Surgery最新文献

{"title":"A decade of progress: Declining readmissions for dehydration and acute kidney injury after bariatric surgery.","authors":"Emil Maric, Colin Wang, Kristine Kuchta, Michael Ujiki, Natalie Liu","doi":"10.1016/j.surg.2026.110647","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110647","url":null,"abstract":"<p><strong>Background: </strong>Dehydration and acute kidney injury are leading causes of readmission following bariatric surgery. Although the overall bariatric surgical safety profile has improved substantially, national trends in readmissions specifically attributed to dehydration and acute kidney injury remain unknown. The objective of our study was to evaluate national trends in postoperative readmissions because of dehydration and acute kidney injury among bariatric surgical patients.</p><p><strong>Methods: </strong>The Metabolic and Bariatric Accreditation and Quality Improvement Program database was queried to identify patients who underwent primary minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass between 2015 and 2023. The primary outcome was 30-day readmission for dehydration/acute kidney injury, defined by Metabolic and Bariatric Accreditation and Quality Improvement Program readmission codes for \"nausea, vomiting, fluid, electrolyte and nutritional depletion,\" \"renal insufficiency,\" and \"renal failure.\" Annual readmission rates were calculated by procedure type. Multivariable regression analysis was used to identify associated factors.</p><p><strong>Results: </strong>A total of 1,456,480 patients were included; 73.2% underwent sleeve gastrectomy. Mean age was 44 years; mean body mass index was 45.2 kg/m². The overall readmission rate was 3.3%, of which 28.0% were for dehydration/acute kidney injury. Readmission rates because of dehydration/acute kidney injury declined significantly for both sleeve gastrectomy (1.2%-0.5%; P < .0001) and Roux-en-Y gastric bypass (1.8%-0.9%; P < .0001). On multivariable analysis, undergoing sleeve gastrectomy, female sex, and Non-Hispanic Black race were associated with significantly higher odds of readmission. Comorbidities, such as insulin-dependent diabetes, hypertension, and renal insufficiency, were also independently associated with increased odds of readmission.</p><p><strong>Conclusion: </strong>Readmissions for dehydration/acute kidney injury decreased by more than 50% between 2015 and 2023 among primary bariatric surgical patients. Despite this global improvement, patient- and procedure-related factors confer persistently elevated readmission risk, identifying high-risk patient populations and the need for targeted preventative strategies.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110647"},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115102","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":"From deployment to durability: Mesh positioning systems in minimally invasive intraperitoneal underlay ventral hernia repair and association with patient-reported recurrence.","authors":"Nicolette Winder, Joshua Lyons, Ayesha Siddiq, Marisa H Blackman, Jeffrey Marks, Samuel Zolin","doi":"10.1016/j.surg.2026.110649","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110649","url":null,"abstract":"<p><strong>Background: </strong>Mesh positioning systems may facilitate deployment/centering during minimally invasive intraperitoneal underlay mesh ventral hernia repair, but multicenter comparative data are limited. We evaluated associations between mesh positioning system use, operative time, and clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed Abdominal Core Health Quality Collaborative data for adults undergoing elective, clean minimally invasive intraperitoneal underlay mesh for midline hernias between 2016 and 2025. Patients were categorized by mesh positioning system use. One-to-one propensity matching balanced patient, hernia, mesh, closure, fixation, and operative approach variables. Balance was assessed with standardized mean differences. Outcomes included operative time, morbidity, patient-reported outcomes, and recurrence. Recurrence-specific balance and calendar-year sensitivity analyses were performed.</p><p><strong>Results: </strong>Of 154,582 registry patients, 3,951 met analytic criteria, 3,898 entered the propensity cohort, and 1,570 were matched. Operative time did not differ (P = .928). Among 210 patients with patient-reported recurrence data, recurrence was lower with mesh positioning systems (15.7% vs 3.6%; P = .012); surgeon-reported and pragmatic recurrence did not differ. Recurrence-subset balance demonstrated residual imbalance. Calendar-year adjusted Cox analysis for pragmatic recurrence showed mesh positioning systems (hazard ratio, 0.60; 95% confidence interval, 0.37-0.98; P = .042) and year (hazard ratio, 1.28; 95% confidence interval, 1.12-1.47; P < .001).</p><p><strong>Conclusion: </strong>Mesh positioning systems were associated with lower patient-reported recurrence among patients with available follow-up. Within the constraints of limited follow-up, recurrence-subset imbalance, discordant recurrence definitions, and temporal confounding, the findings are hypothesis generating rather than evidence that mesh positioning systems reduce anatomic recurrence, and further prospective evaluation is needed.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110649"},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115154","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":"Predictors of outcome in 215 patients requiring emergency department thoracotomy: A 2-year prospective study in a large urban trauma center.","authors":"Juan A Asensio, Shane D Martin, Julio Roque-Buenrostro, Eduardo Smith-Singares, David J Mondschein, Santiago A Ceron, Vincent L Rowe, Luis A Garcia, Kenneth L Wilson, Mallory W Williams, Hernán Oliu Lambert, Jose M Velasco","doi":"10.1016/j.surg.2026.110607","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110607","url":null,"abstract":"<p><strong>Background: </strong>Emergency department thoracotomy is a formidable procedure. We prospectively evaluated physiologic parameters in patients undergoing emergency department thoracotomy, mortality at the scene of the traumatic incident, and upon arrival, including cardiopulmonary resuscitation time, cardiovascular respiratory score, time to emergency department thoracotomy, and restoration of blood pressure, and identified predictors of outcomes.</p><p><strong>Methods: </strong>This was a prospective 2-year study of patients in cardiopulmonary arrest requiring emergency department thoracotomy in a trauma center. Statistical analysis included univariate and stepwise logistic regression analysis.</p><p><strong>Results: </strong>Two hundred fifteen patients admitted in cardiopulmonary arrest required emergency department thoracotomy. Penetrating injury (n = 167, 78%), gunshot wounds (n = 142, 78.0%), stab wounds (n = 21, 12.6%), shotgun wounds (n = 4, 2.4%), and blunt (n = 48, 22%). The mean revised trauma score was -0.6, the mean injury severity score was -42, and the mean duration of cardiopulmonary resuscitation was 12 minutes. Emergency department deaths totaled 162 (75%), and 1-hour survivors totaled 53 (25%). Overall survivors were 6 of 215 (2.8%). Penetrating cardiac injury survivors were 6 of 74 (8.2%). Two groups were compared: (1) emergency department deaths versus 1-hour survivors-all physiologic parameters were predictive of outcomes (P < .0001) and (2) 1-hour survivors versus overall survivors-no physiologic parameters were predictive of outcome. Duration of cardiopulmonary resuscitation (P = .04), penetrating mechanism (P < .001), and exsanguination (P < .006) were significant. The cardiovascular respiratory score revealed a trend (P = .007). Death versus overall survival-restoration of blood pressure was predictive (P < .006). Stepwise logistic regression, using a 4-factor model, including no spontaneous ventilation, absence of pulse upon arrival, injury severity score >45, and blunt mechanism of injury, was 99.3% predictive of mortality.</p><p><strong>Conclusion: </strong>For patients presenting in arrest requiring emergency department thoracotomy, all parameters plus a cardiopulmonary resuscitation duration of 12 minutes are predictive of mortality. Seventy-five percent of patients can be excluded from emergency department thoracotomy. Emergency department thoracotomy should be applied selectively to patients sustaining penetrating cardiac injuries and some vascular injuries.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110607"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115208","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":"Factors associated with successful nonoperative management of colonic fistulas from necrotizing pancreatitis.","authors":"Divya L Deverakonda, Noah X Tocci, Breanna C Perlmutter, John McMichael, Daniel Joyce, Toms Augustin, Samer Naffouje, Robert F Naples, R Matthew Walsh, Robert Simon","doi":"10.1016/j.surg.2026.110618","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110618","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing pancreatitis can result in colonic fistulas from inflammatory sequelae or drain erosion. We sought to define the optimal operative management or nonoperative management of colonic fistulas secondary to necrotizing pancreatitis.</p><p><strong>Methods: </strong>A retrospective analysis was performed of adult patients in an institutional necrotizing pancreatitis registry who developed colonic fistulas between 2015 and 2025. Patient cohorts were established by nonoperative management or operative management status, and exploratory univariate analysis was used to compare risk factors for operative management.</p><p><strong>Results: </strong>Among 1,092 necrotizing pancreatitis patients, 47 developed colonic fistulas. The median interval from initial acute pancreatitis diagnosis to colonic fistula was 58 (29-103) days. Nonoperative management was utilized in 20 (43%) patients with initial intervention, including 11 (55%) percutaneous or 4 (20%) endoscopic. Operative management was used in 27 (57%); initial interventions were 10 (37%) percutaneous and 17 (63%) upfront operative management. Twenty-three patients had drain-related colonic fistulas: 10 (50%) nonoperative management and 13 (48%) operative management. Nonoperatively managemed patients had significantly lower Bedside Index for Severity in Acute Pancreatitis (BISAP) scores on presentation to our institution (1.0 [1.0-2.0] vs 3.0 [1.0-3.0]; P = .04) with a BISAP score (≥3) associated with operative management (odds ratio, 6.10; 95% confidence interval, 1.59-30.68; P = .007). Nonoperatively managemed patients also had a shorter length of stay (10 [0-30] vs 39 [24-55] days; P < .01) and less frequent intensive care unit admission (7 [35%] vs 21 [78%]; P < .01). There was no significant difference in overall survival in nonoperative management versus operative management (P = .07).</p><p><strong>Conclusion: </strong>While colonic fistulas are important to identify in patients with necrotizing pancreatitis, they do not mandate operative intervention. Our data suggest that low-risk patients, based on critically ill status and BISAP score, may undergo successful nonoperative management.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110618"},"PeriodicalIF":3.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040739","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":"Extended venous thromboembolism chemoprophylaxis after pancreas surgery for cancer: Does the subcutaneous needle move the needle?","authors":"Andrew J Thyen, Alexa J Hughes, Eugene P Ceppa, Ryan J Ellis, Michael G House, Alexandra M Roch, Cary Jo R Schlick, C Max Schmidt, Nicholas J Zyromski, Thomas K Maatman","doi":"10.1016/j.surg.2026.110624","DOIUrl":"10.1016/j.surg.2026.110624","url":null,"abstract":"<p><strong>Background: </strong>Twenty-eight days of extended chemoprophylaxis is recommended for patients undergoing pancreatectomy for malignancy. We hypothesized that the current strategy of extended venous thrombotic event chemoprophylaxis is ineffective in reducing postoperative venous thrombotic events.</p><p><strong>Methods: </strong>This was a single-institution retrospective review of pancreatectomy patients with cancer. Symptomatic postoperative venous thrombotic event (pulmonary embolism, deep vein thrombosis, and mesenteric vein thrombosis) rates at 90 days were evaluated. Perioperative variables were in accordance with National Surgical Quality Improvement Program and International Study Group for Pancreatic Surgery definitions. Univariable and multivariable analyses were performed. Institutional practice for extended venous thrombotic event prophylaxis is 28 days of once-daily subcutaneous enoxaparin.</p><p><strong>Results: </strong>Between 2013 and 2024, 1,667 patients underwent pancreatectomy. The mean age was 67 ± 10.7 years, with a mean body mass index of 27 ± 5.8. Most operations were pancreatic head resections (1,303 [78%]). The incidence of postoperative thrombotic events was 115 (6.9%), deep vein thrombosis or pulmonary embolism was 63 (3.8%), and mesenteric vein thrombosis (portal vein/superior mesenteric vein/splenic vein) was 58 (3.5%). Sixty-nine (60%) were diagnosed with venous thrombotic event after discharge. Excluding inpatient venous thrombotic events, comparing venous thrombotic event rates between patients with and without chemoprophylaxis, there was no difference in rates of any thrombus, deep vein thrombosis/pulmonary embolism, mesenteric vein thrombosis, or clinically significant bleeding events. Among patients discharged with extended venous thrombotic event prophylaxis, multivariable logistic regression found increasing body mass index as a significant risk factor for venous thrombotic event after hospital discharge (odds ratio, 1.10; 95% confidence interval, 1.05-1.15; P ≤ .001).</p><p><strong>Conclusion: </strong>Routine chemoprophylaxis after pancreatectomy for cancer did not reduce rates of deep vein thrombosis, pulmonary embolism, or mesenteric vein thrombosis. Among patients discharged on extended prophylaxis, a higher body mass index was associated with an increased venous thrombotic event risk. This suggests that current prophylaxis strategies may be inadequate, and future strategies may utilize weight-based dosing for prophylaxis regimens.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110624"},"PeriodicalIF":3.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064450","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":"Age alone is not a barrier: Outcomes of geriatric patients undergoing component separation during open abdominal wall reconstruction.","authors":"Victoria L Walker, Samantha W Kerr, Lucy R Hinton, Mary C Devane, Gregory T Scarola, Kent W Kercher, Vedra A Augenstein, B Todd Heniford, Sullivan A Ayuso","doi":"10.1016/j.surg.2026.110622","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110622","url":null,"abstract":"<p><strong>Background: </strong>The component separation technique is used in complex, open abdominal wall reconstruction to facilitate fascial closure. This study compared outcomes between geriatric and nongeriatric patients undergoing open abdominal wall reconstruction with the component separation technique and evaluated outcomes before and after the implementation of a geriatric medicine program.</p><p><strong>Methods: </strong>Patients undergoing open abdominal wall reconstruction + component separation technique at a single institution were stratified by age: <65 versus ≥65. A subgroup analysis compared outcomes before and after the implementation of a multidisciplinary, perioperative, optimization geriatric medicine program. Standard descriptive, comparative, and logistic regression analyses were performed.</p><p><strong>Results: </strong>Among 748 patients (475 nongeriatric, 273 geriatric), nongeriatric patients had a higher body mass index (33.4 ± 6.7 vs 30.6 ± 5.8 kg/m²; P < .001) and fewer comorbidities (4.5 ± 2.5 vs 5.2 ± 2.3; P < .001). The mean age was 52.0 ± 9.1 vs 70.7 ± 4.4 years (P < .001). Most hernias were recurrent (67.8% vs 68.5%; P = .841) and giant (321.1 ± 243.3 vs 307.5 ± 182.3 cm²; P = .756). Length of stay (8.3 ± 18.3 vs 7.8 ± 6.0 days; P = .126) and wound complication rates (32.2% vs 29.7%; P = .471) were not different; age was not an independent predictor of wound morbidity. Geriatric patients had higher rates of postoperative pneumonia (1.3% vs 4.5%; P = .009) and intensive care unit transfer (8.9% vs 16.7%; P = .007). Subgroup analysis identified 94 pre-geriatric medicine program and 47 post-geriatric medicine program geriatric patients. Pre-geriatric medicine program patients had more comorbidities (5.4 ± 2.3 vs 4.4 ± 2.1; P = .015). Geriatric medicine program implementation was associated with reduced length of stay (6.5 ± 2.6 vs 5.6 ± 5.8; P < .001), with no postoperative pneumonias in the post-geriatric medicine program cohort. While intensive care unit transfers decreased (15.9% vs 7.3%; P = .245), this was not statistically significant. There was no difference in 30-day readmission (7.4% vs 6.4%; P > .05).</p><p><strong>Conclusion: </strong>Component separation technique demonstrates similar surgical outcomes in geriatric and nongeriatric patients, although rates of pneumonia and intensive care unit transfers were higher. Geriatric medicine program implementation was associated with fewer medical complications and shorter length of stay, with no increase in readmissions.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110622"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064315","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":"Transarterial therapies versus portal vein embolization prior to major hepatectomy: A national comparison of perioperative outcomes.","authors":"Alexa J Hughes, Dhruv J Patel, Thomas K Maatman, C Max Schmidt, Eugene P Ceppa, Paul M Haste, Nicholas J Zyromski, Alexandra Roch, Cary Jo R Schlick, Michael G House, Ryan J Ellis","doi":"10.1016/j.surg.2026.110614","DOIUrl":"10.1016/j.surg.2026.110614","url":null,"abstract":"<p><strong>Background: </strong>Preoperative liver remnant hypertrophy has historically been achieved with portal vein embolization, but transarterial embolizations, such as radioembolization, have gained interest as alternative hypertrophy mechanisms in select patients. National practice patterns and outcomes between these 2 modalities are poorly characterized. The objective of this study is to compare preoperative utilization of transarterial therapies versus portal vein embolization and assess perioperative outcomes.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing right hepatectomy or trisegmentectomy after preoperative portal vein embolization or transarterial embolization between 2014 and 2024. Univariable and multivariable regression analyses were performed to identify factors associated with utilization, perioperative transfusion, posthepatectomy liver failure, and serious morbidity.</p><p><strong>Results: </strong>Among 1,240 patients who met inclusion criteria, 1,068 (86.1%) underwent portal vein embolization and 172 (13.9%) underwent transarterial embolization. Transarterial embolization utilization increased from 8.8% in 2014 to 23.7% in 2024 (P < .001). In multivariable analysis, patients were more likely to receive transarterial embolization if they underwent resection in 2020 and after (odds ratio, 2.17; 95% confidence interval, 1.46-3.26; P < .001) or had hepatocellular carcinoma (odds ratio, 4.35; 95% confidence interval, 2.41-7.99; P < .001). Rates of transfusion (374/1,068 [35.0%] vs 61/172 [35.5%], P = .978), serious posthepatectomy liver failure (120/1,068 [11.2%] vs 17/172 [9.9%], P = .695), and serious morbidity (391/1,068 [36.6%] vs 59/172 [34.3%], P = .618) were comparable between portal vein embolization and transarterial embolization, respectively, with no further differences on adjusted multivariable analysis.</p><p><strong>Conclusion: </strong>Utilization of transarterial embolization prior to major hepatectomy has increased over the past decade with no associated increase in relative morbidity. In appropriate clinical scenarios, transarterial embolization may serve as a reasonable alternative to portal vein embolization prior to major hepatectomy.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110614"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and oncologic outcomes of rectal cancer patients with downstaged lateral pelvic lymph nodes in the era of total neoadjuvant therapy.","authors":"Metincan Erkaya, Mustafa Oruc, Awwab F Hammad, Joseph A Trunzo, Andrei S Purysko, David R Rosen, Josh Sommovilla, Salih Karahan, Michael Valente, Scott R Steele, David Liska, Emre Gorgun","doi":"10.1016/j.surg.2026.110621","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110621","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer patients with positive lateral pelvic lymph nodes have traditionally been associated with poor prognosis. Although lateral pelvic lymph nodes often respond to neoadjuvant therapy, uncertainty remains regarding the management of patients whose initially positive lateral pelvic lymph nodes achieve complete radiographic regression in the era of total neoadjuvant therapy. This study aims to evaluate the oncologic outcomes and management of lateral pelvic lymph node-positive rectal cancer patients who completely respond to total neoadjuvant therapy.</p><p><strong>Methods: </strong>Retrospective analysis of stage III rectal cancer patients completing total neoadjuvant therapy (2016-2025) at a high-volume center. Patients were stratified into 2 groups: the lateral pelvic lymph node-negative group (no suspicious lateral pelvic lymph nodes on baseline magnetic resonance imaging, remaining node negative on restaging magnetic resonance imaging) and the lateral pelvic lymph node-positive group (at least 1 lateral pelvic lymph node ≥7 mm short axis with malignant features on baseline magnetic resonance imaging, achieving complete nodal response on restaging magnetic resonance imaging). Patients with persistent lateral pelvic lymph node positivity or requiring lateral pelvic lymph node dissection were excluded. The primary outcome was disease-free survival; secondary outcomes included distant metastasis-free survival, overall survival, and local control.</p><p><strong>Results: </strong>Of 325 patients, 68 (21%) were lateral pelvic lymph node positive and 257 (79%) were lateral pelvic lymph node negative. Lateral pelvic lymph node-positive patients had larger tumors (6 vs 5 cm; P = .003) and more lower rectal tumors (62% vs 39%; P = .004). In the surgery cohort (n = 226), 3-year disease-free survival (83% vs 80%), distant metastasis-free survival (87% vs 80%), local recurrence-free survival (91% vs 91%), and overall survival (97% vs 90%) did not differ between groups (P > .05). In the watch-and-wait cohort (n = 99), salvage surgery rates were identical (19% vs 19%; P = .99), and 3-year disease-free survival (81% vs 88%), distant metastasis-free survival (85% vs 89%), local regrowth-free survival (74% vs 70%), and overall survival (94% vs 98%) were comparable (P > .05).</p><p><strong>Conclusion: </strong>Lateral pelvic lymph node positivity at baseline is not associated with worse oncologic outcomes in rectal cancer patients whose lateral pelvic lymph nodes respond completely to total neoadjuvant therapy in both total mesorectal excision and watch-and-wait cohorts. Post-total neoadjuvant therapy nodal status, rather than baseline lateral pelvic lymph node involvement, may better guide management and organ preservation decisions.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110621"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075363","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":"Postoperative outcomes and health care utilization after gastrostomy in children with autism spectrum disorder and developmental delay.","authors":"Blake Hardin, Stephanie Papillon, Claire Wunker, Briana Mezuk, Samir Gadepalli","doi":"10.1016/j.surg.2026.110605","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110605","url":null,"abstract":"<p><strong>Background: </strong>Gastrostomy tube placement is commonly performed in children with autism spectrum disorder, yet it remains unclear whether autism spectrum disorder is independently associated with postoperative outcomes. We compared short-term outcomes after primary gastrostomy tube placement by autism spectrum disorder and developmental delay status.</p><p><strong>Methods: </strong>Children (<17 years) undergoing laparoscopic gastrostomy tube placement were identified from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (2019-2024). Patient selection was limited to a single institution (n = 386). Autism spectrum disorder status (confirmed [F84.0] or suspected [R68.89]) solicited from individual medical records was linked to National Surgical Quality Improvement Program-Pediatric data. Primary outcomes were postoperative length of stay and a composite 30-day complication outcome. The relationship between autism spectrum disorder and postoperative outcomes was assessed using multivariable regression, accounting for age, sex, developmental delay, and preoperative nutritional support.</p><p><strong>Results: </strong>Patients with autism spectrum disorder (n = 82) were older (4.9 vs 1.3 years, P < .001) and more likely to have developmental delay (72% vs 41%, P < .001) than those without. Autism spectrum disorder was not associated with longer length of stay (adjusted geometric means ratio, 0.80; P = .27) or postoperative complications (adjusted odds ratio, 0.98; P = .97). Developmental delay similarly was not associated with longer length of stay (adjusted geometric means ratio, 0.52; P < .001), although it was independently associated with short-term postoperative complications (adjusted odds ratio, 1.94; P < .05). Nutritional support was independently associated with longer length of stay (adjusted geometric means ratio, 1.68; P < .01) and higher odds of complications (adjusted odds ratio, 2.36; P = .02).</p><p><strong>Conclusion: </strong>Autism spectrum disorder is not associated with postoperative length of stay or complications after gastrostomy tube placement. Preoperative nutritional support is strongly associated with postoperative outcomes, suggesting these are driven by overall medical complexity rather than autism spectrum disorder diagnosis.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110605"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064439","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":"Perioperative use of temporary diaphragm pacing in surgical patients with unilateral diaphragm dysfunction to decrease mechanical ventilation.","authors":"Kallie Wynens, MaryJo Elmo, Nicholas Carl, Raymond P Onders","doi":"10.1016/j.surg.2026.110620","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110620","url":null,"abstract":"<p><strong>Background: </strong>Unilateral diaphragmatic dysfunction, most commonly from phrenic nerve injury, is associated with difficult ventilator weaning and increased postoperative pulmonary complications. Diaphragm pacing prevents ventilator-induced diaphragm dysfunction and supports ventilation during periods of perioperative vulnerability. We report perioperative utilization of temporary diaphragm pacing in patients with pre-existing or anticipated postoperative unilateral diaphragmatic dysfunction.</p><p><strong>Methods: </strong>This cohort analysis was derived from a prospective, institutional review board-approved database at a single institution. Eligible patients demonstrated unilateral diaphragmatic elevation on preoperative imaging or sustained intraoperative phrenic nerve injury or sacrifice. Subjects received a Food and Drug Administration-authorized temporary diaphragm pacing system with intramuscular electrodes placed in each hemidiaphragm and tunneled percutaneously. Diaphragm electromyography confirmed dysfunction and guided therapy. A disposable multichannel stimulator delivered postoperative stimulation. Primary outcomes included mechanical ventilation duration and postoperative respiratory complications.</p><p><strong>Results: </strong>Between January 2020 and December 2025, 544 patients underwent diaphragm pacing implantation for all indications. Subgroup analysis identified 21 high-risk surgical patients with unilateral dysfunction (17 preoperative; 4 intraoperative phrenic injury). Procedures included cardiac (n = 16), thymectomy (n = 3), vascular (n = 1), and liver transplantation (n = 1). Mean age was 62 years. Diaphragm electromyography confirmed unilateral phrenic dysfunction in 20 of 21 patients. Diaphragm pacing was initiated immediately postoperatively with a mean duration of 14.4 days. Excluding 1 patient, mean mechanical ventilation duration was 12 hours. No pneumonias, device-related complications, or 30-day mortalities occurred.</p><p><strong>Conclusion: </strong>Unilateral diaphragmatic dysfunction is an overlooked contributor to perioperative respiratory morbidity. In this high-risk surgical cohort, temporary diaphragm pacing was safe and associated with short mechanical ventilation durations and low postoperative pulmonary complication rates, supporting further prospective evaluation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110620"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115116","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}