Surgery最新文献

{"title":"Lightweight polypropylene mesh is associated with higher long-term recurrence after open ventral hernia repair.","authors":"Samantha W Kerr, Lucy R Hinton, Gregory T Scarola, Sullivan A Ayuso, Kent W Kercher, Vedra A Augenstein, B Todd Heniford","doi":"10.1016/j.surg.2026.110609","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110609","url":null,"abstract":"<p><strong>Background: </strong>Mesh selection in ventral hernia repair remains controversial. Lightweight mesh was developed as a replacement for heavier meshes to reduce foreign body response and improve abdominal wall compliance, but concerns regarding durability remain. This study evaluated long-term recurrence rates after open ventral hernia repair using lightweight mesh versus midweight mesh.</p><p><strong>Methods: </strong>A prospectively maintained tertiary hernia center database was queried for elective open ventral hernia repair performed with lightweight mesh or midweight mesh. Propensity-score matching (1:1) was performed using body mass index, Centers for Disease Control and Prevention wound class, and defect size. Multivariable regression determined independent predictors of recurrence. A Kaplan-Meier survival curve modeled recurrence-free survival.</p><p><strong>Results: </strong>Propensity score matching yielded 310 patients as 155 well-matched pairs. Lightweight mesh versus midweight mesh had similar average age (56.4 ± 13.3 vs 57.0 ± 12.4 years), body mass index (33.6 ± 8.1 vs 33.5 ± 8.4 kg/m²), smoking status (current: 2.6% vs 10.3%; former: 7.7% vs 14.2%), and diabetes (19.4% vs 26.5%) (all P > .05), though lightweight mesh patients had fewer comorbidities (3.3 ± 2.3 vs 4.1 ± 2.0; P = .001). Defect size (123.7 ± 149.5 vs 123.1 ± 140.5 cm²; P = .956) and mesh size (716.2 ± 402.7 vs 708.0 ± 434.3 cm²; P = .445) were similar, and mesh was placed in the preperitoneal plane in most cases (80.0% vs 80.0%; P = .119). There was no statistical difference in average length of stay (5.1 ± 5.9 vs 4.9 ± 3.6 days; P = .608), wound complications (21.9% vs 24.5%; P = .591), 30-day reoperations (3.2% vs 2.6%; P > .999), or mesh infections (0.0% vs 0.6%). Lightweight mesh had significantly higher recurrence rates (12.9% vs 1.9%; P < .001) over an extended follow-up (63.3 ± 61.6 vs 49.2 ± 52.8 months; P = .257). Multivariable regression demonstrated that lightweight mesh was 6.57x more likely to recur than midweight mesh (odds ratio, 6.57; 95% confidence interval, 1.69-25.59; P = .007).</p><p><strong>Conclusion: </strong>Mesh selection is an important consideration for durable ventral hernia repair. Lightweight mesh should be avoided in open ventral hernia repair, given its high rate of long-term recurrence compared with midweight mesh.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110609"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115191","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":"Weighing the evidence: The obesity paradox and its impact on lower extremity bypass surgery outcomes.","authors":"Tien Nguyen, Arnav Mahajan, Pooja Podugu, Ali Mansoor Kara, Ariadna Marrero, Garietta Falls-Beddies","doi":"10.1016/j.surg.2026.110617","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110617","url":null,"abstract":"<p><strong>Background: </strong>The obesity paradox, a reduced risk in overweight/obese patients but higher risk at body mass index extremes, has uncertain applicability for lower extremity bypass. We analyzed postoperative outcomes by body mass index category in patients undergoing lower extremity bypass.</p><p><strong>Methods: </strong>We analyzed 67,842 lower extremity bypass patients using the TriNetX platform. Body mass index stratification included underweight, normal, overweight, and obesity class I-III. Each body mass index group was 1:1 propensity score matched to normal body mass index patients. Outcomes included mortality, major reintervention, major amputation, wound infection, nonhealing wounds, hemorrhage, and seroma.</p><p><strong>Results: </strong>Overweight, class I (odds ratio, 0.88; odds ratio, 0.84; P < .001) and II (odds ratio, 0.89; P = .014) patients had lower mortality risk at 30 days and 1 year. Class I and II (odds ratio, 0.87; odds ratio, 0.83; P < .001) patients had lower amputation risk. Underweight and class III patients had increased mortality (odds ratio, 1.21; P < .001; odds ratio, 1.18; P = .002), major reintervention (odds ratio, 1.13; P = .002; odds ratio, 1.19; P < .001), amputation (odds ratio, 1.19; P < .001; odds ratio, 1.14; P = .021), and hemorrhage/seroma (odds ratio, 1.21; P = .015; odds ratio, 1.27; P = .009). Wound complications rose with each body mass index class for class I-III (odds ratio, 1.31; odds ratio, 1.58, all P < .001).</p><p><strong>Conclusion: </strong>The obesity paradox applies to mortality and amputation after lower extremity bypass. However, wound complication risk increased linearly with increased body mass index. This suggests that body mass index extreme patients warrant preoperative optimization while affirming the association of obesity and poor wound healing.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110617"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115152","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":"Defining the impact of time to surgery on survival after colon cancer diagnosis: A national trend analysis.","authors":"Julia Frebault, Sarah L Mott, Catherine Tran, Imran Hassan, Schelomo Marmor, Sayeed Ikramuddin, Pridvi Kandagatla, Paolo Goffredo","doi":"10.1016/j.surg.2026.110611","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110611","url":null,"abstract":"<p><strong>Background: </strong>While it is generally accepted that delays in oncologic care negatively impact patients' outcomes, the optimal time to surgery for colon cancer is not established. The aim of this study was to assess the impact of time to surgery on survival in stage I-III colon cancer.</p><p><strong>Methods: </strong>The National Cancer Database was queried for adults who underwent upfront colectomy for clinical stage I-III colon adenocarcinoma 14-90 days from diagnosis (2006-2021). Patients with time to surgery <14 days (a surrogate for emergency cases), neoadjuvant therapy, or missing follow-up data were excluded. Time to surgery was grouped into early (14-48 days), middle (49-69), and late (70-90) intervals based on clusters of similar survival outcomes for final multivariable models.</p><p><strong>Results: </strong>Of 46,392 patients (52% female, 61% age ≥65, 84% White, 68% Charlson-Deyo score 0, 50% stage I), 86% underwent surgery in the early interval, 11% in the middle interval, and 4% in the late interval. White race, private insurance, lower Charlson-Deyo score, and later-stage tumors were associated with increased odds of early time to surgery (all P < .01). Five-year overall survival was 77% for early, 73% for middle, and 67% for late intervals. Delayed surgery was associated with worse 5-year overall survival compared with early surgery (middle hazard ratio, 1.30; 95% confidence interval, 1.20-1.39; late hazard ratio, 1.60; 95% confidence interval, 1.44-1.79).</p><p><strong>Conclusion: </strong>Improved survival was noted in those with time to surgery ≤48 days. Healthy patients, higher stage disease, and sociodemographic characteristics typically associated with improved access to health care were associated with early time to surgery. These results highlight a potential opportunity to define benchmark time to surgery and identify areas for quality improvement to ensure timely surgical intervention.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110611"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064313","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":"Association between neck hematoma and postoperative hypocalcemia: Analysis of 53,091 thyroidectomies from the American College of Surgeons-National Surgical Quality Improvement Program database.","authors":"Anastasios Karneris, Mason Forchetti, Nigel E Sim, Pinar J Smith, Sara Cohen, Sean M Wrenn, Vinod Narra, Theodoros Michelakos","doi":"10.1016/j.surg.2026.110604","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110604","url":null,"abstract":"<p><strong>Background: </strong>Neck hematoma and hypocalcemia are among the most significant complications after thyroidectomy, but their relationship remains unclear. We hypothesized that post-thyroidectomy neck hematoma is associated with an increased risk of postoperative hypocalcemia. We aimed to test this hypothesis using a large national cohort and identify high-risk patients.</p><p><strong>Methods: </strong>We performed a retrospective cohort analysis of thyroidectomy patients using the American College of Surgeons-National Surgical Quality Improvement Program database (2016-2023). The primary exposure was postoperative neck hematoma, and outcomes included multiple hypocalcemia metrics. Associations were evaluated using the χ² test or the Fisher exact test and multivariable logistic regression.</p><p><strong>Results: </strong>Among 53,091 thyroidectomy patients, most patients were female (76.8%) and White (70.2%), with a median age of 53 years (interquartile range, 40-64). Most cases were performed for a solitary nodule (N = 20,894, 40.6%). Postoperative hematoma complicated 916 (1.7%) cases, of which 223 (24.3%) were managed nonoperatively. The hematoma cohort exhibited a higher frequency of Graves' disease (10.2% vs 6.7%, P < .001). Hematoma patients had higher rates of all hypocalcemia metrics, including hypocalcemia before discharge (6.6% vs 3.7%, P < .001) and severe hypocalcemia events (5.2% vs 3.3%, P = .005). These associations persisted even for hematomas managed nonoperatively. Among nonreoperative open thyroidectomies without neck dissection (n = 22,157), similar results were observed: for example, hypocalcemia before discharge (6.0% vs 2.8%, P < .001) and severe hypocalcemia events (6.5% vs 2.8%, P < .001). Findings were more pronounced among Graves' disease patients (eg, intravenous calcium requirement 16.2% vs 5.8%, P < .001).</p><p><strong>Conclusion: </strong>Post-thyroidectomy neck hematoma is associated with an increased risk of hypocalcemia-related complications even when managed nonoperatively. This suggests a possible pathophysiologic mechanism such as hematoma-induced parathyroid ischemia or venous congestion. Proactive calcium monitoring and supplementation are warranted in patients developing postoperative hematoma. Further studies are needed to elucidate the underlying pathophysiology.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110604"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064355","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":"Recurrent laryngeal nerve monitoring and postoperative airway complications following thyroid surgery: A multivariable national surgical quality improvement program analysis.","authors":"Abigail Catherine Chmiel, Jenna S Brambora, John A Olson, Taylor C Brown","doi":"10.1016/j.surg.2026.110616","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110616","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recurrent laryngeal nerve injury during thyroid surgery can result in clinically significant airway compromise, particularly in patients with limited pulmonary reserve. Although intraoperative nerve monitoring is widely used to reduce nerve injury, its association with postoperative airway complications has not been well characterized. This study evaluates trends in intraoperative nerve monitoring and its relationship with postoperative airway compromise after thyroidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective cohort study of adult patients who underwent thyroid surgery between 2018 and 2022 using the National Surgical Quality Improvement Program database. Patients were stratified by use of intraoperative nerve monitoring. The primary outcome was postoperative airway compromise, defined as prolonged ventilation (&gt;48 hours postoperatively) and unplanned postoperative reintubation. Secondary outcomes included recurrent laryngeal nerve injury, neck hematoma, and pneumonia. Univariate and multivariate analyses were performed to identify factors independently associated with airway complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 33,211 patients were included; 23,757 (71.5%) underwent surgery with intraoperative nerve monitoring. On univariate analysis, patients undergoing intraoperative nerve monitoring had lower rates of postoperative airway compromise compared with those without monitoring (0.4% vs 0.6%, P = .048). Although individual airway events were infrequent and did not differ significantly between groups, intraoperative nerve monitoring was associated with a lower rate of recurrent laryngeal nerve injury (5.7% vs 6.5%, P &lt; .001). On multivariable analysis, preoperative dyspnea, American Society of Anesthesiologists class III or higher, advanced tumor stage (T3-4), chronic obstructive pulmonary disease, older age, and longer operative time were independently associated with increased odds of postoperative airway compromise. After adjustment for patient, tumor, and operative factors, intraoperative nerve monitoring remained independently associated with decreased odds of postoperative airway compromise (odds ratio, 0.64; P = .04). In subgroup analysis of patients with American Society of Anesthesiologists class III or higher, recurrent laryngeal nerve monitoring was associated with lower adjusted odds of postoperative airway compromise (adjusted odds ratio, 0.68), consistent with findings in the overall cohort, though estimates were limited by low event rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this large national cohort, intraoperative recurrent laryngeal monitoring was independently associated with reduced postoperative airway complications after thyroidectomy. Airway risk was driven primarily by patient comorbidity, physiologic reserve, disease severity, and operative complexity. These findings suggest that recurrent laryngeal nerve monitoring may be of greatest benefit in","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110616"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064389","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":"Expected, unexpected, and unintended consequences of the Afirma gene sequencing classifier.","authors":"Jessica Leng, Yomna Amer, Abby Turza, Santhi Ganesan, Christopher R McHenry","doi":"10.1016/j.surg.2026.110619","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110619","url":null,"abstract":"<p><strong>Background: </strong>Molecular testing is a diagnostic adjunct that refines cancer risk assessment of cytologically indeterminate thyroid nodules. The aim of this study was to investigate the impact of the Afirma gene sequencing classifier on clinical practice. Our hypothesis was that the gene sequencing classifier has led to an increased rate of atypia of undetermined significance.</p><p><strong>Methods: </strong>A single-center retrospective analysis of thyroid fine-needle aspiration was performed from October 2021 to January 2025. Rates of atypia of undetermined significance for 19 months before and after the introduction of the gene sequencing classifier were compared. Cytopathologists (n = 6) were divided into those with <15 years or ≥15 years of experience.</p><p><strong>Results: </strong>There were 2,481 thyroid fine-needle aspirations: 1,164 pre-gene sequencing classifier and 1,317 post-gene sequencing classifier. Pre-gene sequencing classifier, 16% of fine-needle aspirations were atypia of undetermined significance compared with 20% post-gene sequencing classifier (P = .003). Following implementation of the gene sequencing classifier, there was an increase in atypia of undetermined significance from 18% to 20% for less experienced cytopathologists (P = .4), compared with 15%-20% for more experienced cytopathologists (P = .004). Pre-gene sequencing classifier, 39 patients with atypia of undetermined significance underwent thyroidectomy; 30 (77%) had benign disease and 9 (23%) had cancer. Median days to surgery was 147 (interquartile range, 89-308.5). Post-gene sequencing classifier, 51 patients with atypia of undetermined significance underwent thyroidectomy; 30 (59%) had benign disease and 21 (41%) had cancer. Median days to surgery was 151 (interquartile range, 66-249).</p><p><strong>Conclusion: </strong>An unintended consequence of the gene sequencing classifier was an increase in atypia of undetermined significance, a phenomenon unexpectedly observed among more experienced cytopathologists. The gene sequencing classifier was associated with an 18% absolute increase in malignancy for patients undergoing thyroidectomy for atypia of undetermined significance without significant change in time to surgery.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110619"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064422","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":"Ventriculoperitoneal shunt management strategies during emergency abdominal surgery: A retrospective cohort analysis.","authors":"Anum Iqbal, Mohamed M Elgohary, Ricardo A Caravantes Armas, Abdelrahman M Hamouda, Erica A Loomis, Hossam Moustafa Elkhatib, Myung S Park, Beth A Ballinger, Benjamin D Elder, Roderick W Davis, Michelle S Junker","doi":"10.1016/j.surg.2026.110623","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110623","url":null,"abstract":"<p><strong>Background: </strong>Emergency general surgery interventions may risk infection of previously implanted ventriculoperitoneal shunts, yet evidence guiding intraoperative shunt management in adults is limited. We evaluated postoperative shunt-related infections among adults with ventriculoperitoneal shunts undergoing emergency general surgery.</p><p><strong>Methods: </strong>We performed a single-institution 25-year (2000-2025) retrospective cohort study of adults (≥18 years) with ventriculoperitoneal shunts undergoing emergency general surgery. The primary outcome was ventriculoperitoneal shunt infection within 30 days, stratified by Centers for Disease Control and Prevention surgical wound class.</p><p><strong>Results: </strong>Forty-five patients with ventriculoperitoneal shunts undergoing emergency general surgery were included. Median age was 63 years (interquartile range, 39-73), and 62.2% were male. The most common emergency general surgery diagnoses were classified as biliary (35.6%), small bowel (20%), and appendiceal (17.8%). Minimally invasive approaches were used in 42.2% of cases. The most common wound class was II (44.4%), followed by III (28.9%) and IV (17.8%). Among 44 patients with available shunt-management data, ventriculoperitoneal shunt was maintained at the time of emergency general surgery in 37 (84.1%). Valve types were programmable in 46.7%. Antibiotic-impregnated catheters were present in 64.4% of patients. The 30-day ventriculoperitoneal shunt-related infection rate was 4.4%. The first occurred following a laparoscopic appendectomy (wound class III, day 2); the ventriculoperitoneal shunt was removed on postoperative day 2, followed by eventual replacement after completing antibiotic therapy. The second infection was following percutaneous endoscopic gastrostomy placement (wound class II, day 4); ventriculoperitoneal shunt was removed, and temporary ventricular drainage was established. This patient suffered an unrelated mortality prior to reimplantation.</p><p><strong>Conclusion: </strong>Our study suggests that, in selected adults with ventriculoperitoneal shunts undergoing emergency general surgery, shunt preservation is associated with a low rate of shunt-related infection, with no observed adverse consequences among patients who subsequently required shunt explantation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110623"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064455","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":"Outcomes in clinical stage IB cutaneous melanoma managed with only wide local excision.","authors":"Brandon Charles Toliver, Keely Kringlen, Hisakazu Hoshi","doi":"10.1016/j.surg.2026.110610","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110610","url":null,"abstract":"<p><strong>Introduction: </strong>Standard treatment of IB cutaneous melanoma is wide local excision with sentinel lymph node biopsy. Due to the low positivity rate, cost, complications, and limited management changes associated with positive sentinel lymph node biopsy for clinical stage IB melanoma, we sought to determine if omission of sentinel lymph node biopsy impacted outcomes.</p><p><strong>Methods: </strong>We performed a single-institution retrospective study including patients with clinical stage IB (pT1b/2a, cN0, and cM0) cutaneous melanoma who underwent wide local excision with at least 6 months of follow-up. Primary end points were melanoma-specific survival and recurrence-free survival, and secondary end points were patterns of recurrence. Survival was estimated with Kaplan-Meier analysis.</p><p><strong>Results: </strong>We identified 125 patients from 2015 to 2025. The sample was 49.6% male, with a median age of 59 years. By the National Cancer Comprehensive Network risk thresholds, 34 (27.2%) and 43 (34.4%) exceeded 10% predicted sentinel lymph node + risk per Memorial Sloan Kettering and Melanoma Institute of Australia, respectively. Primary lesion sites were 62.4% extremity, 36% trunk, and 1.6% head and neck. The predominant histologic subtype was superficial spreading (75.2%). Median follow-up was 43.2 months. Melanoma-specific survival probability was 99.1% at 13 months and 90.8% at 62 months. Eleven recurrences (8.8%) were observed: 2 (1.6%) regional lymph node, 4 (3.2%) distant, and 5 (4.0%) in-transit or local. Recurrence-free survival probability was 96.6% at 20 months and 82.7% at 60 months.</p><p><strong>Conclusions: </strong>Our data suggest that sentinel lymph node biopsy does not confer regional nodal basin control in clinical stage IB cutaneous melanoma, and its omission does not appear to negatively impact melanoma-specific survival or recurrence-free survival.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110610"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040777","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":"Inadvertent parathyroidectomy during thyroid surgery: Incidence, risk factors, and clinical significance.","authors":"James Stathakios, Tiffany A Johnson, Dharmindra Dulal, Andrew Boring, Avish S Persaud, Meghan Barber, Leah Stevenson, Laura Wharry, Joseph Sferra","doi":"10.1016/j.surg.2026.110613","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110613","url":null,"abstract":"<p><strong>Background: </strong>Inadvertent parathyroidectomy is a well-recognized complication of thyroid surgery, which is associated with postoperative hypoparathyroidism and hypocalcemia. Reported incidence rates of inadvertent parathyroidectomy vary widely in the existing literature, and patient- and procedure-specific risk factors remain incompletely defined. This study analyzes the incidence and risk factors associated with inadvertent parathyroidectomy during thyroidectomy.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 830 patients who underwent thyroidectomy at a single high-volume endocrine surgery center from 2016 to 2022. The primary outcome was the occurrence of inadvertent parathyroidectomy, which was obtained from final surgical pathology reports. Multivariable analysis using logistic regression was performed to assess adjusted outcomes.</p><p><strong>Results: </strong>Among 830 patients, the overall incidence of inadvertent parathyroidectomy was 13.5%. After adjustment, thyroidectomy with central neck dissection (adjusted odds ratio, 4.35; 95% confidence interval, 2.29-8.24) was independently predictive of inadvertent parathyroidectomy, whereas age >65 years (adjusted odds ratio, 0.59; 95% confidence interval, 0.36-0.99), goiter (adjusted odds ratio 0.76; 95% confidence interval, 0.60-0.95), and total thyroidectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.28-0.59) were associated with lower odds of inadvertent parathyroidectomy. Gender, malignancy, specimen weight, operative time, and prior neck surgery were not associated with inadvertent parathyroidectomy.</p><p><strong>Conclusion: </strong>Inadvertent parathyroidectomy is common following thyroidectomy and is associated with select patient- and procedure-related factors. Recognition of high-risk cases may support targeted intraoperative mitigation strategies to improve parathyroid identification and preservation, including autotransplantation when in situ preservation is not feasible. Future efforts should focus on investigation of emerging strategies, such as indocyanine green fluorescence imaging and near-infrared autofluorescence, to enhance intraoperative parathyroid identification and preservation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110613"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040776","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":"Chronic steroid use is not associated with increased short-term morbidity after distal pancreatectomy: A propensity-matched analysis.","authors":"Sangrag Ganguli, Jason Z Gao, Mohammed F Almeflehi, Amir Ebadinejad, Hassan Aziz","doi":"10.1016/j.surg.2026.110606","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110606","url":null,"abstract":"<p><strong>Background: </strong>A national study analyzing the association between chronic steroid use and outcomes after pancreatic resection is lacking. This study aimed to evaluate the association between chronic glucocorticoid use and outcomes after distal pancreatectomy using a national database.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing distal pancreatectomy was performed using the National Surgical Quality Improvement Program database (2018-2024). In addition, we used propensity score matching to compare patients on chronic steroids with those who were not. The outcomes measured included 30-day complications and mortality, need for readmission, prolonged hospital stay, and pancreatic fistula.</p><p><strong>Results: </strong>Of the 6,876 patients who underwent distal pancreatectomy, 623 were on chronic steroids. After propensity score matching, 438 patients in the steroid group and 876 patients in the nonsteroid group were compared. There were no significant differences in pancreatic fistula (23.7% vs 21.7%; P = .3), major complications (31.7% vs 30.1%; P = .1), minor complications (42.2% vs 41.6%; P = .6), mortality (3.4% vs 3.2%; P = .6), readmission (15.8% vs 14.7%; P = .3), or prolonged length of stay (11.4% vs 10.5%; P = .5). On multivariate analysis, chronic steroid use was not independently associated with any adverse outcomes.</p><p><strong>Conclusion: </strong>Chronic glucocorticoid use was not associated with increased short-term morbidity, pancreatic fistula, or mortality following distal pancreatectomy. These findings suggest that chronic steroid dependence should not be considered a contraindication to distal pancreatectomy, although the results should be interpreted with caution, given the inability to assess dose-response relationships and the potential for residual confounding.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110606"},"PeriodicalIF":3.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064330","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}