Surgery最新文献

{"title":"Assessment of health literacy across types of hyperparathyroidism.","authors":"Hameeda Arif Arain, Daniel Gomez Carrillo, Niranjna Swaminathan, Chandler McLeod, Peter Abraham, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen","doi":"10.1016/j.surg.2026.110685","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110685","url":null,"abstract":"<p><strong>Background: </strong>Health literacy is the ability to obtain, process, and understand basic health information necessary to make informed decisions. Low health literacy has been associated with delays in diagnosis and treatment, reduced adherence, and worse clinical outcomes. This study aimed to assess health literacy among individuals with hyperparathyroidism.</p><p><strong>Methods: </strong>The National Institutes of Health All of Us Research database was used to evaluate health literacy in adults with primary, renal secondary, nonrenal secondary, and tertiary hyperparathyroidism. Health literacy was assessed using 3 questions from the Overall Health survey adapted from the Brief Health Literacy Screening Tool (BRIEF-3). Scores ranged from 3 to 15, with >9 indicating adequate health literacy and ≤9 indicating inadequate health literacy. Chi-square tests compared health literacy across hyperparathyroidism subtypes and demographic variables, with P < .05 considered significant.</p><p><strong>Results: </strong>Among 6,473 participants, 85.7% demonstrated adequate health literacy and 14.3% had inadequate health literacy. Females were more likely to have adequate health literacy than males (88.1% vs 81.8%, P < .001). Inadequate health literacy was more prevalent among Black participants compared with White participants (16.7% vs 6.4%, P < .001). Employment, higher education, and higher income were strongly associated with adequate health literacy (all P < .001). Inadequate health literacy was most common in renal secondary hyperparathyroidism (18.0%), followed by tertiary (12.4%), nonrenal secondary (9.5%), and primary hyperparathyroidism (8.3%) (P < .001).</p><p><strong>Conclusion: </strong>Inadequate health literacy is more prevalent among socioeconomically disadvantaged patients and those with renal secondary hyperparathyroidism. These disparities highlight the need for targeted educational interventions and tailored communication strategies to improve care in vulnerable populations.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110685"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183968","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 is in, but robot access is running behind.","authors":"Scott M Atay, Ory Wiesel, Anthony W Kim","doi":"10.1016/j.surg.2026.110681","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110681","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110681"},"PeriodicalIF":3.2,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228737","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":"Changes in body composition and insulin resistance after parathyroidectomy for primary hyperparathyroidism: A pilot prospective case-control study.","authors":"Yan Luk, Matrix M H Fung, David T W Lui, Brian H H Lang","doi":"10.1016/j.surg.2026.110653","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110653","url":null,"abstract":"<p><strong>Background: </strong>Recent literature suggested that parathyroidectomy for primary hyperparathyroidism may improve metabolic outcomes. This prospective study compared body composition and insulin resistance changes in patients with primary hyperparathyroidism undergoing parathyroidectomy versus nonoperative management.</p><p><strong>Methods: </strong>Consecutive patients with primary hyperparathyroidism meeting indications for parathyroidectomy were prospectively recruited. Patients undergoing parathyroidectomy (surgery group) were compared with patients who declined surgery or were pending parathyroid localization imaging (nonsurgery group). Metabolic assessment comprised body composition measurements with bioelectrical impedance analysis and blood indices for the Homeostasis Model Assessment for Insulin Resistance score. The surgery group was assessed preoperatively, at postoperative 3 and 6 months; the nonsurgery group at baseline and 6 months.</p><p><strong>Results: </strong>Sixty-six patients were analyzed (surgery: n = 31; nonsurgery: n = 35). Forty-five (68.2%) were females; mean age was 63 years. Baseline demographics and body composition parameters were comparable. The surgery group had increased fat-free mass (median, 42.4 vs 43.6 kg; P = .048), muscle mass (39.9 vs 41 kg, P = .045), and skeletal muscle mass (24 vs 24.7 kg, P = .046) at 3 months postoperatively. The nonsurgery group had increased fat percentage (29.3% vs 31.6%, P = .018) and fat mass (16.6 vs 18.4 kg, P = .005) at 6 months. Comparing the 2 groups, the nonsurgery group had a greater increase in fat proportion (-0.1% vs 0.8%, P = .042) and fat mass (-1% vs 3.67%, P = .040) over 6 months. Six-month Homeostasis Model Assessment for Insulin Resistance changes between the 2 groups were statistically insignificant (-0.18 vs 0.07, P = .920).</p><p><strong>Conclusion: </strong>Parathyroidectomy minimizes increase in fat mass in patients with primary hyperparathyroidism. By improving body composition, parathyroidectomy may reduce metabolic risk.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110653"},"PeriodicalIF":3.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168425","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 acceptability of a choice architecture intervention to promote use of thyroid lobectomy for low-risk thyroid cancer.","authors":"Steven Xie, Elizabeth M Bacon, Sarah E Bradley, Brian J Zikmund-Fisher, Mary Byrnes, Sarah T Hawley, Michael A Rubyan, Susan C Pitt","doi":"10.1016/j.surg.2026.110652","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110652","url":null,"abstract":"<p><strong>Background: </strong>With the 2025 American Thyroid Association guidelines supporting de-escalation of total thyroidectomy for low-risk thyroid cancer, interventions that distill guideline recommendations and facilitate rapid adoption are needed. This study evaluated the acceptability of a novel surgeon-directed intervention designed to increase thyroid lobectomy use.</p><p><strong>Methods: </strong>This convergent triangulation mixed-methods study enrolled thyroid surgeons using purposive and snowball sampling. Acceptability of a choice architecture-based intervention was quantified using the validated Theoretical Framework of Acceptability, which measures affective attitude, self-efficacy, perceived effectiveness, intervention coherence, burden, opportunity cost, and ethicality. Semistructured qualitative interviews explored initial impressions, strengths and weaknesses, and usability of the intervention and were analyzed deductively using the Theoretical Framework of Acceptability constructs.</p><p><strong>Results: </strong>Twenty-one participants completed the Theoretical Framework of Acceptability survey, and 12 participated in interviews. Participants were 47.1 ± 10.0 years old, mostly male (61.9%), White (71.4%), and self-identified as endocrine surgeons (71.4%). Theoretical Framework of Acceptability scores demonstrated good general acceptability, positive attitudes, and confidence in ability to use the intervention. Scores also revealed strong perceived effectiveness and clarity about how the intervention could improve surgical decision-making with minimal concern for the burden of incorporating into practice or ethical consequences. Participants noted the intervention could be \"helpful…especially for low-volume surgeons\" and appreciated both the \"appropriate amount\" of information and discussion of benefits and risks that was \"easier than having to do it all on [their] own.\"</p><p><strong>Conclusion: </strong>This novel intervention was acceptable among thyroid surgeons across all domains of the Theoretical Framework of Acceptability. Participants valued the intervention's practicality, clarity, and usability in guiding patient discussions and supporting decision-making for low-risk thyroid cancer.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110652"},"PeriodicalIF":3.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184235","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":"Metabolic reprogramming in differentiated thyroid cancer progression: A tumor metabolomics analysis.","authors":"Joshua D Preston, Logan D Glosser, Zachery R Jarrell, Mihini S Senanayake, ViLinh Tran, Jaclyn Weinberg, Jennifer M Robertson, Collin J Weber, Matthew Ryan Smith, Yongliang Liang, Jiada Zhan, Susan A Safley, Anee S Jackson, Snehal G Patel, Jyotirmay Sharma, Neil D Saunders, Young-Mi Go, Dean P Jones, Thomas Szabo Yamashita","doi":"10.1016/j.surg.2026.110658","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110658","url":null,"abstract":"<p><strong>Background: </strong>Differentiated thyroid cancers exhibit biologic and clinical heterogeneity not fully explained by conventional staging. Metabolic reprogramming is a hallmark of cancer, and its contribution to differentiated thyroid cancer progression is an ongoing area of study. Metabolomics-the comprehensive analysis of metabolites within biologic systems-may identify stage-specific metabolic signatures.</p><p><strong>Methods: </strong>Fifty-five differentiated thyroid cancer specimens underwent untargeted metabolomic profiling using liquid chromatography-mass spectrometry. Stage was assigned per American Joint Committee on Cancer, Eighth Edition criteria. Pathway enrichment analysis was performed, and specific metabolites were evaluated to define metabolic phenotypes of early-stage (I/II; n = 49) versus advanced-stage (III/IV; n = 6) tumors.</p><p><strong>Results: </strong>Over 10% of 17,270 metabolic features were significantly (P < .05; |fold change| >1.5) altered in advanced-stage differentiated thyroid cancers. Pathway analysis demonstrated remodeling of fatty acid, linoleate, pyrimidine, and alanine/aspartate metabolism with tumor progression. Advanced-stage tumors accumulated metabolites associated with nucleotide and epigenetic flux (guanosine monophosphate, adenosine monophosphate, S-adenosyl-L-homocysteine, and 1-methylnicotinamide), invasive membrane remodeling (γ-linolenate, oleate), and immune evasion (kynurenine, serotonin) while attenuating markers of oxidative metabolism (α-ketoisocaproate, acetyl phosphate) and adrenergic signaling (adrenaline). Correlation analysis demonstrated internal synchrony among these markers and a counter-regulatory relationship between differentiated function and biosynthetic expansion.</p><p><strong>Conclusion: </strong>Locally advanced differentiated thyroid cancers appear to exhibit a metabolic phenotype characterized by adrenergic suppression, immune evasion, invasive membrane remodeling, nucleotide and methylation flux, bioenergetic collapse, and resource shunting, all at the expense of differentiated and homeostatic functions. These hypothesis-generating findings suggest that metabolomic profiling could complement existing risk-stratification frameworks. Prospective validation of metabolic phenotypes as predictors of recurrence and progression is warranted.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110658"},"PeriodicalIF":3.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147960","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 clinical utility of \"suspicious\" molecular profile results and the Afirma Xpression Atlas in detecting thyroid malignancy: A long-term single-center validation study of the Afirma Genomic Sequencing Classifier.","authors":"Justin Bauzon, Eduardo Canalizo, Amy Han, Angela Thelen, Ludovico Sehnem, Katherine Heiden, Judy Jin, Joyce Shin, Eren Berber, Vikram Krishnamurthy, Allan Siperstein, Gustavo Romero-Velez","doi":"10.1016/j.surg.2026.110654","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110654","url":null,"abstract":"<p><strong>Background: </strong>A \"benign\" result from the Afirma Genomic Sequencing Classifier molecular test effectively rules out malignancy in cytologically indeterminate thyroid nodules. When a nodule is interpreted as \"suspicious,\" the ability of the Genomic Sequencing Classifier to predict cancer has been less precise. Separately, the Xpression Atlas panel identifies gene mutations that may augment Genomic Sequencing Classifier-suspicious results. We assessed the long-term performance of the Genomic Sequencing Classifier with Xpression Atlas to identify malignancy in indeterminate thyroid nodules.</p><p><strong>Methods: </strong>This is a single-center retrospective analysis of indeterminate (former Bethesda III/IV), Genomic Sequencing Classifier-suspicious thyroid nodules that underwent surgical resection from July 2017 to September 2024. Nodules were classified as thyroid cancer or nonthyroid cancer based on final pathology. Outcomes included the positive predictive value of the Genomic Sequencing Classifier with and without an Xpression Atlas-identified mutation.</p><p><strong>Results: </strong>Of 593 resected Genomic Sequencing Classifier-suspicious nodules, 512 (86%) were malignant. Mutations were more frequently detected via Xpression Atlas in malignant nodules (34.4% vs 11.1%; P < .001) compared with the nonthyroid cancer group. The overall rate of malignancy was 86.3%, with an increasing positive predictive value from 2017 (83.3%) to 2024 (89.0%). Absolute malignancy risk was significantly lower with age >55 years (83.2% vs 89.7%; P = .021) and higher with an Xpression Atlas-identified mutation (95.1% vs 82.4%; P < .001). On multivariable analysis, the presence of any mutation independently predicted thyroid cancer (odds ratio, 4.03; 95% confidence interval, 2.06-8.9; P < .001).</p><p><strong>Conclusion: </strong>In this large cohort study, the Afirma Genomic Sequencing Classifier demonstrated excellent rule-in performance, contrary to previous reports. Xpression Atlas-identified mutations further enhanced cancer detection, regardless of the specific mutation detected, supporting the clinical utility of Xpression Atlas with the Genomic Sequencing Classifier to correctly identify malignancy in indeterminate nodules.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110654"},"PeriodicalIF":3.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167320","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 estimated blood volume-guided prophylactic enoxaparin dosing in patients following minimally invasive surgery.","authors":"Laken Anderson, Tammy Kindel, William J Peppard, Lisa Rein","doi":"10.1016/j.surg.2026.110646","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110646","url":null,"abstract":"<p><strong>Background: </strong>Enoxaparin is commonly used for venous thromboembolism prophylaxis in surgical patients. Whether body mass index or estimated blood volume-based dosing better achieves target anti-factor Xa levels remains unclear. We compared body mass index and estimated blood volume-based dosing for accuracy in achieving target anti-factor Xa levels.</p><p><strong>Methods: </strong>Patients underwent primary or revisional minimally invasive surgery from January 2015 to June 2024. Inclusion required an anti-factor Xa drawn 2.5-6 hours after 3 consecutive enoxaparin doses. The target range for anti-factor Xa draw was 0.2-0.5 IU/mL. Enoxaparin was dosed based on estimated blood volume using the following guidelines: estimated blood volume 3-4.9 received 30 mg twice daily, estimated blood volume 5-6.9 received 40 mg twice daily, and estimated blood volume >7 received 60 mg twice daily. The dosage based on body mass index used the following: body mass index 18-40 received 40 mg once daily, body mass index 40-50 received 40 mg twice daily, and body mass index >50 received 60 mg twice daily.</p><p><strong>Results: </strong>Two hundred eighty-seven patients were included for analysis (137 received body mass index dosing, 150 received estimated blood volume dosing). The mean anti-factor Xa level for the estimated blood volume-dosed cohort was 0.27 compared with 0.36 for the body mass index cohort. Estimated blood volume-based enoxaparin dosing produced less variability of anti-factor Xa values than body mass index-based dosing. Spearman rank correlation coefficient showed that estimated blood volume tracks more closely to anti-factor Xa than body mass index.</p><p><strong>Conclusion: </strong>Estimated blood volume-based enoxaparin dosing resulted in lower and more consistent anti-factor Xa levels compared with body mass index-based dosing and demonstrated a stronger correlation with anticoagulant exposure. However, subtherapeutic levels were more frequent with estimated blood volume-based dosing, highlighting ongoing challenges in achieving optimal prophylaxis with current dosing strategies.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110646"},"PeriodicalIF":3.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184285","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":"Post-transplant hepatocellular carcinoma score: A simple point-based risk stratification system for 5-year mortality after liver transplantation in patients with hepatocellular carcinoma and explant pathology beyond Milan criteria.","authors":"Serkan Sucu, Aditya V Kotla, Ethan Angle, Andy Tran, Hassan Aziz","doi":"10.1016/j.surg.2026.110650","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110650","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing liver transplantation for hepatocellular carcinoma beyond the Milan criteria represent an expanding population with heterogeneous outcomes. We developed and validated a point-based score (post-transplant hepatocellular carcinoma score) to stratify 5-year mortality risk using readily available clinical and pathologic variables analyzed via machine learning.</p><p><strong>Methods: </strong>We analyzed hepatocellular carcinoma liver transplant recipients from the United Network for Organ Sharing database (2012-2019) with determinable 5-year outcomes whose explant pathology exceeded Milan criteria. A gradient-boosting classifier identified key predictors of mortality. Based on feature importance, we developed a 0-5 point score using the post-transplant-hepatocellular carcinoma components. Risk categories were low (score 0), moderate (score 1-2), and high (score 3-5).</p><p><strong>Results: </strong>Among 2,952 patients, 812 (27.5%) died within 5 years of transplantation. The post-transplant hepatocellular carcinoma score stratified patients into 3 risk groups, with 5-year survival of 82.7% (low), 72.2% (moderate), and 50.2% (high). Survival decreased monotonically with score, from 82.7% at score 0 to 39.0% at score 4. In the temporally independent 2019 validation cohort, the score demonstrated an area under the curve of 0.619 (95% confidence interval, 0.554-0.678), with 5-year survival of 84.0%, 72.2%, and 47.1% in the low-, moderate-, and high-risk groups, respectively. The score performed similarly to the Risk Estimation of Tumor Recurrence After Transplant score (area under the curve, 0.619 vs 0.629; P = .72).</p><p><strong>Conclusion: </strong>The post-transplant hepatocellular carcinoma score is a simple, validated tool for stratifying 5-year mortality risk in hepatocellular carcinoma transplant recipients beyond the Milan criteria and may assist in surveillance planning, patient counseling, and clinical decision-making pending external validation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110650"},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115187","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 impact of trauma faculty workforce expansion on advanced practice provider experience: Is there a ripple effect?","authors":"Courtney Pokrzywa, Anna Tatakis, Simin Golestani, Jeremy Levin, David Milia, Thomas Carver, Colleen Trevino, Marc de Moya, Patrick Murphy","doi":"10.1016/j.surg.2026.110645","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110645","url":null,"abstract":"<p><strong>Background: </strong>Appropriate trauma team staffing is essential for managing high patient volumes while supporting provider well-being. Although expanding attending surgeon coverage is a common strategy to address physician workload, the impact of additional faculty and team structure on advanced practice providers is not well defined. This study evaluates the effect of implementing a 2-surgeon trauma staffing model on patient outcomes and advanced practice provider-reported perceptions.</p><p><strong>Methods: </strong>We performed a retrospective review of adult trauma patients before (January 2018-March 2020) and after (March 2021-January 2023) implementation of a 2-surgeon staffing model. Outcomes, including mortality, complications, intensive care unit and hospital length of stay, and operative metrics, were compared between single- and 2-attending periods. Trauma advanced practice providers completed a 6-point Likert survey assessing workload, communication, job satisfaction, burnout, and overall satisfaction.</p><p><strong>Results: </strong>A total of 6,146 patients were treated under the single-attending model and 10,936 under the 2-attending model. Median patient census per surgeon decreased from 31 (interquartile range, 14; maximum, 80) to 21 (interquartile range, 6; maximum, 36). Advanced practice provider survey responses showed modest, nonsignificant improvements in workload, communication, job satisfaction, and burnout following implementation. Clinical outcomes remained similar between models, including hospital length of stay and complication rates (deep vein thrombosis: 0.26% vs 0.37%; pulmonary embolism: 0.46% vs 0.61%; and surgical site infection: 0.70% vs 0.75%).</p><p><strong>Conclusion: </strong>A 2-surgeon trauma staffing model maintained clinical outcomes but did not significantly improve advanced practice provider-reported workload, communication, or well-being. Attending-level expansion alone may be insufficient to enhance advanced practice provider experience, highlighting the need for interventions targeting advanced practice provider-specific workflows and system-level contributors to workload.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110645"},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115114","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":"Bone mineral density surveillance before and after parathyroidectomy: A provincial quality assurance retrospective cohort study.","authors":"Sydney Candy, Barak Almarzouq, Palak Sharma, Kevin Liu, Rebecca Andraos, Samantha Wolfe, Adrian Harvey, Caitlin T Yeo","doi":"10.1016/j.surg.2026.110648","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110648","url":null,"abstract":"<p><strong>Background: </strong>Most patients with primary hyperparathyroidism have relatively mild disease with a negative impact on bone mineral density developing over years. Surgery to correct hyperparathyroidism has a protective effect on bone mineral density. The aim of this study was to evaluate the postoperative surveillance and outcomes of osteoporosis patients after parathyroidectomy.</p><p><strong>Methods: </strong>Primary hyperparathyroidism patients who had undergone parathyroidectomy from 2020 to 2022 were identified using a prospective provincial operative reporting database. Follow-up data were extracted from a centralized patient record system. The primary outcome was the rate of bone mineral density evaluation within 5 years postparathyroidectomy in patients with preoperative osteoporosis (T score ≤-2.5). Secondary outcomes were change in bone mineral density and rates of persistent osteoporosis.</p><p><strong>Results: </strong>There were 305 parathyroidectomy patients with a median age of 64, and 77% were female. Preoperative bone mineral density was available for 245 of 305 (80%) patients, of whom 103 (34%) had osteoporosis. Median follow-up was 2.24 years (interquartile range, 1.04-2.93) for patients with osteoporosis. Only 64% of osteoporosis patients had a repeat bone mineral density within 5 years after surgery. There was a large positive effect on spine and hip bone mineral density and a small positive effect on the radius. In patients with postoperative bone mineral density, 86% still had osteoporosis.</p><p><strong>Conclusion: </strong>Findings support improved bone mineral density after parathyroid surgery in patients with osteoporosis. However, over one-third of patients did not undergo postoperative bone mineral density reassessment despite having preoperative osteoporosis. Given the high rate of persistent osteoporosis, further investigation is required to identify barriers to postoperative bone mineral density monitoring and to optimize long-term care for this patient population.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110648"},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115084","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}