract this, surgeons must proactively engage with legislators, build long-term relationships, support political action efforts, and participate in organized medicine. These steps do not require holding office or mastering policy intricacies but just consistent, informed involvement. Advocacy is a professional responsibility, an extension of surgical leadership that goes beyond the operating room. By becoming more engaged, surgeons can protect the integrity of their practice, ensure patients maintain access to high-quality surgical care, and shape a health care system that values expertise and evidence-based care. The call to action is clear; if surgeons want a seat at the decision-making table, they must claim it. The scalpel may heal patients, but the pen shapes the system, and both are needed to lead the future of surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110068"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980617","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}