Surgery最新文献

{"title":"Outcomes among undocumented immigrants undergoing liver transplant: A nationwide retrospective cohort","authors":"Azza Sarfraz MBBS,&nbsp;Miho Akabane MD,&nbsp;Abdullah Altaf MD,&nbsp;Mujtaba Khalil MD,&nbsp;Zayed Rashid MD,&nbsp;Shahzaib Zindani MD,&nbsp;Jun Kawashima MD,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA,&nbsp;Austin D. Schenk MD, PhD","doi":"10.1016/j.surg.2025.109965","DOIUrl":"10.1016/j.surg.2025.109965","url":null,"abstract":"<div><h3>Background</h3><div>Undocumented immigrants face significant barriers to health care access, including organ transplantation. However, their post–liver transplant outcomes remain poorly understood. This study evaluates graft survival and overall survival among undocumented immigrants undergoing liver transplant compared with US citizens.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the Scientific Registry of Transplant Recipients database, including adult liver transplant recipients from 1987 to 2022. The primary outcomes were 1-year graft survival and 5-year overall survival, analyzed using Fine-Gray competing risks and Cox proportional hazards models. A total of 88,603 adult liver transplant recipients were included, with 1,331 (1.5%) identified as undocumented immigrants.</div></div><div><h3>Results</h3><div>Compared with US citizens, undocumented immigrants had a lower body mass index (27.4 vs 28.1 kg/m²), lower diabetes prevalence (0.2% vs 4.4%), and higher rates of alcohol-associated liver disease (53.9% vs 43.9%) (all <em>P</em> &lt; .05). Median Model for End-Stage Liver Disease with Sodium Adjustment scores (undocumented immigrant: 21 vs US citizen: 18) and wait times (undocumented immigrant: 105 vs US citizen: 95 days) were statistically different (<em>P</em> &lt; .001) but clinically similar. In unadjusted analyses, undocumented immigrants had higher 1-year graft survival (hazard ratio: 0.27, 95% confidence interval: 0.19–0.39) and 5-year overall survival (hazard ratio: 0.49, 95% confidence interval: 0.42–0.58) than US citizens (<em>P</em> &lt; .05). Adjusted analyses found no significant differences in 1-year graft survival (hazard ratio: 0.79, 95% confidence interval: 0.20–3.15) or 5-year overall survival (hazard ratio: 0.68, 95% confidence interval: 0.35–1.32) (both <em>P</em> &gt; .05).</div></div><div><h3>Conclusion</h3><div>Post–liver transplant survival among undocumented immigrants was comparable to US citizens after adjustment. These findings support policies that enhance equitable liver transplant access while maintaining comparable outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109965"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744347","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":"Decoding risk factors for prolonged hospitalization after take-back to the operating room after liver transplantation: Escalating costs and clinical implications","authors":"Ayato Obana MD ,&nbsp;Miho Akabane MD ,&nbsp;Khalid Mumtaz MBBS, MSc ,&nbsp;Hannah Chi MD ,&nbsp;Nolan Ladd MD ,&nbsp;Matthew Yoder BS ,&nbsp;Lily Kaufman BS ,&nbsp;Rithin Punjala MBBS ,&nbsp;Kejal Shah MD ,&nbsp;Matthew Hamilton DO ,&nbsp;Ashley Limkemann MD, MPH ,&nbsp;Austin Schenk MD, PhD ,&nbsp;Navdeep Singh MBBS ,&nbsp;Sylvester Black MD, PhD ,&nbsp;Timothy M. Pawlik MD, PhD, MPH, MTS, MBA, FACS, FSSO, FRACS (Hon) ,&nbsp;Kenneth Washburn MD ,&nbsp;Musab Alebrahim MD","doi":"10.1016/j.surg.2025.109902","DOIUrl":"10.1016/j.surg.2025.109902","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in liver transplantation, unplanned take-back to the operating room remains a significant challenge. This study aimed to identify characteristics associated with take-back procedures, determine predictors of extended length of stay after take-back, and evaluated associated health care costs.</div></div><div><h3>Methods</h3><div>In this single-center retrospective study of 914 adult liver transplantation recipients (2016–2023), extended length of stay was defined as hospitalization exceeding the 75th percentile (&gt;19 days) among patients requiring take-back. Multivariate analysis identified predictors of prolonged length of stay, and comprehensive cost analysis quantified health care expenditures between cohorts.</div></div><div><h3>Results</h3><div>Take-back occurred in 12.7% (<em>n</em> = 116) of recipients, with postoperative bleeding/hematoma being the primary indication (67.2%). Patients requiring take-back demonstrated greater median Model for End-Stage Liver Disease including sodium scores (25 vs 22, <em>P</em> = .041), increased rates of pretransplant transjugular intrahepatic portosystemic shunt (15.5% vs 6.8%, <em>P</em> = .002), and more frequent female-to-male donor-recipient matching (30.2% vs 17.7%, <em>P</em> = .01). Among take-back cases, multivariate analysis identified Model for End-Stage Liver Disease including sodium score (odds ratio, 1.08; 95% confidence interval, 1.01–1.16, <em>P</em> = .02) and operating time (odds ratio, 1.62; 95% confidence interval, 1.18–2.21, <em>P</em> = .001) as independent predictors of extended length of stay. Take-back was associated with greater in-hospital costs per case (median [interquartile range], $199,438 [$170,710–$257,159] vs $155,780 [$135,476–$181,953], <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>This study identified distinct characteristics associated with take-back to the operating room after liver transplantation and demonstrated that elevated Model for End-Stage Liver Disease including sodium scores and extended operating time independently predict prolonged length of stay after reoperation. The substantial cost differential associated with take-back procedures highlights the economic impact of this complication. These readily available clinical parameters enable practical risk stratification for extended hospitalization, facilitating more effective resource planning and optimization of health care resource allocation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109902"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668492","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 axillary ultrasound performance on Sentinel Node versus Observation after Axillary Ultrasound (SOUND) trial–eligible patients","authors":"Kyle R. Stephens MD, MS,&nbsp;Megan Wilson BS,&nbsp;Manting Xu BA,&nbsp;Kelly M. McMasters MD, PhD,&nbsp;Nicolas Ajkay MD, MBA","doi":"10.1016/j.surg.2025.109927","DOIUrl":"10.1016/j.surg.2025.109927","url":null,"abstract":"<div><h3>Background</h3><div>The Sentinel Node versus Observation after Axillary Ultrasound (SOUND) trial suggested that sentinel lymph node biopsy could be omitted in small breast cancers with negative axillary ultrasound, despite 13.7% of preoperative axillary ultrasound being falsely negative when validated on sentinel lymph node biopsy. Our aim was to evaluate the performance of axillary ultrasound in our patient population using SOUND trial criteria.</div></div><div><h3>Methods</h3><div>A retrospective review was performed between 2015 and 2023 of SOUND trial–eligible patients. Two subgroup univariate analyses, pathologic T classification group and molecular subgroup, were performed comparing preoperative axillary ultrasound performance metrics, demographics, and tumor characteristics. Multivariate analysis was performed to predict false-negative axillary ultrasound.</div></div><div><h3>Results</h3><div>263 patients were SOUND trial–eligible, whereas only 223 had a sentinel lymph node biopsy. Overall, this study was similar to the SOUND trial in terms of demographics and tumor characteristics, as well as false-negative axillary ultrasound (13.5%). The remaining performance metrics of preoperative axillary ultrasound were sensitivity (23%), specificity (94%), positive predictive value (37%), and negative predictive value (88%). There were significant differences in specificity (<em>P</em> = .005) among molecular subgroups (Luminal/HER2–, HER2/neu+, and triple-negative). False-negative axillary ultrasound was significantly different (<em>P</em> value .015) when comparing pathologic T group (31% T2, 13% T1c, 11% T1b, and 0% T1mi/T1a). Multivariate analysis demonstrated that each 1-cm increase in tumor size was associated with 46% higher odds of a false-negative axillary ultrasound (odds ratio 1.46 per cm, <em>P</em> = .018).</div></div><div><h3>Conclusions</h3><div>The high specificity and negative predictive value of axillary ultrasound suggests that foregoing sentinel lymph node biopsy in small breast cancers with negative preoperative AUS is reasonable, especially in patients with T1mi/T1a and T1b tumors.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109927"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834859","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":"Understanding unrealized trial enrollments following patient-to-trial matching with large language models","authors":"Claire T. Verhagen BS ,&nbsp;Grace Westerman BS ,&nbsp;Haley Heaviland BS ,&nbsp;Erin Lynch MS ,&nbsp;Olivia Brandenburg BS ,&nbsp;Jennifer Adams-Patton BSN ,&nbsp;Regina Schwind MS ,&nbsp;Yongwoo David Seo MD ,&nbsp;Callisia N. Clarke MD, MS ,&nbsp;Ben George MD ,&nbsp;Anai N. Kothari MD, MS","doi":"10.1016/j.surg.2025.109915","DOIUrl":"10.1016/j.surg.2025.109915","url":null,"abstract":"<div><h3>Background</h3><div>Clinical trials are essential for advancing cancer care, but identifying eligible patients in surgical clinics can be challenging due to the manual and time-consuming enrollment process. Artificial intelligence tools, such as large language models, have the potential to automate aspects of clinical trial matching. This study identified reasons why patients did not enroll in a clinical trial after receiving a recommendation from OncoLLM-MCW, a large language model–based platform for matching patients to clinical trials.</div></div><div><h3>Methods</h3><div>This retrospective study included patients seen by surgeons participating in a prospective pilot using a large language model–based platform within gastrointestinal surgical oncology clinics between July and December 2024. OncoLLM-MCW, a fine-tuned large language model trained on institutional clinical data and oncology guidelines, was used to identify eligible clinical trial matches. Each week, new patients were processed, and matches were shared with provider teams for review. The primary outcome was unrealized trial enrollment, defined as a match that did not result in enrollment. Secondary outcomes included reasons for non-enrollment.</div></div><div><h3>Results</h3><div>Using OncoLLM-MCW, 514 patients were evaluated, resulting in 34 trial matches across 32 patients. Of these, 9 matches (26.5%) resulted in enrollment, whereas 25 (73.5%) did not. Among the 25 non-enrolling matches, 9 (36%) patients were ineligible, 5 (20%) declined participation, 4 (16%) were not enrolled due to provider discretion, and 7 (28%) had no documented reason.</div></div><div><h3>Conclusion</h3><div>OncoLLM-MCW automated clinical trial matching in surgical clinics, screening more than 500 patients. Identifying and addressing reasons for unrealized enrollments may optimize accrual and advance cancer care.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109915"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640013","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":"Characterizing liver disease in patients undergoing bariatric surgery: Prevalence and outcomes of 180,544 cases","authors":"Mélissa V. Wills MD ,&nbsp;Valentin Mocanu MD, PhD ,&nbsp;Doua Elamin MD ,&nbsp;Pattharasai Kachornvitaya MD ,&nbsp;Juan S. Barajas-Gamboa MD ,&nbsp;Gabriela Restrepo-Rodas MD ,&nbsp;Juan Aulestia MD ,&nbsp;Ricard Corcelles MD, PhD ,&nbsp;Matthew Allemang MD ,&nbsp;Andrew Strong MD ,&nbsp;Salvador Navarrete MD ,&nbsp;Matthew Kroh MD ,&nbsp;Jerry Dang MD, PhD","doi":"10.1016/j.surg.2025.109966","DOIUrl":"10.1016/j.surg.2025.109966","url":null,"abstract":"<div><h3>Background</h3><div>The impact of liver disease on perioperative outcomes in bariatric surgery remains incompletely characterized. This study aims to determine the prevalence and outcomes of liver disease in patients who undergo bariatric surgery.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 180,544 patients who underwent primary laparoscopic and robotic bariatric surgery in the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Patients were stratified by presence of documented liver disease. Primary outcomes included 30-day complications and mortality. Multivariable logistic regression identified independent predictors of serious complications.</div></div><div><h3>Results</h3><div>Liver disease was present in 20,678 (11.5%) patients. Compared with patients without liver disease, those with liver disease were older (43.8 ±11.9 vs 42.9 ±11.9 years), less likely to be female (79.4% vs 82.5%), and had greater rates of diabetes (31.9% vs 22.5%), hypertension (48.1% vs 43.1%), and sleep apnea (47.9% vs 36.9%) (all <em>P</em> &lt; .0001). Patients with liver disease experienced greater rates of anastomotic leak (0.3% vs 0.2%, <em>P</em> = .009), bleeding (1.2% vs 0.8%, <em>P</em> &lt; .0001), reoperation (1.0% vs 0.8%, <em>P</em> = .001), and nonoperative reintervention (0.8% vs 0.6%, <em>P</em> &lt; .0001). Overall serious complications were greater in the liver disease group (3.1% vs 2.4%, <em>P</em> &lt; .0001), but mortality remained equivalent (0.07%, <em>P</em> = .855). On multivariable analysis, liver disease independently predicted serious complications (odds ratio, 1.18; 95% confidence interval, 1.09–1.29; <em>P</em> &lt; .0001).</div></div><div><h3>Conclusion</h3><div>Liver disease is common among patients who undergo bariatric surgery and independently associated with increased perioperative complications but not mortality. Although the database lacks granular liver disease characterization preventing stratification by severity despite these short-term risks, bariatric surgery remains important for patients with liver disease, who—with specialized perioperative management—stand to gain significant long-term protection against disease progression.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109966"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752228","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":"Transversus abdominis release (TAR) versus preperitoneal repair (PPR) in complex, open abdominal wall reconstruction","authors":"Alynna J. Wiley MD ,&nbsp;Stephanie M. Jensen MD ,&nbsp;Alexis M. Holland MD ,&nbsp;Gregory T. Scarola MS, MBA ,&nbsp;Keith S. Gersin MD ,&nbsp;Sullivan A. Ayuso MD ,&nbsp;Kent W. Kercher MD ,&nbsp;Vedra A. Augenstein MD ,&nbsp;B. Todd Heniford MD","doi":"10.1016/j.surg.2025.109904","DOIUrl":"10.1016/j.surg.2025.109904","url":null,"abstract":"<div><h3>Introduction</h3><div>The evolution of abdominal wall reconstruction has produced multiple effective techniques for hernia repair. Transversus abdominis release and preperitoneal repair allow for the placement of large mesh constructs. The outcomes of these techniques have not been compared, and this was the aim of this study.</div></div><div><h3>Methods</h3><div>Prospective data from 3,783 open abdominal wall reconstructions underwent a 1:1 propensity-score match for elective transversus abdominis release and preperitoneal repair using comorbidities, wound class, and defects. Standard descriptive and comparative statistics were applied.</div></div><div><h3>Results</h3><div>Propensity-score matching produced 347 pairs. There was no difference in age, body mass index, tobacco use, diabetes, American Society of Anesthesiologists score, wound class, or number of comorbidities. Patients who underwent transversus abdominis release had more recurrent hernias (69.2% vs 53.9%; <em>P</em> &lt; .001). Preoperative Botox injections used for chemical component separation were similar (8.1% vs 9.8%; <em>P</em> = .425). These hernias were large and complex, with more than 22.3% being contaminated. Transversus abdominis release involved larger defects (247.8 ± 137.2 vs 223.4 ± 152.3 cm²; <em>P</em> = .003) and mesh sizes (994.5 ± 417.5 vs 845.7 ± 412.4 cm²; <em>P</em> &lt; .001) with greater use of synthetic versus biologic mesh (70.6% vs 62.0%<em>; P</em> = .019). Fascial closure was not significantly different (98.6% vs 96.3%; <em>P</em> = .056). Transversus abdominis release had longer operative time (209.6 ± 69.6 vs 184.9 ± 75.6 minutes; <em>P</em> &lt; .001), but operating room charges were similar ($18,565 ± 11,792 vs $18,209 ± 11,847; <em>P</em> = .390). There were no differences in infection (6.6% vs 6.9%), seroma intervention (12.7% vs 8.4%), or mesh infection (1.7% vs 0.6%) (all <em>P</em> &gt; .05). Patients who underwent transversus abdominis release experienced greater wound breakdown (7.8% vs 4.0%; <em>P</em> = .036) and overall wound complications (25.6% vs 18.4%; <em>P</em> = .022). With an average follow-up of 21.8 ± 31.9 and 29.1 ± 36.1 months, there was no difference in hernia recurrence (2.9% vs 2.9%; <em>P</em> &gt; .999).</div></div><div><h3>Conclusion</h3><div>Compared with transversus abdominis release, preperitoneal abdominal wall reconstruction demonstrated equivalent hernia recurrence rates with fewer wound complications. Preperitoneal repair represents an effective approach to complex hernia repair for large defects, facilitating wide mesh placement while mitigating wound morbidity.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109904"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726270","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":"Predictive value of individual social risk versus neighborhood-level social vulnerability for trauma outcomes","authors":"Pooja Podugu MD ,&nbsp;Arnav Mahajan MB, BCh, BAO ,&nbsp;Allison Mo BA ,&nbsp;Megen Simpson MAEd ,&nbsp;Sarah A. Sweeney MD ,&nbsp;Vanessa P. Ho MD, PhD, MPH","doi":"10.1016/j.surg.2025.109914","DOIUrl":"10.1016/j.surg.2025.109914","url":null,"abstract":"<div><h3>Background</h3><div>Neighborhood-level indices serve as proxies for social risk in clinical research, although self-reported social determinants of health may better identify vulnerable patients, especially in the context of traumatic injury. We hypothesized that self-reported social determinants of health have stronger predictive value for short-term trauma outcomes than neighborhood aggregates.</div></div><div><h3>Methods</h3><div>Adult inpatients with trauma tic injury (2020–2024) who completed hospital-administered social determinants of health screeners were assigned Social Vulnerability Index, Area Deprivation Index, and Environmental Justice Index scores based on census tract and categorized as high risk/low risk using median splits. Patients were also categorized as at risk/no risk across the 8 self-reported social determinants of health domains, measured by the screener. Primary outcomes were 30-day readmissions and hospital length of stay. Regression models measured the association of social determinants of health measures with outcomes, adjusting for injury and patient factors.</div></div><div><h3>Results</h3><div>A total of 3,115 patients completed social determinants of health screeners with 917 screened pre-trauma (median 152 days) and 2,198 screened post-trauma (median 17 days). Social Vulnerability Index and Environmental Justice Index predicted readmission risk (odds ratio 1.41 [95% confidence interval 1.07–1.86], <em>P</em> = .014, and 1.37 [1.00–1.87], <em>P</em> = .047). Social isolation was associated with significantly greater odds of readmission (odds ratio 2.17 [95% confidence interval 1.12–4.76], <em>P</em> = .032). No other social determinants of health domains predicted readmissions. Social isolation and stress were associated with longer length of stay (β = 1.44 days [95% confidence interval 0.36–2.52], <em>P</em> = .009, and β = 1.31 days [95% confidence interval 0.37–2.24], <em>P</em> = .006). No neighborhood measures predicted length of stay.</div></div><div><h3>Conclusions</h3><div>Social isolation demonstrated a stronger association with 30-day readmissions than neighborhood measures for trauma inpatients. Both social isolation and stress predicted hospital length of stay. Interventions to mitigate isolation and to increase outpatient support after discharge may be effective in reducing readmission in high-risk trauma patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109914"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for readers","authors":"","doi":"10.1016/S0039-6060(26)00023-1","DOIUrl":"10.1016/S0039-6060(26)00023-1","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110101"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188847","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":"Steroid replacement after adrenalectomy for mild autonomous cortisol secretion: Clinical predictors and a practical algorithm","authors":"Arturan Ibrahimli MD ,&nbsp;Edip Memisoglu MD ,&nbsp;Rafael Perez-Soto MD ,&nbsp;Pratibha Rao MD ,&nbsp;Ricardo Correa MD ,&nbsp;Dingfeng Li MD ,&nbsp;Ravali Veeramachaneni MD ,&nbsp;Snigdha Reddy Bendaram MD ,&nbsp;Eren Berber MD, MBA","doi":"10.1016/j.surg.2025.109967","DOIUrl":"10.1016/j.surg.2025.109967","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mild autonomous cortisol secretion is identified in up to 50% of patients with adrenal nodules after a low-dose dexamethasone-suppression test. Although steroids are routinely started in patients with Cushing syndrome after adrenalectomy, there is confusion about postoperative steroid replacement in patients with mild autonomous cortisol secretion. The aim of this study was to investigate the frequency and clinical predictors of postoperative steroid replacement in patients with mild autonomous cortisol secretion undergoing unilateral adrenalectomy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was an institutional review board approved retrospective study. Mild autonomous cortisol secretion was defined as preoperative serum cortisol level of &gt;1.8 μg/dL after low-dose dexamethasone suppression without signs and symptoms of overt Cushing syndrome. In patients who underwent unilateral adrenalectomy between 2000 and 2024 for mild autonomous cortisol secretion, a decision for postoperative steroid replacement was made based on a combination of parameters, including postoperative day 1 cortisol levels, adrenocorticotropic hormone stimulation test results and clinical evidence of adrenal insufficiency. Univariate and multivariate logistic regression models were used to identify predictors of steroid replacement. Continuous data are expressed as medians (interquartile ranges).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There was a total of 139 patients with mild autonomous cortisol secretion who underwent minimally invasive adrenalectomy. All patients had &lt;span&gt;am&lt;/span&gt; cortisol levels, and 85 patients had adrenocorticotropic hormone stimulation tests done on postoperative day 1. Postoperative steroid replacement was done on 32 patients on the basis of postoperative day 1 cortisol level &lt;5 μg/dL (&lt;em&gt;n&lt;/em&gt; = 15), postoperative day 1 cortisol level &lt;10 μg/dL and failed adrenocorticotropic hormone stimulation test (&lt;em&gt;n&lt;/em&gt; = 15), and or symptoms of adrenal insufficiency (&lt;em&gt;n&lt;/em&gt; = 2). Independent predictors of postoperative steroid replacement therapy included preoperative plasma adrenocorticotropic hormone &lt;7.0 pg/mL (&lt;em&gt;P&lt;/em&gt; = .02) and cortisol &gt;4.2 μg/dL on low-dose dexamethasone test (&lt;em&gt;P&lt;/em&gt; = .008). Patients were followed up for a median of 15 months (interquartile range, 5–38 months) with no evidence of adrenal insufficiency with this management. Steroids were weaned off within a median of 78 days (interquartile range, 35–251 days).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;To the best of our knowledge, this is the largest study to date on postoperative steroid management of patients with mild autonomous cortisol secretion. A safe algorithm was described to select patients for steroid replacement. In contrast to previous reports in the literature, a minority (23%) of the patients with mild autonomous cortisol secretion needed postoperative steroid replacement in this cohort with the algorithm used.&lt;/div","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109967"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775706","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":"ERGO (ERGonomics in the Operating room) study: A cross-sectional international online survey.","authors":"Stefano Restaino, Nicoletta Crivellaro, Federico Paparcura, Gianluca Pellino, Mauro Podda, Alice Poli, Giulia Pellecchia, Martina Arcieri, Federica Perelli, Marco D'Indinosante, Benedetto Ielpo, Marcello Di Martino, Giovanni Scambia, Lorenza Driul, Giuseppe Vizzielli, Francesco Pata","doi":"10.1016/j.surg.2025.110049","DOIUrl":"https://doi.org/10.1016/j.surg.2025.110049","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Although work-related physical disorders among surgeons are increasing globally, with potential detrimental effects on surgical performance and patient care, ergonomics is still overlooked in clinical practice. The aim of this study is to investigate ergonomics problems and perceptions in the operating room in an international cohort of surgeons to obtain baseline data necessary to plan implementation initiatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A Checklist for Reporting Results of Internet E-Surveys (CHERRIES)-compliant internet-based survey was developed using Google Forms and distributed via surgical societies, professional associations, and collaborative networks between September 2023 and February 2024 to surgeons from different specialties worldwide. The survey consisted of 6 sections, exploring various aspects such as job history, surgical specialty, practice location and role, surgical training, and injuries related to surgical practice. A total of 1,093 responses were received from surgeons in 42 countries. Because of the open distribution model, a precise response rate could not be calculated. The decision to use an online survey as the primary data collection method was driven by several distinct advantages. Primarily, this approach facilitated access to a broad and heterogeneous sample of surgeons encompassing various specialties and geographic locations-an achievement challenging to replicate with conventional survey techniques. The digital format enabled efficient dissemination through established channels, including surgical societies, professional organizations, and collaborative networks, thereby ensuring extensive reach in a cost-effective and timely fashion. Moreover, the anonymity afforded by the online platform encouraged participants to provide honest and uninhibited responses concerning sensitive topics such as musculoskeletal discomfort and ergonomic behaviors, mitigating potential biases linked to social desirability or fear of professional consequences. The flexibility inherent to an internet-based survey also allowed respondents to participate at their convenience, which likely enhanced overall response rates and engagement among busy health care professionals worldwide. Collectively, these attributes positioned the online survey as an optimal and practical tool for capturing comprehensive baseline data on ergonomic issues within the international surgical community.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The survey received a total of 1,093 responses. Up to 96.9% of surgeons reported experiencing some musculoskeletal discomfort, which were more commonly associated with laparoscopy (55.4%), followed by open surgery (32.9%). Robotic surgery had the lowest rate of pain (1.1%, P &lt; .001). Surgery-related injuries in 9.7% of cases prevented the surgeon from performing clinical or surgical duties, and in 13.4% of cases musculoskeletal pain necessitated absence from work or job leave. Overall, 31.4% ","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110049"},"PeriodicalIF":2.7,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214036","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}