Surgery最新文献

{"title":"Unique aspects of trauma due to thermobaric artillery weapon systems (specifically the Russian TOS-1A) during the war in Ukraine","authors":"Aaron Epstein MD ,&nbsp;Kostianyn V. Humeniuk MD ,&nbsp;Miroslav V. Nagnibedyuk MD ,&nbsp;Steven D. Schwaitzberg MD, FACS ,&nbsp;Global Surgical and Medical Support Group (GSMSG)","doi":"10.1016/j.surg.2025.109310","DOIUrl":"10.1016/j.surg.2025.109310","url":null,"abstract":"<div><div>This paper examines the unique trauma inflicted by the TOS-1A thermobaric weapon system during the conflict in Ukraine. The study aims to analyze the nature and severity of injuries caused by this thermobaric weapon system, comparing them with more conventional thermal injuries. Thermobaric weapons, like the TOS-1A, generate high temperatures and pressure waves without the fragmentation typical of traditional explosives, causing extensive internal and external damage. Data were collected from Role 2 mobile hospitals in various regions, focusing on individuals with thermal injuries. The study categorized patients into 2 groups: those with thermal trauma associated with weapons other than those specifically injured by TOS-1A weapons. The findings revealed that injuries from TOS-1A resulted predominantly in third- and fourth-degree burns, with significant upper respiratory tract damage and barotrauma. These injuries were more severe than general thermal injuries, which included a broader range of burn degrees. The study highlights the critical need for injury prevention and specialized medical response and treatment for such trauma, emphasizing the inefficacy of traditional protective structures against thermobaric weapons. The paper concludes with recommendations for improving survival rates, including prompt evacuation and advanced medical care in specialized burn centers.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109310"},"PeriodicalIF":3.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704625","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":"Utility of 4-dimensional computed tomography in predicting single-gland parathyroid disease—Can we abandon intraoperative parathyroid monitoring?","authors":"Michael S. Lui MD ,&nbsp;Jason C. Fisher MD ,&nbsp;Natalie Berger MD ,&nbsp;Alex J. Gordon MD ,&nbsp;Kyla Wright MD ,&nbsp;Vinh Nguyen MD ,&nbsp;Michael J. Persky MD ,&nbsp;Babak Givi MD ,&nbsp;Carolyn D. Seib MD ,&nbsp;John D. Allendorf MD ,&nbsp;Jason D. Prescott MD ,&nbsp;Kepal N. Patel MD ,&nbsp;Insoo Suh MD","doi":"10.1016/j.surg.2025.109327","DOIUrl":"10.1016/j.surg.2025.109327","url":null,"abstract":"<div><h3>Background</h3><div>Four-dimensional computed tomography is routinely used to localize parathyroid disease, with consistently excellent parathyroid gland localization rates reported. This study evaluated whether pairing 4-dimensional computed tomography results with preoperative clinical variables can accurately predict single-gland disease in primary hyperparathyroidism.</div></div><div><h3>Methods</h3><div>Patients with primary hyperparathyroidism who underwent both 4-dimensional computed tomography imaging and parathyroidectomy between January 2019 and September 2021 at a large academic health system were included. Patient demographics, preoperative characteristics, and peri- and postoperative data were collected. The accuracy of 4-dimensional computed tomography in correctly identifying patients with single-gland disease with and without preoperative calcium and parathyroid hormone levels was calculated. Single-gland disease was defined by intraoperative parathyroid hormone decrease &gt;50% and a hypercellular gland on pathology.</div></div><div><h3>Results</h3><div>One hundred seventy-five patients had 4-dimensional computed tomography results suggestive of single gland disease. One hundred fifty-two patients (87%) were predicted correctly to have single-gland disease. The predictive accuracy increased when stratifying by preoperative calcium (≥10.5 mg/dL, ≥11 mg/dL, and ≥12 mg/dL) and parathyroid hormone levels (≥65 pg/mL, ≥100 pg/mL, and ≥200 pg/dL). The accuracy further increased when stratifying by age (≤50 years). Accuracy for single gland disease was 100% when combined with any of the following: (1) calcium ≥12 mg/dL, (2) parathyroid hormone ≥200 pg/dL, or (3) calcium ≥11 mg/dL in patients ≤50 years.</div></div><div><h3>Conclusion</h3><div>Four-dimensional computed tomography alone accurately predicted single gland disease in 87% of patients with primary hyperparathyroidism. When combined with preoperative calcium, parathyroid hormone and age thresholds, predictive accuracy for single-gland disease approached 100%. Given the high likelihood of single-gland disease in these scenarios, clinicians may consider offering focused unilateral parathyroidectomy without intraoperative parathyroid hormone monitoring in selected patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109327"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695916","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":"Oncological outcomes of palliative minimally invasive distal pancreatectomy for unexpected metastatic pancreatic ductal adenocarcinoma: A single-center experience","authors":"Yejong Park MD, PhD ,&nbsp;Dae Wook Hwang MD, PhD ,&nbsp;Jae Hoon Lee MD, PhD ,&nbsp;Ki Byung Song MD, PhD ,&nbsp;Eunsung Jun MD, PhD ,&nbsp;Woohyung Lee MD, PhD ,&nbsp;Min Kyu Sung MD, PhD ,&nbsp;Song Cheol Kim MD, PhD","doi":"10.1016/j.surg.2025.109331","DOIUrl":"10.1016/j.surg.2025.109331","url":null,"abstract":"<div><h3>Background</h3><div>The benefits of palliative minimally invasive distal pancreatectomy for patients with unexpectedly metastatic pancreatic ductal adenocarcinoma have not been previously studied. This retrospective study compared the outcomes of palliative minimally invasive distal pancreatectomy with those of minimally invasive biopsy in these patients.</div></div><div><h3>Methods</h3><div>We reviewed the records of 46 patients with unexpected metastasis of left-sided pancreatic ductal adenocarcinoma that were discovered during surgery between 2005 and 2019. Nineteen patients underwent palliative resection (minimally invasive distal pancreatectomy group), whereas 27 patients underwent only minimally invasive biopsy (minimally invasive biopsy group). Demographic, clinical, and operative data, as well as survival rates, were compared between the 2 groups.</div></div><div><h3>Results</h3><div>Major complications (Clavien-Dindo grade ≥3) were comparable between the 2 groups (11.8% vs 5.6%; <em>P</em> = .603). Postoperative chemotherapy was administered to 84.2% of the minimally invasive distal pancreatectomy group and 77.8% of the minimally invasive biopsy group (<em>P</em> = .716). The minimally invasive distal pancreatectomy group had a higher completion rate of first-line palliative chemotherapy (42.9% vs 8.7%; <em>P</em> = .007) and a higher 2-year survival rate (36.8% vs 18.8%; <em>P</em> = .004). In multivariate analysis, survival was associated with completion of first-line chemotherapy (hazard ratio: 2.962; <em>P</em> = .003) and maintenance chemotherapy for over 12 months (hazard ratio: 2.339; <em>P</em> = .010). Gastric outlet obstruction was less prevalent in the minimally invasive distal pancreatectomy group (5.3% vs 25.9%, <em>P</em> = .037).</div></div><div><h3>Conclusion</h3><div>Palliative minimally invasive distal pancreatectomy may improve survival and facilitate the continuation of chemotherapy in selected patients with unexpected metastatic pancreatic ductal adenocarcinoma. However, the small sample size and potential selection bias limit the generalizability of these findings. Larger, prospective, multicenter studies are needed to confirm the role of minimally invasive distal pancreatectomy and to establish optimal management strategies for these patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109331"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143696903","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":"Atypical care of burned patients is typical in war: Adapting old dogma for maximal survival","authors":"Peter Sienko BS,&nbsp;Gary A. Vercruysse MD, FACS","doi":"10.1016/j.surg.2025.109306","DOIUrl":"10.1016/j.surg.2025.109306","url":null,"abstract":"<div><div>During the wars in Iraq and Afghanistan, US troops experienced burns were stabilized and quickly evacuated out of theater to Germany and then to the US Army Institute of Surgical Research in San Antonio, Texas. This was not true of casualties involving non-US or non-North Atlantic Treaty Organization soldiers and medical systems. In such situations, soldiers and civilians alike were treated in North Atlantic Treaty Organization medical treatment facilities and/or were transferred to host nation health care facilities until they healed or died from their wounds. Before 1970, most burns worldwide were treated conservatively and managed with some form of resuscitation and dressing changes. Debridement and skin grafting were reserved for burn wounds that became infected or granulated after separation of the burn wound eschar. This treatment algorithm was developed because of a lack of modern equipment (such as a dermatome or skin mesher) and partly because of adherence to dogmatic principles adopted for the previous century of battlefield burn wound treatment. Modern burn care standards in developed countries have advanced dramatically in the last several decades. However, employing these standards in under-resourced and overburdened hospital systems, such as those in the combat environment, will lead to a waste of resources and unnecessary loss of life. The following is a primer to burn care in war, tailored for providers in austere systems, that will maximize survival, help obviate the need for intensive care unit care, and save valuable resources and hospital bedspace.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109306"},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687904","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":"Trauma registry: The first step for global trauma systems development initiated by disaster and conflict zones","authors":"Francesca A. Voza MD ,&nbsp;Enrique Ginzburg MD","doi":"10.1016/j.surg.2025.109309","DOIUrl":"10.1016/j.surg.2025.109309","url":null,"abstract":"<div><div>The systematic collection of casualty data has been crucial in developing integrated trauma systems. Electronic repositories such as the Joint Theater Trauma Registry have facilitated evidence-based guidelines and protocols, enhancing trauma care globally. While civilian patient care has seen improved outcomes, readiness for modern and massively destructive weaponry requires a new set of guidelines. The critical need is for meticulous data collection, interdisciplinary collaboration, standardized terminology for effective global data analysis and continuous trauma registries for quick needs assessment in conflict zones and guidance for future studies. Comprehensive use and standardization of trauma registry remains essential for medical teams' preparedness in the face of modern large scale combat operations.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109309"},"PeriodicalIF":3.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687905","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":"Evaluation and comparison of machine learning algorithms for predicting discharge against medical advice in injured inpatients","authors":"Xiu Dai BS ,&nbsp;Shifang Liu MM ,&nbsp;Xiangyuan Chu BS ,&nbsp;Xuheng Jiang MM ,&nbsp;Weihang Chen BS ,&nbsp;Guojia Qi MM ,&nbsp;Shimin Zhao BS ,&nbsp;Yanna Zhou MM ,&nbsp;Xiuquan Shi PhD","doi":"10.1016/j.surg.2025.109335","DOIUrl":"10.1016/j.surg.2025.109335","url":null,"abstract":"<div><h3>Background</h3><div>Whether the application of machine learning algorithms offers an advantage over logistic regression in forecasting discharge against medical advice occurrences needs to be evaluated.</div></div><div><h3>Methods</h3><div>This retrospective study included all inpatient records from January 1, 2018, to December 31, 2023. The foundational data set (2018–2021) was divided into a training set (80%) and a test set (20%) for model construction and internal validation. The temporal validation data set (2022–2023) was used to assess the model's prospective performance. Feature selection was performed using the BorutaShap method. Techniques including random oversampling, random undersampling, synthetic minority oversampling technique, and edited nearest neighbors were applied to address data imbalance. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve, accuracy, specificity, sensitivity, F1 score, and geometric mean. The Shapley Additive Explanations analysis provided interpretation for the best machine learning model.</div></div><div><h3>Results</h3><div>A total of 48,394 inpatient records for injured patients met the study criteria, of which 44,119 were discharged following medical advice and 4,275 chose discharge against medical advice, resulting in a ratio of 10.32:1. Among injury inpatients, 8.8% opted for discharge against medical advice. Based on the results of feature selection and multicollinearity analysis, 16 variables were ultimately selected for the construction and evaluation of the discharge against medical advice model. The light gradient boosting machine + edited nearest neighbors model showed the best generalization, with areas under the curves of 0.820 for internal validation and 0.837 for temporal validation. The Shapley Additive Explanations method was used to interpret the model, indicating that the grade of surgery is the most important variable.</div></div><div><h3>Conclusions</h3><div>The study is the first to use machine learning models to predict discharge against medical advice in injured inpatients, demonstrating its feasibility. In the future, health care institutions can learn from these models to optimize patient management and reduce discharge against medical advice incidents.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"182 ","pages":"Article 109335"},"PeriodicalIF":3.2,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687903","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":"Letter to the editor regarding: \"Impact of chronic lymphocytic thyroiditis on the diagnostic and intraoperative management of papillary thyroid cancer\".","authors":"Tanaz M Vaghaiwalla, John I Lew","doi":"10.1016/j.surg.2025.109337","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109337","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109337"},"PeriodicalIF":3.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692991","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":"Preparing for the “unthinkable”: A call for trauma system preparedness in conflict-vulnerable settings","authors":"Kent Garber MD, MPH,&nbsp;Rochelle Dicker MD, FACS,&nbsp;Weidun Alan Guo MD, PhD, FACS,&nbsp;Randeep S. Jawa MD, MS, FACS, FCCM,&nbsp;Oleksandr Linchevskyy MD, PhD,&nbsp;Tejal S. Brahmbhatt MD,&nbsp;Miloš Buhavac MD, FACS,&nbsp;Christine Gaarder MD, PhD, FACS","doi":"10.1016/j.surg.2025.109308","DOIUrl":"10.1016/j.surg.2025.109308","url":null,"abstract":"<div><div>As global armed conflicts proliferate, the need for trauma care of injured civilians in fragile and conflict-affected settings is rising, but current approaches to providing trauma care are inadequate. The humanitarian community is overstretched, and local health systems are often under-resourced and ill-equipped to handle surges in civilian casualties. In this article, we argue for applying a preparedness lens to this challenge, focusing on opportunities for strengthening trauma systems for conflict-vulnerable populations. Specifically, we review current deficiencies in humanitarian trauma care and advocate for the need to (1) identify countries or subnational regions at risk of future armed conflict; (2) assess trauma system capacities and deficiencies in those locations; and (3) foster partnerships and collaborations with local governing bodies and health care providers to improve education, training, and overall trauma system readiness.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"181 ","pages":"Article 109308"},"PeriodicalIF":3.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682693","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":"Information for readers","authors":"","doi":"10.1016/S0039-6060(25)00149-7","DOIUrl":"10.1016/S0039-6060(25)00149-7","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"180 ","pages":"Article 109297"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685768","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":"Triumphs, challenges, and new initiatives in SURGERY","authors":"Caitlin W. Hicks MD, MS, FACS, FAHA, DFSVS (Co-Editor-In-Chief)","doi":"10.1016/j.surg.2025.109328","DOIUrl":"10.1016/j.surg.2025.109328","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"180 ","pages":"Article 109328"},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685771","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}