Surgery最新文献

{"title":"Resource use in infants undergoing esophageal atresia repair at major children's hospitals","authors":"Anne M. Sescleifer MD ,&nbsp;Annalise B. Penikis MD ,&nbsp;Charbel Chidiac MD ,&nbsp;Pooja S. Salvi MD ,&nbsp;Shelby R. Sferra MD, MPH ,&nbsp;Abigail J. Engwall-Gill MD ,&nbsp;Daniel G. Solomon MD ,&nbsp;Shaun M. Kunisaki MD, MSc","doi":"10.1016/j.surg.2025.109428","DOIUrl":"10.1016/j.surg.2025.109428","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal atresia with or without tracheoesophageal fistula is a resource-intensive neonatal surgical condition; however, the magnitude of the institutional cost burden is not well understood. In this study, we used a national database to measure resource use associated with the initial management of esophageal atresia at major children's hospitals nationwide.</div></div><div><h3>Methods</h3><div>The Pediatric Health Information System database was queried for infants undergoing esophageal atresia repair at 1 of 47 children's hospitals in the United States between 2014 and 2021. Those undergoing concomitant cardiac surgery were excluded. The primary outcome measure was total adjusted cost (in US dollars) during the index hospitalization. Multivariable linear regression analyses were performed (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>Of 1,346 infants with esophageal atresia who were identified, 993 (73.8%) met inclusion criteria. The median cost per patient was $545,000 (interquartile range, $302,000–$1,130,000). Room charges (median $391,000; interquartile range, $219,000–$841,000) accounted for nearly three-quarters of total costs. There was no correlation between institutional surgical volume and hospital cost. Long-gap disease (β: 867.3, <em>P</em> &lt; .0001) was the most significant preoperative factor associated with increased hospital cost. The major postoperative events associated with increased cost were mechanical ventilation days (β: 17.7, <em>P</em> &lt; .0001), pneumonia (β: 168.6, <em>P</em> = .006), and anastomotic leak (β: 137.2, <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>In this multicenter cohort study, the median cost associated with the surgical management of a newborn with esophageal atresia exceeded a half a million dollars. The development of esophageal atresia–specific clinical practice guidelines aimed at reducing postoperative respiratory morbidity and anastomotic leak rates may be useful to minimize the resource burden associated with the care of these challenging patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109428"},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212397","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 of interfacility transfer patterns among patients with emergency general surgery conditions","authors":"Nina M. Clark MD, MS ,&nbsp;Rebecca G. Maine MD, MPH ,&nbsp;Mariam N. Hantouli MD ,&nbsp;Ellen Cooper MD ,&nbsp;Alison Porter MD ,&nbsp;Colleen M. Sitlani PhD ,&nbsp;Nicholas L. Smith PhD ,&nbsp;Giana H. Davidson MD, MPH","doi":"10.1016/j.surg.2025.109448","DOIUrl":"10.1016/j.surg.2025.109448","url":null,"abstract":"<div><h3>Background</h3><div>Interfacility transfer for emergency general surgery is a key strategy for improving access to care. However, lower-intensity transfers are linked to increased costs, poor patient and family experience, and inefficient resource allocation. Clinical and health system characteristics associated with lower-intensity transfers among patients with emergency general surgery conditions remain unclear.</div></div><div><h3>Methods</h3><div>We performed a cohort study among adults with emergency general surgery conditions using claims data from Florida and California. Lower-intensity transfers were defined as admissions ≤3 days with discharge to home without procedural intervention. These were compared with greater-intensity transfers (admission &gt;3 days, nonhome discharge, or procedural intervention), lower-intensity nontransfers, and higher-intensity nontransfers. We used multinomial logistic regression to identify patient and facility factors present on admission that were associated with lower-intensity transfer compared with other encounter types.</div></div><div><h3>Results</h3><div>Of 211,466 patients who underwent emergency general surgery, lower-intensity transfers encompassed 0.7% of encounters overall and 30% of transfers. Factors associated with lower-intensity transfer compared with nontransfer included Medicaid insurance, history of bariatric surgery, patients presenting to a critical access hospital, patients with cholecystitis, and patients presenting with higher-complexity surgical disease. Patients presenting to hospitals with advanced gastroenterology and palliative care were less likely to undergo lower-intensity transfer (<em>P</em> &lt; .05 for all).</div></div><div><h3>Conclusion</h3><div>Facility characteristics are associated with lower-intensity transfers among patients who undergo emergency general surgery and may be a future target for policy aimed at improving the efficiency and quality of regional emergency general surgery care. Understanding clinical and resource needs of patients who undergo emergency general surgery may facilitate the development of interventions to support emergency general surgery care in resource-limited settings and triage patients requiring high-complexity care to tertiary and quaternary facilities.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109448"},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212395","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":"Cancer-specific survival of colorectal adenocarcinomas according to the type of pre-existing adenoma: A Surveillance, Epidemiology, and End Results registry analysis","authors":"Sameh Hany Emile MBBCh, MSc, MD, FACS ,&nbsp;Zoe Garoufalia MD ,&nbsp;Anjelli Wignakumar MBBS, BSc (Hon) ,&nbsp;Steven D. Wexner MD, PhD (Hon)","doi":"10.1016/j.surg.2025.109468","DOIUrl":"10.1016/j.surg.2025.109468","url":null,"abstract":"<div><h3>Background</h3><div>More than 90% of colorectal cancers originate from preexisting adenomas. The present study aimed to assess the association between the type of preexisting adenomas and cancer-specific survival of subsequent colorectal cancer.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results registry 2000–2020 on patients surgically treated for colorectal adenocarcinomas with known types of preexisting adenomas. Kaplan-Meier statistics and Cox regression analyses were used to assess 5-year cancer-specific survival according to the adenoma types.</div></div><div><h3>Results</h3><div>The study included 65,365 patients (52.7% male, median age 67 years). Overall, 75.7% of tumors were associated with tubulovillous adenomas, 23.4% with villous adenomas, 0.66% with tubular adenomas, and 0.1% with serrated adenomas. The 5-year cancer-specific survival was best for serrated adenoma-associated carcinomas (87.9%), followed by tubular adenoma-associated carcinomas (84.2%) and tubulovillous adenomas-associated carcinomas (81.5%) whereas villous adenomas-associated carcinomas had the lowest cancer-specific survival (74.1%). The same finding was noted when cancer-specific survival was stratified by disease location and stage. Patients with villous adenomas-associated carcinomas had a lower likelihood of cancer-specific survival compared to tubular adenoma-associated carcinomas (hazard ratio, 1.56, <em>P</em> &lt; .001) whereas tubulovillous adenomas and serrated adenoma-associated carcinomas had a similar risk. However, when adjusted for other survival confounders, the type of preexisting adenoma was not independently associated with cancer-specific survival.</div></div><div><h3>Conclusion</h3><div>Colorectal adenocarcinomas originating from serrated adenomas and tubular adenomas had the highest 5-year cancer-specific survival. Conversely, villous adenomas-associated adenocarcinomas had the lowest cancer-specific survival. The type of preexisting adenoma was not independently associated with 5-year cancer-specific survival.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109468"},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205274","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 coronary artery bypass grafting excess readmission ratios.","authors":"Tyler Zander, Melissa A Kendall, Emily A Grimsley, Paul C Kuo","doi":"10.1016/j.surg.2025.109462","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109462","url":null,"abstract":"<p><strong>Background: </strong>The Hospital Readmissions Reduction Program determines Medicare readmission penalties through risk-adjusted excess readmissions ratios. This study uses interpretable machine learning to identify associations with coronary artery bypass grafting excess readmissions ratios.</p><p><strong>Methods: </strong>Florida Agency for Healthcare Administration database (2017-2019) was queried for patients with Medicare who underwent coronary artery bypass grafting and linked to Hospital Readmissions Reduction Program and RAND Hospital data. Univariable analysis compared hospitals above compared with below the median excess readmissions ratios. LightGBM and XGBoost modeled excess readmissions ratios using patient data. SHapley Additive exPlanations were used for interpretation.</p><p><strong>Results: </strong>The cohort had 7,776 patients from 64 hospitals. Hospitals above the median excess readmissions ratios had more emergent admissions (35.4 vs 29.8%, P < .01), greater mortality (2.1 vs 1.3%, P < .01), and more expensive postoperative care charges (P < .01). Models had mean absolute errors <0.06 and R² > 0.79. SHapley Additive exPlanations revealed charges and length of stay as most influential. Greater postoperative care charges and shorter length of stay were associated with greater excess readmissions ratios.</p><p><strong>Conclusion: </strong>Hospitals with greater excess readmissions ratios charge more for postoperative care. Whether this association is caused by hospital differences alone or also by unadjusted differences in patient severity and functional status is unknown. The association of shorter length of stay with greater excess readmissions ratios could suggest that hospitals with greater excess readmissions ratios discharge patients too early. Future research should investigate the causes of these associations and their impact on excess readmissions ratios to ensure that hospitals are not unfairly penalized.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109462"},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235307","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":"Severe liver injuries in a contemporary national trauma registry: In-hospital mortality remains high regardless of therapeutic approach","authors":"Terry R. Schaid Jr. MD ,&nbsp;Ernest E. Moore MD ,&nbsp;Renaldo Williams MD ,&nbsp;Fredrick M. Pieracci MD, MPH ,&nbsp;Isabella M. Bernhardt BA ,&nbsp;Daniel D. Yeh MD ,&nbsp;Angela Sauaia MD, PhD","doi":"10.1016/j.surg.2025.109457","DOIUrl":"10.1016/j.surg.2025.109457","url":null,"abstract":"<div><h3>Background</h3><div>Severe liver injuries remain a common cause of lethal uncontrolled cavitary bleeding. Therapeutic approaches include laparotomy, angioembolization, and observation, alone or in combination. We hypothesized that angioembolization use increased and liver injury in-hospital mortality decreased over time.</div></div><div><h3>Methods</h3><div>We queried the 2017–2022 Trauma Quality Improvement Program database for adults with severe liver injury (Abbreviated Injury Scale score = 4/5). Management within the first 24 hours was categorized as laparotomy only, laparotomy → angioembolization, angioembolization only, angioembolization → laparotomy, or observation (no surgical or interventional radiology procedures). Cox proportional hazards models were used to adjust in-hospital mortality for confounders.</div></div><div><h3>Results</h3><div>18,445 patients were managed by laparotomy = 42.7%; observation = 47.0%; laparotomy → angioembolization = 5.1%; angioembolization = 4.5%; angioembolization → laparotomy = 0.8%. The confounder-adjusted use of angioembolization (alone or in combination with laparotomy) increased over time (<em>P</em> = .002). In-hospital mortality (18.7%) remained stable over time (<em>P</em> = .63). Compared to laparotomy-only, all other therapeutic approaches were associated with a lower adjusted hazard ratio: angioembolization-only = 0.81 (0.79–0.83); angioembolization → laparotomy = .89 (0.81–0.97); laparotomy → angioembolization = 0.88 (0.84–0.92); observation = 0.84 (0.83–0.85). Patients with admission hypotension and grade 5 (vs 4) liver injury experienced similar results. Of all therapeutic approaches, only observation was associated with a significant in-hospital mortality increase over time (adjusted hazard ratio = 1.003 [1.0001–1.005]).</div></div><div><h3>Conclusions</h3><div>Severe liver injury mortality remains high and unabated over recent years. Management with angioembolization has increased over time and was associated with improved survival, even when employed in patients hypotensive on admission and with grade 5 liver injury. These data support an integrated approach to severe liver injuries, possibly optimized in a hybrid operating room environment.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109457"},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212394","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 of frailty with outcomes of endovascular thoracic and abdominal aneurysm repairs","authors":"Dariush Yalzadeh BS ,&nbsp;Oh Jin Kwon MD ,&nbsp;Daniel Tabibian BS ,&nbsp;Arjun Chaturvedi ,&nbsp;Nam Yong Cho BS ,&nbsp;Mahima Chillakanti BS ,&nbsp;Soroush Shahamatdar BS ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.surg.2025.109449","DOIUrl":"10.1016/j.surg.2025.109449","url":null,"abstract":"<div><h3>Background</h3><div>Given the increasing use of endovascular repair of aortic aneurysms in elderly patients, accurate identification of patients with frailty is crucial for optimizing patient selection and care. The present study represents the first application of the recently developed Hospital Frailty Risk Score and its comparison with commonly used surgical frailty indices to investigate the association between frailty and outcomes after endovascular abdominal repair and thoracic endovascular aortic repair using a nationally representative database.</div></div><div><h3>Methods</h3><div>Adults undergoing elective endovascular abdominal repair and thoracic endovascular aortic repair for unruptured aortic aneurysms were identified in the 2016–2021 Nationwide Readmission Database and grouped into <em>non-Frail</em> and <em>Frail</em> cohorts using the Hospital Frailty Risk Score, Administrative Risk Analysis Index, and Johns Hopkins Adjusted Clinical Groups instruments. Multivariable regression models and area under the receiver operating characteristic curve were used to assess and compare the associations between frailty, adverse outcomes, and resource use.</div></div><div><h3>Results</h3><div>Of an estimated 105,265 patients who underwent endovascular abdominal repair and 16,595 patients who underwent thoracic endovascular aortic repair, 10.1% and 23.4% were classified as <em>frail</em> by Hospital Frailty Risk Score, respectively. After multivariable adjustment, frailty identified by Hospital Frailty Risk Score was associated with increased odds of mortality and perioperative complications, including respiratory, renal, and thromboembolic events. The Hospital Frailty Risk Score demonstrated the greatest discriminatory power, sensitivity, and specificity in predicting outcomes, outperforming the models that included Administrative Risk Analysis Index and Johns Hopkins Adjusted Clinical Groups.</div></div><div><h3>Conclusion</h3><div>The Hospital Frailty Risk Score appears to be a reliable frailty instrument for predicting adverse outcomes in vulnerable populations undergoing vascular procedures. Given the critical role of accurately identifying frailty to optimize postoperative care and resource allocation, selecting the most appropriate frailty instrument is essential.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109449"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205287","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":"Partial adrenalectomy for pheochromocytoma in the multiple endocrine neoplasia type 2 population: Time to reconsider?","authors":"Diederik P.D. Suurd MD ,&nbsp;Medard F.M. Van den Broek MD, PhD ,&nbsp;Charlotte L. Viëtor MD ,&nbsp;Tessa M. Van Ginhoven MD, PhD ,&nbsp;Richard A. Feelders MD, PhD ,&nbsp;Inne H.M. Borel Rinkes MD, PhD ,&nbsp;Gerlof D. Valk MD, PhD ,&nbsp;Menno R. Vriens MD, PhD","doi":"10.1016/j.surg.2025.109452","DOIUrl":"10.1016/j.surg.2025.109452","url":null,"abstract":"<div><h3>Background</h3><div>Adrenalectomy is considered the standard of care for multiple endocrine neoplasia type 2–related pheochromocytomas. Recently, partial adrenalectomy has been suggested as an alternative to prevent adrenal insufficiency in hereditary pheochromocytoma. Nevertheless, this comes with the risk of ipsilateral recurrence. Therefore, we aimed to determine the incidence of ipsilateral recurrence after partial adrenalectomy and assess the proportion of prevented adrenal insufficiency due to partial adrenalectomy in cases of bilateral disease.</div></div><div><h3>Methods</h3><div>A retrospective, multicenter cohort study was conducted between 1977 and 2022 via a standardized medical record review. The primary outcome was the incidence of ipsilateral recurrence after partial adrenalectomy compared with total adrenalectomy. The secondary outcomes included disease-free survival and incidence of adrenal insufficiency and crisis after bilateral surgery.</div></div><div><h3>Results</h3><div>In 50 patients with multiple endocrine neoplasia type 2, a total of 88 adrenalectomies were performed, including 23 partial adrenalectomies and 65 total adrenalectomies. After a median follow-up after last surgery of 8.3 years, 7 (30.4%) of the partial adrenalectomies and 2 (3.1%) of total adrenalectomies had recurrent disease (<em>P</em> &lt; .001, χ² test). The median time to recurrence was 4 and 21 years after partial adrenalectomy and total adrenalectomy, respectively. After bilateral surgery with at least partial adrenalectomy on one side, 50.0% of patients did not require corticosteroids.</div></div><div><h3>Conclusion</h3><div>These data show that there is a considerable risk of ipsilateral recurrent disease in the short term after partial adrenalectomy for multiple endocrine neoplasia type 2–related pheochromocytoma with a 50% chance of adrenal insufficiency in cases of bilateral surgery. Therefore, we doubt whether partial adrenalectomy should be preferred for multiple endocrine neoplasia type 2–associated pheochromocytoma. We propose total adrenalectomy as the standard technique and partial adrenalectomy only for selected cases.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109452"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195127","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":"Repeated surgery for recurrence is not a risk factor for conversion in patients undergoing laparoscopic ileo-colonic resection for Crohn disease","authors":"Federico Ghignone MD ,&nbsp;Giovanni Taffurelli MD, PhD ,&nbsp;Federica Greco MD ,&nbsp;Davide Zattoni MD ,&nbsp;Isacco Montroni MD, PhD ,&nbsp;Giampaolo Ugolini MD, PhD","doi":"10.1016/j.surg.2025.109456","DOIUrl":"10.1016/j.surg.2025.109456","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo ileo-colonic resection for Crohn disease are at risk of repeated surgery because of recurrence. Minimally invasive approach is debated in recurrent cases. This study aims to identify predictors for conversion to open surgery and explore if a repeated laparoscopic procedure represents a risk factor for conversion. Outcomes of recurrent versus primary surgery were also evaluated.</div></div><div><h3>Methods</h3><div>This is retrospective single-center cohort study enrolling all patients undergoing laparoscopic surgery for primary and recurrent ileo-colic Crohn disease between January 2017 and December 2023. Univariate and multivariate analysis according to the least absolute shrinkage and selection operator were carried out to identify factors associated with conversion to open surgery and postoperative outcomes.</div></div><div><h3>Results</h3><div>A total of 202 patients were included; the mean age was 49 years. Half were malnourished and received steroids/biologics before surgery. One hundred twenty patients (59.4%) underwent surgery for stenosing disease. Most had American Society of Anesthesiologists score 1 or 2. One hundred thirty-four patients underwent primary ileo-colonic resection and 68 (33.6%) were operated for recurrence. Conversion rate was 10.3% (21/202). Mean length of stay was 5.2 days. Eight patients (3.9%) had severe complications, and anastomotic leak rate was 3.4%. Multivariate analysis showed that only American Society of Anesthesiologists score was a risk factor for conversion. No statistically significant differences were noted in terms of diverting stoma, complications, reoperation, length of stay, and readmission between primary and recurrent ileo-colonic resection.</div></div><div><h3>Conclusions</h3><div>Previous surgery for Crohn disease is not correlated with the risk of conversion; postoperative outcomes are not significantly different from those for primary ileo-colonic resection. Minimally invasive approach should be attempted in every patient undergoing surgery for recurrent Crohn disease.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109456"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190238","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":"Does cognition influence the perioperative trajectory of health-related quality of life? A longitudinal prospective cohort study","authors":"Ellene Yan HBSc ,&nbsp;Yasmin Alhamdah MSc ,&nbsp;Nina Butris MSc ,&nbsp;Paras Kapoor MSc ,&nbsp;Leif Erik Lovblom PhD ,&nbsp;Jean Wong MD ,&nbsp;Aparna Saripella MSc ,&nbsp;David He MD, PhD ,&nbsp;Frances Chung MD, FRCPC","doi":"10.1016/j.surg.2025.109450","DOIUrl":"10.1016/j.surg.2025.109450","url":null,"abstract":"<div><h3>Background</h3><div>Further characterization is needed to capture the trajectory of health-related quality of life in older surgical populations with cognitive impairment. This study aimed to (1) compare the perioperative trajectory of health-related quality of life between older noncardiac surgical patients with and without cognitive impairment; (2) assess preoperative health-related quality of life values associated with adverse clinical outcomes; and (3) explore preoperative factors associated with poorer health-related quality of life over time.</div></div><div><h3>Methods</h3><div>Health-related quality of life was assessed online using the EuroQol 5-Dimension 5-Level questionnaire preoperatively and postoperatively at 30, 90, and 180 days. A greater score indicated greater health-related quality of life. Cognition was assessed preoperatively using the Ascertain Dementia Eight-item Questionnaire and the Telephone Montreal Cognitive Assessment. Participants identified as having probable cognitive impairment were referred to as having cognitive impairment.</div></div><div><h3>Results</h3><div>EuroQol 5-Dimension 5-Level questionnaire scores significantly improved within 30 days postoperatively (0.718 ± 0.012 vs 0.690 ± 0.011, <em>P</em> = .04), with sustained gains at 90 (0.784 ± 0.013 vs 0.690 ± 0.011, <em>P</em> ≤ .001) and 180 days (0.797 ± 0.013 vs 0.690 ± 0.011, <em>P</em> ≤ .001). Although participants with cognitive impairment on the Ascertain Dementia Eight-item Questionnaire and those undergoing orthopedic surgery reported poorer health-related quality of life than their counterparts, they exhibited a greater rate of improvement over time. Lower education level, higher pain level, functional disability, depression, and having orthopedic surgery were associated with poorer health-related quality of life across all time points. Poorer preoperative health-related quality of life was associated with a higher incidence of delirium and non-home discharge.</div></div><div><h3>Conclusion</h3><div>Health-related quality of life improves by 30 days postoperatively, with a greater rate of improvement among those with cognitive impairment on the Ascertain Dementia Eight-item Questionnaire and those undergoing orthopedic surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109450"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195128","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":"Splenic artery ligation in hepatectomy: Unanswered questions and the need for higher-quality evidence.","authors":"Ayesha Khaliq, Brijesh Sathian, Ashfaq Ahmad, Javed Iqbal, Syed Muhammad Ali","doi":"10.1016/j.surg.2025.109440","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109440","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109440"},"PeriodicalIF":3.2,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217003","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}