World Journal of Surgery最新文献

{"title":"Physiological Emergency Surgery Acuity Score Predicts Mortality and Anastomotic Leak in Emergency Laparotomy: An External Validation Study.","authors":"Wade Hopper, Anthony J Duncan, Mentor Ahmeti","doi":"10.1002/wjs.70562","DOIUrl":"https://doi.org/10.1002/wjs.70562","url":null,"abstract":"<p><strong>Background: </strong>The Physiological Emergency Surgery Acuity Score (PESAS) predicts 30-day mortality but has not been externally validated in emergency general surgery (EGS) patients. The study aim was to evaluate PESAS discrimination for predicting mortality and anastomotic leak in patients receiving emergency laparotomy.</p><p><strong>Methods: </strong>We retrospectively evaluated PESAS in a single-center cohort of adults receiving exploratory laparotomy for emergent, nontraumatic indications. PESAS and 30-day mortality were calculated for all patients. Discrimination of PESAS for 30-day mortality was assessed using area under receiver operator curve (AUROC). Secondary analysis was conducted in similar fashion for the outcome of anastomotic leak requiring reoperation.</p><p><strong>Results: </strong>In 1086 patients with 160 cases of 30-day mortality (14.7%), PESAS showed strong discrimination for the primary outcome (AUROC 0.86; 95% CI 0.83-0.88) with acceptable calibration-in-the-large. In an exploratory secondary analysis of 414 patients who received bowel anastomosis with 21 cases of leak (5.1%), PESAS also showed good discrimination for anastomotic leak (AUROC 0.82; 95% CI 0.73-0.90). Observed mortality rates showed clear inflection points at PESAS values of 5 and 10, respectively, corresponding to mortality exceeding 10% and 50%.</p><p><strong>Conclusions: </strong>PESAS demonstrates good discrimination, calibration-in-the-large, and net benefit as an ordinal risk stratification tool for prediction of 30-day mortality among patients undergoing emergency laparotomy, with exploratory analysis suggesting promise for predicting anastomotic leak. Because it is derived entirely from objective physiologic variables, it may be well-suited for automated risk stratification in EGS populations. Further patient-level calibration is needed to justify expanded use.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video-Assisted Versus Conventional Surgical Informed Consent in Visceral Surgery-A Cluster Quasi-Randomized Clinical Trial.","authors":"Svenja G P D Leicht, Leon Schuetze, Johan F Lock, Christoph-Thomas Germer, Johanna C Wagner","doi":"10.1002/wjs.70561","DOIUrl":"https://doi.org/10.1002/wjs.70561","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive informed consent is a core surgical responsibility but is increasingly challenged by rising patient volumes and limited personnel resources. Digital solutions in healthcare offer opportunities to optimize patient education. Video-assisted informed consent may reduce time expenditure without compromising informational quality. The objective was to compare video-assisted with conventional informed consent regarding duration, patient understanding, patient, and physician satisfaction.</p><p><strong>Methods: </strong>In this prospective, cluster quasi-randomized clinical trial at the University Hospital Wuerzburg, Germany (September 2023-March 2025), 153 of 330 screened patients scheduled for elective cholecystectomy or colon resection were enrolled. The intervention group received a video developed by medudoc education GmbH, while the control group received physician-led informed consent according to the hospital's standard. Consultation duration was recorded using a stopwatch. Patients completed questionnaires on satisfaction and understanding immediately after consent and postoperatively, physicians rated satisfaction at study completion. The primary outcome was time reduction for the physician consultation time. Secondary outcomes included patient understanding, patient satisfaction, physician satisfaction, and postoperative pain.</p><p><strong>Results: </strong>Of 153 participants, 84 (55%) received video-assisted and 69 (45%) conventional consent. Median physician consultation time was significantly reduced with video assistance for cholecystectomy (1.5 vs. 8.1 min) and colon resection (3.3 vs. 11.9 min). Patient understanding, satisfaction, and postoperative pain outcomes were high in both groups. Physician satisfaction with the video-assisted process was consistently high.</p><p><strong>Conclusions: </strong>Video-assisted surgical informed consent serves as a valuable adjunct in preoperative patient education and represents a promising approach to digital innovation in clinical practice.</p><p><strong>Trial registration: </strong>ISRCTN registry ISRCTN26680260 (https://www.isrctn.com/search?q=ISRCTN26680260).</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vein-Guided Approach for Safe Control of Splenic Vein Tributaries in Robot-Assisted Splenic Vessel-Preserving Distal Pancreatectomy.","authors":"Hiroki Sunagawa, Keigo Hayashi, Tomofumi Orokawa","doi":"10.1002/wjs.70557","DOIUrl":"https://doi.org/10.1002/wjs.70557","url":null,"abstract":"<p><p>Splenic vessel-preserving distal pancreatectomy (SVPDP) preserves splenic function while maintaining physiological perfusion and drainage, but remains technically demanding. Standardization has so far centered on the splenic artery, with prior strategies describing whether it is approached from the ventral or dorsal aspect of the pancreas. The venous side has received little systematic attention: small tributaries draining the pancreas into the splenic vein, most consistently the centro-inferior pancreatic vein (CIPV), are a frequent unpredictable source of bleeding during posterior dissection. A vein-guided approach is described that uses the splenic vein and its tributaries as the anatomical roadmap for posterior dissection, maintaining continuous \"vein-on-sight\" visualization to safely control these venous branches as a group rather than relying on any single landmark. Because the splenic artery runs immediately cephalad to the vein on the dorsal pancreatic surface, the venous plane developed by this approach also facilitates subsequent arterial control. Among 24 patients undergoing SVPDP (13 laparoscopic and 11 robot-assisted), the robotic approach showed favorable nonsignificant trends toward lower blood loss, fewer clinically relevant pancreatic fistulas, and higher splenic vein patency. This vein-guided approach complements existing artery-based strategies, extending technical standardization of SVPDP to the venous side.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenges of Predicting Rare Outcomes: A Critical Appraisal of Machine Learning Using the Pediatric Resuscitation and Trauma Outcome (PRESTO) Model in a Tanzanian Injury Registry.","authors":"Joao Vitor Pereze de Souza, Elizabeth M Keating, William Nkenguye, Rosalia Njau, Happiness Kajoka, Pollyana Coelho Pessoa Santos, Edwin Joseph Shewiyo, Catherine A Staton, Blandina T Mmbaga, Joao Ricardo Nickenig Vissoci","doi":"10.1002/wjs.70553","DOIUrl":"https://doi.org/10.1002/wjs.70553","url":null,"abstract":"<p><strong>Background: </strong>Injuries are responsible for 950,000 deaths per year among children and adolescents under 18 years old. Trauma prediction scores are useful in determining severity and prognosis of injury patients. The pediatric resuscitation and trauma outcome (PRESTO) score was developed as a simple score for short-term mortality prediction in pediatric populations in low- and middle-income countries (LMICs). Using variables available at the bedside in resource-limited settings, PRESTO has been validated in South Africa, Rwanda, and Tanzania. In Tanzania, our team found these variables were present for most pediatric injury patients and that the model performed well in predicting mortality. However, we faced challenges due to small sample size and mortality being a rare outcome.</p><p><strong>Objective: </strong>We sought to determine whether we could improve predictability of the PRESTO model for pediatric patients by increasing sample size through inclusion of adult trauma patients from the same population at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania.</p><p><strong>Design/methods: </strong>Data were collected between November 2020 and February 2024 from a pediatric registry, and between April 2018 and February 2024 from an adult injury registry at KCMC. Missing data were addressed using multiple imputation. The dataset was split into training and testing sets (75/25). Ten machine learning algorithms were trained to predict in-hospital mortality using clinical and demographic variables, with performance evaluated using cross-validation, ROC-AUC, sensitivity, and specificity.</p><p><strong>Results: </strong>A total of 5635 injury patients (911 pediatric and 4724 adults) were included. Pediatric in-hospital mortality was 6.8%, while adult mortality was 4.4%. Pediatric patients presented with worse GCS scores compared to adults (4% severe vs. 1.4% severe). The best-performing models were Random Forest (RF), C5, and Extreme Gradient Boosting (XGB), with ROC-AUCs of 0.92, 0.90, and 0.81. In the test set, ROC-AUC for pediatric patients was lower than for adults, with differences of 0.08, 0.06, and 0.05 for XGB, RF, and C5, respectively.</p><p><strong>Conclusions: </strong>Adding adult data did not improve predictability of the PRESTO model, possibly due to the fact that the lower mortality and injury severity in adults compared to children in our dataset statistically diluted the model. This supports the idea that children should be considered separately, especially for vital signs and mortality prediction. These findings highlight the challenge of predicting a rare outcome, and emphasize the need to increase pediatric registry sample sizes to develop more accurate models for mortality risk stratification in LMICs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Bowel Cancer: Implications of Preoperative Work-Up on Surgical Strategy.","authors":"Erik Kjæstad, Espen Thiis-Evensen, Anita Sveen, Arne Olav Bakka, Johannes Kurt Schultz","doi":"10.1002/wjs.70547","DOIUrl":"https://doi.org/10.1002/wjs.70547","url":null,"abstract":"<p><strong>Background: </strong>Small bowel cancers comprise a heterogeneous group of malignancies, making diagnosis and treatment challenging. This study aimed to evaluate the ability of preoperative diagnostic work-up to predict clinical and histopathological findings, facilitate subgroup identification, and support tailored, individualized surgical strategies.</p><p><strong>Methods: </strong>This retrospective single-center analysis included all patients operated 2015-2024 for suspected small bowel cancer at a tertiary referral center. Preoperative assessments-including diagnostic evaluation of tumor type, disease extent, and anatomical localization-were compared to intraoperative findings and final histopathological results.</p><p><strong>Results: </strong>Of 187 operations, 59 (32%) were right colectomies, 50 (27%) robotic/laparoscopic procedures and 36 (19%) emergencies. Preoperative symptoms were present in 156 (83%) patients. CT scans were performed in 184 (98%), somatostatin receptor imaging (SRI) in 120 (64%), endoscopy in 92 (49%), and biopsy in 74 (40%). Small intestinal neuroendocrine tumors (siNET) were found in 108 (58%) patients, carcinomas in 24 (13%), metastatic tumors in 17 (9%), gastrointestinal stromal tumors in 13 (7%), benign lesions in 13 (7%), lymphomas in 8 (4%), and desmoid tumors in 4 (2%). The preoperative tentative tumor entity was correct in 118 (63%). CT sensitivities for mesenteric and peritoneal metastases were 65% and 9%, respectively. SRI was positive in 83/92 siNET and 6/28 non-NET. Mesenteric metastases were found in 99 (95%) siNET patients. SRI failed to identify mesenteric dissemination in 24 (27%) siNET patients. Among patients with siNET, 18 (17%) had liver metastases and 18 (17%) had peritoneal metastases. SiNET multifocality was associated with distant metastatic status (p < 0.001). Pathologists found 313 luminal siNET, 17 tumors were missed by intraoperative palpation, 51 by SRI and 156 by CT. All siNET were in the ileum. Terminal compared to middle/upper ileum siNET were more often solitary (39/42 [93%] vs. 31/60 [52%]; p < 0.001) and had less often advanced mesenteric disease (N2) (9/44 [20%] vs. 31/58 [53%]; p < 0.001).</p><p><strong>Conclusions: </strong>Preoperative work-up of small bowel cancer is often inaccurate, particularly when it comes to identification of bowel tumors and metastases. Intraoperative palpation of the bowel and its mesentery and inspection of the peritoneum remain essential to facilitate an adaptive surgical strategy.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interhospital Transfer Patients With Necrotizing Soft Tissue Infections: An Evaluation of the Role for Pretransport Operation.","authors":"Hans V Strobl, Diane N Haddad, Renee Bicaba, Renee I Tristano, Phillip M Dowzicky, Abid D Khan, Timothy P Plackett, Justin S Hatchimonji","doi":"10.1002/wjs.70546","DOIUrl":"https://doi.org/10.1002/wjs.70546","url":null,"abstract":"<p><strong>Background: </strong>Early debridement is the cornerstone of treatment for necrotizing soft tissue infections (NSTI), but patients are frequently transferred for management. We described practice patterns, hypothesizing that pre-transfer NSTI debridement is associated with improved outcomes.</p><p><strong>Methods: </strong>We analyzed data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for Massachusetts, Wisconsin, and Colorado in 2022. NSTI patients and the subset undergoing operation before transfer (PRE) were identified. The primary outcome was mortality. We performed multivariable logistic regression adjusting for demographics, weekend transfer, severe sepsis or septic shock, and Charlson comorbidity index (CCI). Secondary outcomes were length of stay (LOS) and hospital charges.</p><p><strong>Results: </strong>We identified 243 transferred NSTI patients. Mean age (SD) was 56.7 (14.5) years, and 74 (30.5%) were female. There were 127 referring and 52 receiving centers, with a wide range of case volume and PRE rates. Seventy-seven (31.7%) patients were PRE; there was no difference in rates of sepsis between these patients and the remainder (41.6% vs. 37.4%, p = 0.531). Mortality with and without pre-transfer operation was 7/77 (9.1%) versus 10/166 (6.0%), with aOR = 1.62 for PRE, (p = 0.38). Pre- and post-transfer median LOS were longer for PRE (4 vs. 0 days at the referring hospital, p < 0.001; 15 vs. 10 days at the receiving hospital, p = 0.01), and PRE had higher median charges before ($66,214.50 vs. $11,227.50, p < 0.001) and after transfer ($161,615 vs. $89,728, p = 0.012).</p><p><strong>Conclusion: </strong>Among transferred NSTI patients, mortality did not differ between PRE and the remainder of the cohort. PRE patients had longer hospital stays and higher healthcare charges, possibly due to worse physiology or more complex wounds.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Long-Term Health-Related Quality of Life After Mastectomy and Breast Conserving Therapy.","authors":"Sanna Järvinen, Tiina Jahkola, Hanna Ihalainen, Jussi P Repo, Susanna Kauhanen, Pauliina Homsy","doi":"10.1002/wjs.70517","DOIUrl":"https://doi.org/10.1002/wjs.70517","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer and its treatments have a significant impact on patients' health-related quality of life (HRQL). The aim of this study was to compare HRQL in a long-term, cross-sectional assessment after breast conserving therapy (BCT) and mastectomy without reconstruction, using the BREAST-Q.</p><p><strong>Materials and methods: </strong>Altogether 500 patients who had undergone either mastectomy or BCT between 06/2016 and 8/2018 were approached. The postoperative HRQL was assessed using the BREAST-Q Breast Conserving Therapy and Mastectomy Modules.</p><p><strong>Results: </strong>A total of 171 (34%) women participated, 85 of whom had undergone BCT and 86 mastectomy without reconstruction. The mean (SD) time from surgery to the survey was 3.3 (1) years. The mean age of the participants did not differ in the groups (p = 0.45). Compared to those who had undergone mastectomy, women with a history of BCT reported better psychosocial well-being (78 (19) vs. 66 (17), p < 0.01), sexual well-being (61 (20) vs. 41 (22), p < 0.01) and physical well-being of the chest (86 (16) vs. 77 (20), p < 0.01). They were also more satisfied with their breasts (72 (22) vs. 52 (17), p < 0.01) and reported fewer radiotherapy side effects (7 (1) vs. 8 (3), p = 0.01).</p><p><strong>Conclusions: </strong>These data suggest that the long-term HRQL remains high after both BCT and mastectomy. However, women with a history of BCT reported higher psychosocial, sexual, and physical well-being and greater satisfaction with their breasts than those with a history of mastectomy.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended D3 Mesenterectomy in Small Bowel Cancer Treatment: Feasibility and Importance for Staging. First Results of a Prospective Clinical Trial.","authors":"Erik Kjæstad, Espen Thiis-Evensen, Bjørn Edwin, Arne Olav Bakka, Anne Helene Lilleaas, Yngve Thorsen, Johannes Kurt Schultz","doi":"10.1002/wjs.70550","DOIUrl":"https://doi.org/10.1002/wjs.70550","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on surgical techniques in small bowel cancer, particularly regarding the extent of lymph node dissection and strategic choices according to tumor localization and histological type. Clearance of central lymph node metastases can be challenging, especially when small intestinal neuroendocrine tumor (siNET) metastases give rise to fibrosis and desmoplasia around the cranial parts of the superior mesenteric vessels. The aim of this study was to assess the feasibility and staging implications of new techniques of central (D3) lymphadenectomy.</p><p><strong>Material and methods: </strong>The operative techniques in this prospective small bowel cancer cohort entailed central (D3) removal of all mesenteric tissue anterior and posterior to the superior mesenteric vessels up to the root of the mesentery. Preoperative 3D mapping of the vascular anatomy was performed to facilitate personalized surgery. A new resection classification was developed, based on bowel and mesentery involvement.</p><p><strong>Results: </strong>Among the 86 patients included, D3 lymphadenectomy was performed in 74 (86%). Small bowel resection was done in 40 (54%), and ileocecal or ileocolic resection in 34 (46%). There were five (7%) reoperations (two (3%) anastomotic leaks) and no 30-day mortality. At histopathology, 60 siNET (81%), 5 small bowel carcinomas, 3 metastases of other origin, 1 benign lesion, 3 lymphomas, and 2 gastrointestinal stromal tumors (GIST) were diagnosed. Lymph node count of 71 patients (one benign, two lymphomas not counted) showed mesenteric lymph node metastases in 62 (87%) (median lymph node yield 33). Metastases to the D3 volume were found in 31 (44%) (median D3 lymph node yield 13). In the siNET-group, 28/60 (47%) had D3 metastases, suggested in standard preoperative investigations in 12 (43%). Of all positive siNET lymph nodes, 173/509 (34%) were localized in the D3 volume. Upper/middle ileal siNET were D3 positive in 19/29 (66%) versus in 9/31 (29%) of terminal ileal siNET. All patients had mesenterial R0 resections.</p><p><strong>Conclusions: </strong>Central (D3) small bowel mesenterectomy can be performed with radicality and safety. The high proportion of central metastases that would remain in situ after traditional, less extensive (D2) surgery underlines the potential importance of D3 mesenterectomy for accurate staging and locoregional disease control. Subgroup analyses suggested differences in mesenteric dissemination between terminal ileal and more proximal small intestinal tumors.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Hemoglobin Trajectory and Hemoglobin Decrease in Major Abdominal Surgery.","authors":"Javier Ripollés-Melchor, Ane Abad-Motos, Carlos Jericó, Toby Richards, Ángel Espinosa, Gianluca Pellino, Diana Fernández-García, Rosalía Navarro-Pérez, Rachel Budithi, Kenneth J Macpherson, José A García-Erce","doi":"10.1002/wjs.70560","DOIUrl":"https://doi.org/10.1002/wjs.70560","url":null,"abstract":"<p><strong>Background: </strong>Most studies evaluate perioperative hemoglobin at a single time point despite substantial changes across the perioperative period. We examined whether perioperative hemoglobin trajectory and perioperative hemoglobin decrease were associated with postoperative outcomes after major abdominal surgery.</p><p><strong>Methods: </strong>We performed a secondary analysis of the international POSTVenTT cohort, a prospective multicentre observational study of adults undergoing major abdominal surgery. Hemoglobin trajectory was defined according to anemia status preoperatively and at hospital discharge. Perioperative hemoglobin decrease was defined as the difference between preoperative and discharge hemoglobin concentration. Mixed-effects logistic regression models adjusted for predefined clinical covariates and center clustering were used to evaluate associations with postoperative complications, postoperative transfusion, and 30-day readmission.</p><p><strong>Results: </strong>Among 5302 patients, 3735 had both preoperative and discharge hemoglobin measurements and were included in trajectory analyses. Compared with patients without perioperative anemia, persistent anemia was associated with the higher odds of postoperative complications, postoperative transfusion, and 30-day readmission, whereas new postoperative anemia showed similar but smaller associations. Greater perioperative hemoglobin decrease was associated with higher odds of postoperative complications. For each 10 g/L decrease, the odds of any postoperative complication increased by 35% (OR 1.35, 95% CI 1.26-1.45) and major complication by 49% (OR 1.49, 1.35-1.64). Associations persisted after accounting for transfusion exposure and baseline hemoglobin.</p><p><strong>Conclusions: </strong>Perioperative hemoglobin trajectory and perioperative hemoglobin decrease were associated with postoperative complications and 30-day readmission after major abdominal surgery. Greater hemoglobin decrease remained associated with adverse outcomes after accounting for transfusion exposure and baseline hemoglobin.</p><p><strong>Trial registration: </strong>The POSTVenTT study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621001517864; 8 November 2021). The trial protocol was approved by the South Metropolitan Health Service (Western Australia) Health Research Ethics Committee (EC00265), the Western Australia Research Governance System (RCG 4477), with local ethics and governance confirmed at each site before patient recruitment.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Whole Blood Transfusion With Survival Among Patients Achieving ROSC After Prehospital Traumatic Cardiac Arrest.","authors":"Hui Li, Caitlyn Braschi, Meghan R Lewis, Demetrios Demetriades","doi":"10.1002/wjs.70563","DOIUrl":"https://doi.org/10.1002/wjs.70563","url":null,"abstract":"<p><strong>Background: </strong>While whole blood (WB) is increasingly utilized to mitigate trauma-induced coagulopathy, evidence supporting its use in blunt trauma-associated prehospital cardiac arrest (PHCA) remains scarce. We compared the association of WB versus component therapy (CT) with mortality and early resuscitation balance among patients who achieved return of spontaneous circulation (ROSC).</p><p><strong>Methods: </strong>This retrospective cohort study used National Trauma Data Bank data from 2020 through 2024. Adults aged 16 years or older with blunt trauma, documented PHCA, a nonzero initial emergency department systolic blood pressure, survival beyond 1 hour after arrival, and receipt of at least 1 unit of WB or red blood cells within 4 hours were included. Propensity score overlap weighting balanced measured baseline characteristics. A prespecified 2-h landmark sensitivity analysis evaluated robustness among early survivors, and restricted cubic spline interaction models assessed heterogeneity across Injury Severity Score (ISS).</p><p><strong>Results: </strong>Among 3472 patients, 995 (28.7%) received WB. Unadjusted 30-day in-hospital mortality was 69.9% with WB and 72.6% with component therapy; weighted estimated mortality was 69.7% and 72.2%, respectively (hazard ratio, 0.89; 95% CI, 0.81-0.97; p = 0.01). Findings were similar in the 2-h landmark analysis (hazard ratio, 0.88; 95% CI, 0.80-0.98; p = 0.02). At similar total transfusion volumes, WB transfusion delivered greater calculated platelet (mean ratio, 1.40; 95% CI, 1.27-1.55) and plasma equivalents (mean ratio, 1.21; 95% CI, 1.10-1.33); 55.4% of component-therapy recipients received no platelets within 4 hours. The association with lower mortality was more pronounced at higher ISS values (interaction p = 0.006).</p><p><strong>Conclusions: </strong>Among selected early survivors of blunt traumatic PHCA with restored circulation during initial hospital assessment, WB transfusion was associated with lower 30-day in-hospital mortality and greater calculated plasma and platelet delivery than component-only therapy. Residual confounding and survivor selection remain possible, and prospective confirmation is needed.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}