{"title":"Postoperative respiratory morbidity in chronic obstructive pulmonary disease patients receiving botulinum toxin injection before abdominal wall surgery: A multicentric study","authors":"Gaëtan-Romain Joliat MD, PhD , Pablo Ortega-Deballon MD, PhD , Hessa Alsuwaidan MD , David Moszkowicz MD, PhD , Benoit Romain MD, PhD , Yohann Renard MD, PhD , Guillaume Passot MD, PhD","doi":"10.1016/j.surg.2025.109765","DOIUrl":"10.1016/j.surg.2025.109765","url":null,"abstract":"<div><h3>Background</h3><div>Botulinum toxin A injection is often used before abdominal wall surgery. Because botulinum toxin A inhibits the lateral abdominal muscles that have a secondary role in the breathing biomechanics, potential concerns regarding postoperative respiratory morbidity in patients with chronic obstructive pulmonary disease have been raised. This study assessed the incidence of postoperative pneumonias after abdominal wall surgery in patients with chronic obstructive pulmonary disease with and without botulinum toxin A injection.</div></div><div><h3>Methods</h3><div>A multicentric (4 centers) cross-sectional study was performed. Consecutive patients with chronic obstructive pulmonary disease who underwent abdominal wall surgery (2013–2024) were included. In case of large or complex hernia, botulinum toxin A was performed 4–8 weeks before surgery if judged necessary. Chronic obstructive pulmonary disease was defined based on the anesthesia preoperative consultation. The primary end point was the rate of postoperative hospital-acquired pneumonias.</div></div><div><h3>Results</h3><div>A total of 150 patients with chronic obstructive pulmonary disease were included: median age 68 years (interquartile range: 63–73), 61 women (41%), and median body mass index 29 kg/m<sup>2</sup> (interquartile range: 25–33 kg/m<sup>2</sup>). Sixty patients received botulinum toxin A (40%), and 90 did not receive botulinum toxin A (60%). In the botulinum toxin A group, more patients had loss of domain (28% vs 7%, <em>P</em> < .001), and the median defect size was larger (12 vs 6 cm, <em>P</em> < .001). Fifty-four (90%) and 61 (68%) patients had midline incisional hernias in the botulinum toxin A and non–botulinum toxin A groups (<em>P</em> = .006). Postoperative complications occurred in 26 patients in the botulinum toxin A group (43%) and 33 patients in the non–botulinum toxin A group (37%, <em>P</em> = .413). Postoperative pneumonia incidences were similar in both groups (3/60 vs 4/90, <em>P</em> = .874). On multivariable analysis, component separation was the only predictor of pneumonia (odds ratio: 8.7, 95% confidence interval: 1.7–44.9, <em>P</em> = .010) and not botulinum toxin A (odds ratio: 0.9, 95% confidence interval: 0.2–4.0, <em>P</em> = .920).</div></div><div><h3>Conclusion</h3><div>Regarding postoperative respiratory morbidity, botulinum toxin A seems safe in patients with chronic obstructive pulmonary disease undergoing abdominal wall surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109765"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207625","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}
SurgeryPub Date : 2025-09-30DOI: 10.1016/j.surg.2025.109705
Shaleen V Sathe, Abigail Chmiel, Caroline Jones, William E Gillanders, John A Olson, Taylor C Brown
{"title":"Deviating from Thyroid Imaging Reporting and Data Systems (TI-RADS) guidelines in surgical planning for patients with parathyroid disease: What is the clinical impact?","authors":"Shaleen V Sathe, Abigail Chmiel, Caroline Jones, William E Gillanders, John A Olson, Taylor C Brown","doi":"10.1016/j.surg.2025.109705","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109705","url":null,"abstract":"<p><strong>Background: </strong>The American College of Radiology Thyroid Imaging Reporting and Data Systems standardizes thyroid nodule classification to assess malignancy risk. The use of preoperative ultrasound before parathyroidectomy often detects incidental thyroid nodules, prompting consideration of additional evaluation and/or concomitant thyroid surgery to minimize need for reoperative surgery. This study evaluated clinician adherence to Thyroid Imaging Reporting and Data Systems guidelines for patients with parathyroid disease and associated clinical outcomes.</p><p><strong>Methods: </strong>A retrospective review of 992 patients undergoing parathyroidectomy (2019-2024) examined the role of Thyroid Imaging Reporting and Data Systems in preoperative planning and the clinical decision-making after incidental discovery of thyroid nodules. Descriptive and univariate statistical analyses were performed to compare guideline-concordant and discordant care.</p><p><strong>Results: </strong>Of 957 patients with a formal preoperative ultrasound, 406 (42.4%) had at least 1 thyroid nodule with the Thyroid Imaging Reporting and Data Systems classification reported by a radiologist. Among those with a nodule, 154 (37.9%) underwent fine-needle aspiration and 56 (13.8%) underwent concomitant thyroid surgery for the nodule. Notably, 47 fine-needle aspiration procedures (30.5%) did not meet Thyroid Imaging Reporting and Data Systems criteria. Patients who received guideline-discordant fine-needle aspiration procedures were less likely to undergo thyroid surgery (12.8% vs 34.9%, P = .005) or receive a diagnosis of thyroid cancer (4.3% vs 16.8%, P = .037). Overall, most malignancies were low risk per American Thyroid Association guidelines (n = 20, 80.0%), regardless of Thyroid Imaging Reporting and Data Systems criteria.</p><p><strong>Conclusion: </strong>Many patients undergoing parathyroidectomy receive additional interventions for incidental thyroid nodules. However, adherence to Thyroid Imaging Reporting and Data Systems guidelines may help reduce unnecessary surgery, because most identified malignancies are low risk. The long-term impact remains unclear, emphasizing the need for shared decision-making between surgeons and patients.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109705"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207651","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}
SurgeryPub Date : 2025-09-30DOI: 10.1016/j.surg.2025.109735
Krupa Patel BS , Genaro D. Fullano MS, ATC , Lauren Sickmiller BS , Michelle Wang MS , Mohamed Yassin BA , Clifford L. Craig MD, FACS, FAAP , Maria Skoczylas MD , Heather L. Burrows MD, PhD , Deborah M. Rooney PhD
{"title":"Simulation-based training reduces unnecessary ultrasound referrals for developmental dysplasia of the hip in newborns","authors":"Krupa Patel BS , Genaro D. Fullano MS, ATC , Lauren Sickmiller BS , Michelle Wang MS , Mohamed Yassin BA , Clifford L. Craig MD, FACS, FAAP , Maria Skoczylas MD , Heather L. Burrows MD, PhD , Deborah M. Rooney PhD","doi":"10.1016/j.surg.2025.109735","DOIUrl":"10.1016/j.surg.2025.109735","url":null,"abstract":"<div><h3>Background</h3><div>Developmental dysplasia of the hip is a common newborn condition characterized by malformation or instability of the hip joint. Identifying dysplasia of the hip early is imperative for avoiding long-term consequences. In the United States, dysplasia of the hip screening of newborns uses the Ortolani and Barlow maneuvers. However, evidence suggests that inadequate training in these techniques may lead to unnecessary imaging referrals for further assessment. We investigated the impact of a dysplasia of the hip simulator (MiHip) and its associated training program on ultrasound referral rates and cost-savings at a single institution.</div></div><div><h3>Methods</h3><div>From July 2021 to June 2022, 54 residents on newborn rotations underwent training using the MiHip curriculum. All newborns born at our institution 1 year prior (<em>n</em> = 5,404) and 1-year posttraining period (<em>n</em> = 5,792) were identified. High-risk factors warranting automatic ultrasound referrals (family history of dysplasia of the hip, breech presentation, and multiple births) were excluded. χ<sup>2</sup> tests were used to compare pre- and posttraining incidences of dysplasia of the hip–relevant and unnecessary (defined as dysplasia of the hip–negative) ultrasound referrals. <em>P</em> ≤ .05 was considered statistically significant, and effect, <em>ω</em> ≥ 0.30 considered moderate.</div></div><div><h3>Results</h3><div>Initial referral rates for dysplasia of the hip decreased by 34.07%, χ<sup>2</sup> (1, <em>N</em> = 5,031) = 34.41, <em>P</em> = .02, <em>ω</em> = 0.08. Unnecessary referrals decreased by 23%, χ<sup>2</sup> (1, <em>N</em> = 33) = 17.96, <em>P</em> = .04, <em>ω</em> = 0.74. This coincided with a $14,400 annual savings.</div></div><div><h3>Conclusion</h3><div>The MiHip training curriculum significantly reduced unnecessary ultrasound referrals, demonstrating the value of simulation-based training in enhancing dysplasia of the hip examination skills. This training has the potential to lower financial and emotional burdens associated with extensive imaging, specialist consultations, and follow-up care.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109735"},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207695","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}
SurgeryPub Date : 2025-09-29DOI: 10.1016/j.surg.2025.109709
Man Him Matrix Fung, Chun Chung Cheng, Yan Luk, Brian Hung Hin Lang
{"title":"Laryngeal ultrasound-guided adhesive transcutaneous electrodes versus conventional endotracheal electrodes for intraoperative neuromonitoring during thyroid and neck surgery.","authors":"Man Him Matrix Fung, Chun Chung Cheng, Yan Luk, Brian Hung Hin Lang","doi":"10.1016/j.surg.2025.109709","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109709","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional intraoperative neuromonitoring during thyroid surgery commonly uses electromyography electrodes embedded in endotracheal tubes. Adhesive transcutaneous electrodes may be a novel, noninvasive and low-cost alternative, but its accuracy and limitations remain less known. This prospective study compared the accuracy of adhesive transcutaneous electrodes placed under laryngeal ultrasound guidance to that of conventional endotracheal tube electrodes and assessed the factors associated with success in adhesive transcutaneous electrodes intraoperative neuromonitoring.</p><p><strong>Methods: </strong>Consecutive patients undergoing open thyroid and neck surgery in a tertiary endocrine surgery unit were prospectively recruited. Before skin incision, the position of vocal cords relative to the thyroid cartilage was marked with laryngeal ultrasonography, and a pair of adhesive transcutaneous electrodes was placed on the overlying skin. Endotracheal tube electrode was used simultaneously. Standardized vagus and recurrent laryngeal nerve stimulation protocol was followed. On each stimulation, electromyography signals were simultaneously recorded by adhesive transcutaneous electrodes and endotracheal tube electrodes and later verified by postoperative flexible laryngoscopy.</p><p><strong>Results: </strong>From 2023 to 2024, 300 nerves at risk from 216 patients were analyzed. Median age was 59 (50-70) years; 72.7% were female. Adhesive transcutaneous electrode electromyography had lower amplitudes for both recurrent laryngeal nerve and vagus nerve (P < .001). All 4 vocal cord vocal cord paresis (1.33%, transient and unilateral) were detected by adhesive transcutaneous electrodes and endotracheal tube electrodes, that is, 100% sensitivity and negative predictive value for vocal cord vocal cord paresis. Adhesive transcutaneous electrodes had slightly lower specificity (91.6% vs 96.5%) and accuracy (91.8% vs 96.6%), and lower positive predictive value (14.3% vs 28.6%). Signal interference in adhesive transcutaneous electrodes occurred in 6 patients (2.8%). Higher body mass index (BMI) was the only factor associated with false results from adhesive transcutaneous electrodes (P = .002, odds ratio 1.176, 95% confidence interval 1.060-1.305). Accuracy of adhesive transcutaneous electrodes (94.6%) became comparable to endotracheal tube electrodes in patients with body mass index <25. Adhesive transcutaneous electrodes cost less than endotracheal tube electrodes (32 vs 427 US dollars) for each surgery. Two patients with misplaced endotracheal tube electrodes (false endotracheal tube electrodes signal loss) had normal recurrent laryngeal nerve function correctly predicted by adhesive transcutaneous electrodes.</p><p><strong>Conclusion: </strong>Laryngeal ultrasound-guided adhesive transcutaneous electrode intraoperative neuromonitoring has comparable sensitivity and negative predictive value to endotracheal tube electrodes an","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109709"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201375","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}
SurgeryPub Date : 2025-09-29DOI: 10.1016/j.surg.2025.109718
Sameh Hany Emile MBBCh, MSc, MD, FACS , Nir Horesh MD , Zoe Garoufalia MD , Rachel Gefen MD , Peige Zhou MD , Steven D. Wexner MD, PhD (Hon)
{"title":"Development and validation of a predictive score of 30-day mortality following proctectomy for rectal cancer: A National Cancer Database analysis","authors":"Sameh Hany Emile MBBCh, MSc, MD, FACS , Nir Horesh MD , Zoe Garoufalia MD , Rachel Gefen MD , Peige Zhou MD , Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109718","DOIUrl":"10.1016/j.surg.2025.109718","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate predictors of 30-day mortality after rectal cancer surgery and develop a predictive score using significant independent predictors.</div></div><div><h3>Methods</h3><div>A retrospective case-control analysis of the National Cancer Database (2010–2017) was conducted. Patients with stage I-III rectal adenocarcinoma who underwent proctectomy were included. Patients who died within 30 days of surgery were compared to patients alive at 30 days after surgery for patient, disease, and treatment characteristics. Binary logistic regression was used to develop a predictive model; independent predictors of 30-day mortality were incorporated into a predictive risk score and validated using another cohort from the National Cancer Database (2018–2019).</div></div><div><h3>Results</h3><div>53,651 patients with rectal cancer (60.9% male) were included. Thirty-day mortality was 1.1%. Independent predictors of 30-day mortality were increased age (odds ratio: 1.07, 95% confidence interval: 1.05–1.08), male sex (2.19, 1.61–2.98), Black race (2.16, 1.44–3.25), Charlson score ≥3 (1.86, 1.05–3.3), tumor-node-metastasis stage III (1.66, 1.12–2.46), neoadjuvant systemic treatment (0.523, 0.296–0.925), prolonged hospitalization (1.02, 1.01–1.03), and conversion to open surgery (1.59, 1.13–2.23). A predictive score entailing 3 risk groups was developed. There was a linear trend of increased 30-day mortality across the three groups (0.8% to 1.9% to 4.5%; <em>P</em> < .001). Score specificity in the development and validation datasets was 99.6% and 99.5% and accuracy was 98.7% and 98.8%, respectively.</div></div><div><h3>Conclusions</h3><div>Independent predictors of increased 30-day mortality were incorporated into a risk score with a specificity and accuracy of more than 98%. The score may be used to improve outcomes of high-risk patients by implementing additional strategies to reduce the risk of short-term mortality.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"188 ","pages":"Article 109718"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201406","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}