Surgery最新文献

{"title":"Measuring what matters: The role of synoptic operative reports in patient outcomes.","authors":"Tracy S Wang","doi":"10.1016/j.surg.2025.109784","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109784","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109784"},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275984","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.2025.109772","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109772","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109772"},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275918","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":"Is it possible to predict functional recovery of vocal folds palsy? Role of intraoperative neuromonitoring and laryngostroboscopy findings.","authors":"Pierpaolo Gallucci, Priscilla Francesca Procopio, Francesco Pennestrì, Luca Revelli, Annamaria D'Amore, Annamaria Martullo, Giuseppe Marincola, Maria Raffaella Marchese, Lucia D'Alatri, Carmela De Crea, Marco Raffaelli","doi":"10.1016/j.surg.2025.109712","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109712","url":null,"abstract":"<p><strong>Background: </strong>Vocal fold palsy is a common reason for claims after thyroidectomy. We evaluated the prognostic role of intraoperative neuromonitoring and postoperative flexible fiberoptic laryngostroboscopy findings in patients with type I or type II loss of signal, indicating the injury in an exact point of recurrent laryngeal nerve and whether the damage level cannot be determined, respectively.</p><p><strong>Methods: </strong>Among 4,526 intraoperative neuromonitoring-assisted thyroidectomies (2021-2024), all cases of loss of signal were prospectively analyzed. Flexible fiberoptic laryngostroboscopy was performed in first, 15th, 45th, and 180th postoperative day for the evaluation of arytenoid motility and arytenoid inward rotation. On the basis of vocal fold motility at postoperative day 180, patients were categorized into a recovery group and nonrecovery group. Predictive factors for vocal fold palsy were assessed using univariable and multivariable analyses.</p><p><strong>Results: </strong>Of 104 included patients, 87 (83.6%) patients recovered vocal fold motility within postoperative day 180. After univariable analysis, type I loss of signal (P = .001) and postoperative day 15 arytenoid inward rotation (P = .001) were significantly more frequent in the nonrecovery group, whereas postoperative day 15 arytenoid motility was more frequent in the recovery group (P = .001). Type I loss of signal, absence of arytenoid motility, and presence of arytenoid inward rotation at postoperative day 15 were associated with recovery in 1 case (P = .001), whereas type II loss of signal with presence of arytenoid motility and absence of arytenoid inward rotation related to recovery in all cases (P = .001). Multivariable analysis showed preserved arytenoid motility as a protective factor for persistent vocal fold palsy (P = .010), whereas the presence of arytenoid inward rotation increased the risk of persistent vocal fold palsy (P = .002).</p><p><strong>Conclusion: </strong>This study results support the prognostic role of loss of signal type and postoperative day 15 arytenoid features on vocal fold palsy persistence 6 months after surgery. The identification of these parameters may help clinicians to address patients to early management of vocal fold palsy.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109712"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259292","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":"Causes and overlap of chronic postoperative inguinal pain: A retrospective cohort study and implications for clinical practice and research","authors":"John M. Findlay PhD ,&nbsp;Matthew Lund MSc ,&nbsp;Lucy Miller FRCA ,&nbsp;David Sanders MSc ,&nbsp;Alan Bennett FFA ,&nbsp;Jan Vollert PhD","doi":"10.1016/j.surg.2025.109769","DOIUrl":"10.1016/j.surg.2025.109769","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109769"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259261","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.2025.109760","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109760","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109760"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259326","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.2025.109808","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109808","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109808"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252815","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":"Barriers to workup and referral of primary hyperparathyroidism: A qualitative study of providers' perspectives.","authors":"Elizabeth Cooper, Diana Gutierrez-Meza, Esra Alagoz, John O'Connor, Anjali Sanghvi, Courtney Balentine, Rebecca Sippel, Alexander Chiu","doi":"10.1016/j.surg.2025.109711","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109711","url":null,"abstract":"<p><strong>Background: </strong>Patients with primary hyperparathyroidism are underdiagnosed and undertreated. As the treatment pathway starts in primary care, we sought to examine the barriers primary care providers encounter when diagnosing and referring patients with primary hyperparathyroidism.</p><p><strong>Methods: </strong>We conducted semistructured interviews with 19 primary care providers. Virtual interviews were audio-recorded, transcribed verbatim, and deidentified. A multidisciplinary team coded and analyzed all transcripts using deductive thematic analysis based on the Disparities in the Treatment of primary hyperparathyroidism framework.</p><p><strong>Results: </strong>Providers overall felt comfortable diagnosing straightforward primary hyperparathyroidism, but struggled with nuanced or complex cases, and desired ways to informally discuss cases with specialists. Commonly identified barriers to workup include competing patient social and medical priorities and lack of time and patient education resources to guide patients through the needed steps. Primary care providers identified areas for improvement including developing resources to help busy primary care providers educate patients on primary hyperparathyroidism, locally tailored diagnostic and referral algorithms, and the ability to obtain informal input from surgeons.</p><p><strong>Conclusions: </strong>Primary care providers are generally knowledgeable of primary hyperparathyroidism and its management; however, they often face barriers in understanding the nuances of primary hyperparathyroidism and coordinating a multistep workup in a time-limited setting. This presents opportunities for action, including creating patient-centered education materials on primary hyperparathyroidism for providers to use, and specialists making their expertise more available to local primary care providers via e-consults and clear referral pathways and guidelines. Ultimately, eliminating barriers to workup and referral will improve the care of patients with primary hyperparathyroidism.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109711"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252866","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":"Surgeon-performed transcutaneous laryngeal ultrasonography after thyroidectomy: Diagnostic accuracy and learning curve","authors":"David Figueroa-Bohorquez MD ,&nbsp;Marcela Marulanda MD ,&nbsp;Carlos Betancourt MD ,&nbsp;Carlos Garcia MD ,&nbsp;Juan G. Sanchez MD ,&nbsp;Yessica Trujillo MD ,&nbsp;Anibal Ariza MD ,&nbsp;Laura Mendieta MD ,&nbsp;Alvaro Sanabria PhD","doi":"10.1016/j.surg.2025.109779","DOIUrl":"10.1016/j.surg.2025.109779","url":null,"abstract":"<div><h3>Introduction</h3><div>Vocal cord paralysis is an uncommon complication after thyroidectomy, reported in approximately 3% to 4% of procedures. Flexible laryngoscopy is the gold standard for assessing postoperative vocal cord mobility, but its usage is limited because of expense, discomfort, and availability. Transcutaneous laryngeal ultrasonography has evolved as a noninvasive and widely available alternative.</div></div><div><h3>Materials and Methods</h3><div>We conducted a prospective cross-sectional study on adult patients receiving total or partial thyroidectomy by head and neck surgeons. The operating surgeon performed transcutaneous laryngeal ultrasonography postoperatively and compared the results to a blinded laryngoscopic examination. The sensitivity, specificity, predictive value, and likelihood ratios were calculated. For nondiagnostic tests, best- and worst-case scenarios were evaluated. A learning curve study was also conducted.</div></div><div><h3>Results</h3><div>A total of 146 patients with 239 nerves at risk were included. Vocal cord paralysis was observed in 2.1% of nerves at risk. Transcutaneous laryngeal ultrasonography demonstrated a sensitivity of 80% and a specificity ranging from 94.4% to 99.6%, depending on the clinical scenario. The negative predictive value remained high (99.6%), whereas the positive predictive value ranged from 23.5% to 80%. After about 50 examinations, the learning curve stabilized, and the median examination length was 26.9 seconds.</div></div><div><h3>Conclusion</h3><div>Surgeons may conduct transcutaneous laryngeal ultrasonography with good diagnostic accuracy and efficiency, making it a cost-effective technique for postoperative vocal cord evaluation in thyroidectomy patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109779"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259202","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 association of community-level social vulnerability with access to high-volume endocrine surgeons.","authors":"Marin Kheng, Alexander Manzella, Grigor Simitian, Amanda M Laird, Toni Beninato","doi":"10.1016/j.surg.2025.109691","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109691","url":null,"abstract":"<p><strong>Background: </strong>Community-level factors have been linked to disparities in access to health care. We examined the relationship between social vulnerability and access to high-volume surgeons.</p><p><strong>Methods: </strong>The Vizient Clinical Database was queried to identify patients who underwent thyroidectomy from 2013 to 2021. Surgeons were classified as low- (1-24 annual cases), medium- (25-49 cases), or high-volume (50+ cases). Regression was used to estimate the probability of operation with a high-volume surgeon based on community-level social vulnerability index scores across nine domains: economic, education, health care, neighborhood, housing, clean environment, social environment, transportation, and public safety. Patient demographics were also analyzed.</p><p><strong>Results: </strong>Of 375,663 cases, 36.8% were performed by low-volume surgeons, 21.7% by medium-volume surgeons, and 41.5% by high-volume surgeons. Decreased odds of operation with a high-volume surgeon were found among patients residing in communities with higher vulnerability in health care (odds ratio 0.83 [0.82-0.84]), education (odds ratio 0.88 [0.87-0.89]), environmental pollution (odds ratio 0.91 [0.90-0.93]), and public safety (odds ratio 0.95 [0.93-0.97]). Conversely, vulnerabilities in neighborhood resources (odds ratio 1.15 [1.13-1.16]) and transportation (odds ratio 1.07 [1.06-1.09]) were associated with increased access to high-volume care. Males and those without private insurance were less likely to undergo surgery with a high-volume surgeon (odds ratio 0.76 [0.75-0.77] and odds ratio 0.65-0.80, respectively). Patients undergoing operations for malignancy were slightly more likely to see a high-volume surgeon (odds ratio 1.05 [1.04-1.06]).</p><p><strong>Conclusions: </strong>Patients residing in communities with fewer educational and health care resources were significantly less likely to undergo thyroidectomy with a high-volume surgeon. Policies targeting these domains may yield the greatest community-level impact on patients' access to such care. Individual demographics, however, remain critical determinants of access.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109691"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259240","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.2025.109737","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109737","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109737"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259379","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}