Scandinavian Journal of Surgery最新文献

{"title":"Obesity and outcomes after esophagectomy: A nationwide population-based cohort study.","authors":"Martin Löfling Skogar, Mats Lindblad, Gustav Linder","doi":"10.1177/14574969261464155","DOIUrl":"10.1177/14574969261464155","url":null,"abstract":"<p><strong>Background: </strong>The global prevalence of obesity is rising and has been linked to increased perioperative risks in esophageal cancer surgery, while its impact on long-term survival remains uncertain. This study aims to examine the association between body mass index (BMI, kg/m²) and perioperative complications and long-term survival.</p><p><strong>Methods: </strong>This nationwide, population-based cohort study included all patients undergoing esophageal cancer resection in Sweden between 2006 and 2018. Data were obtained from the National Register for Esophageal and Gastric Cancer. Patients were categorized by BMI as underweight (<20), normal (20-24.9), overweight (25-30), or obese (>30). Logistic regression and Cox regression were used for adjusted analyses, reporting odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 1494 patients (81.6% male) were included, and out of these, there were 227 (15.2%) patients with obesity. Patients with obesity had more comorbidities, more often adenocarcinoma, and underwent surgery more frequently during the later time period of the study. Compared with patients with normal weight, obesity was not associated with increased risk of surgical complications (OR = 0.92, 95% CI: 0.62-1.39), but obesity was linked to higher risk of non-surgical complications, including pulmonary embolism (OR = 1.64, 95% CI: 1.10-2.45). Obesity was associated with reduced all-cause mortality (HR = 0.75, 95% CI: 0.57-0.98).</p><p><strong>Conclusion: </strong>Patients with obesity undergoing esophagectomy did not have higher rates of surgical complications but faced an elevated risk of non-surgical complications. Obesity appeared linked to better long-term survival. However, residual confounding, including potential reverse causation from pre-diagnosis weight loss, cannot be excluded.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"282-290"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521381","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":"Symptoms versus ultrasound for monitoring urinary retention after total knee arthroplasty: The UREA randomized clinical trial protocol.","authors":"Juho Sippola, Jonne Åkerla, Ilkka Jussila, Pirkko Kinnunen, Taru Rossi, Aleksi Reito, Konsta Pamilo, Juha Paloneva, Heikki Seikkula","doi":"10.1177/14574969261438678","DOIUrl":"10.1177/14574969261438678","url":null,"abstract":"<p><strong>Background: </strong>Postoperative urinary retention (POUR) is a frequent complication after total knee arthroplasty (TKA), contributing to prolonged hospital stays, higher healthcare costs, and an increased risk of urinary tract infections (UTIs) and other postoperative complications. Despite the widespread use of bladder ultrasound to guide catheterization decisions, evidence supporting its superiority over symptom-based monitoring is limited. The UREA trial evaluates whether patients undergoing TKA can be safely monitored for POUR based solely on urinary symptoms, potentially reducing unnecessary catheterizations and resource use.</p><p><strong>Methods: </strong>The UREA study is a randomized clinical open-label single-center trial including 170 patients undergoing elective TKA. Participants are randomized in a 1:1 ratio through a sex-stratified sealed-envelope method into either (1) an ultrasound monitoring group or (2) a symptoms monitoring group. In the ultrasound group, bladder volume is assessed repeatedly with a portable scanner, with catheterization performed at a threshold of 800 mL or upon symptoms. In the symptoms monitoring group, follow-up relies exclusively on patient-reported urinary symptoms, with catheterization performed only if symptoms occur or if no spontaneous urination has occurred by 10 h postoperatively. The primary outcome is the difference in International Prostate Symptom Score (IPSS) between groups at 3 months. Secondary outcomes include IPSS at 12 months, urinary complications, and health-related quality of life assessed with the 15D instrument at 3 and 12 months. Statistical analyses will be performed on an intention-to-treat basis, with adjustments for relevant baseline variables.</p><p><strong>Discussion: </strong>This trial is the first randomized study to compare symptom-based with ultrasound-based monitoring of postoperative urinary retention after TKA. If symptom-based monitoring is found to be safe, it may allow for substantial reductions in unnecessary catheterization, procedural discomfort, infection risk, and resource burden. The findings have the potential to inform future clinical guidelines and promote more efficient, patient-centered postoperative care.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"383-390"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949701","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":"Predicting lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma: A risk model based on prelaryngeal and paratracheal lymph nodes.","authors":"Chang Deng, Zhixin Yang, Yijia Cao, Chun Huang, Jing Zhou, Xinliang Su","doi":"10.1177/14574969261440429","DOIUrl":"https://doi.org/10.1177/14574969261440429","url":null,"abstract":"<p><strong>Objective: </strong>To identify independent risk factors for lymph node metastasis posterior to the right recurrent laryngeal nerve (RLN) in cN0 papillary thyroid carcinoma and develop a predictive model for preoperative risk stratification.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 721 cN0 papillary thyroid carcinoma patients that underwent lymph node dissection posterior to the right RLN between 2016 and 2019. Univariable and multivariable logistic regression analyses were used to assess clinical and pathological characteristics, and a nomogram was constructed. The model was validated using receiver operating characteristic curves and calibration curves.</p><p><strong>Results: </strong>The incidence of lymph nodes posterior to the right was 19.8%. Multivariable analysis revealed three independent predictors: the number of paratracheal lymph node metastases (OR = 1.360, p = 0.021), combined prelaryngeal and paratracheal lymph node metastases (1-2 involved nodes: OR = 3.433; ⩾ 3 involved nodes: OR = 4.402, p < 0.05), and extrathyroidal extension (OR = 0.580, p = 0.021).</p><p><strong>Conclusion: </strong>This model provides a quantitative tool for intraoperative risk assessment and guides the development of individualized surgical plans for high-risk patients with cN0 papillary thyroid carcinoma.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":"115 3","pages":"312-321"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820018","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":"Treatment of early gastric cancer in Sweden: A nationwide registry-based cohort study.","authors":"Henrik Maltzman, Peter Elbe, Martin Jeremiasen, Masami Omae, Francisco Baldaque-Silva, Erik von Seth, Mats Lindblad, Fredrik Klevebro","doi":"10.1177/14574969261440339","DOIUrl":"https://doi.org/10.1177/14574969261440339","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic resection (ER) for early gastric cancer is a well-established treatment. Previous research is predominantly based on Asian patients. The aim of this study was to evaluate treatment strategies and outcomes for early gastric cancer in Sweden, based on data from a population-based cancer registry.</p><p><strong>Methods: </strong>We conducted a nationwide population-based cohort study using data from the Swedish National Registry for Esophageal and Gastric Cancer. All patients with pT1N0M0 gastric cancer or high-grade dysplasia who underwent surgical or ER between 2006 and 2022 were included. The primary endpoint was 5-year overall survival. Secondary endpoints included length of hospital stay, 30- and 90-day mortality rates, and postoperative complications.</p><p><strong>Results: </strong>In total, 278 patients were included. Of these, 189 (68.0%) underwent surgery and 89 (32.0%) ER. The two groups were comparable regarding baseline parameters (age, sex, smoking, ASA-score) but the surgery group had a higher clinical T-stage. The 5-year overall survival was 67 of 104 patients (64.4%) in the surgery group and 24 of 37 patients (64.9%) in the ER group. Multivariable Cox regression showed no difference between the groups (<i>p</i> = 0.685). ER was associated with a shorter hospital stay (median 1 day compared to 9 days for surgery, <i>p</i> < 0.001). The 30- and 90-day mortality was 0 and 1 (1.1%) for ER and 4 (2.1%) and 9 (4.8%) for surgery (<i>p</i> = 0.310 and 0.176, respectively). Complications occurred in 9 patients (12.7%) in the ER group and 42 (25.6%) in the surgery group.</p><p><strong>Conclusions: </strong>In this population-based study, ER and surgery had comparable 5-year overall survival for early gastric cancer. ER was associated with a shorter hospital stay and fewer postoperative complications.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261440339"},"PeriodicalIF":2.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622203","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":"Revisiting the ASA physical status classification: Differential associations with long-term survival in abdominal cancer surgery.","authors":"Lars A B Grønvold, Linn S Nymo, Dyre Kleive, Kjerstin Havnes, Stig Norderval, Kristoffer Lassen, Kristoffer W Brudvik","doi":"10.1177/14574969261463220","DOIUrl":"https://doi.org/10.1177/14574969261463220","url":null,"abstract":"<p><strong>Background: </strong>This cohort study evaluates the American Society of Anesthesiologists (ASA) Physical Status Classification as a predictor for long-term survival after major abdominal cancer surgery and reassesses its conventional use for perioperative risk assessment.</p><p><strong>Method: </strong>Using data from the Norwegian Registry for Gastrointestinal Surgery (NORGAST), we identified patients who underwent formal resection for colorectal cancer, as well as patients undergoing surgery for pancreatic or liver malignancies, between January 2016 and December 2023. Log-rank analyses were used to assess survival differences according to ASA class.</p><p><strong>Results: </strong>This study analyzed 20,784 patients undergoing surgery for colorectal cancer and 4792 patients undergoing surgery for pancreatic or liver malignancy. After excluding patients who died within 90 days postoperatively, 20,244 colorectal and 4702 pancreatic/liver patients remained for survival analysis. ASA class was associated with postoperative morbidity, mortality, and length of stay after colorectal cancer surgery; however, a very large number of patients was required to demonstrate a modest percentage-point differences. In both log-rank and multivariable analyses, ASA class was strongly associated with long-term survival after colorectal cancer surgery (p < 0.001) and after resection for pancreatic and liver malignancies (p < 0.001). This association persisted across age-matched cohorts, and ASA class outperformed age in multivariable survival analysis.</p><p><strong>Conclusion: </strong>Although the ASA classification demonstrates clear relevance in predicting long-term survival after major abdominal cancer surgery, its clinical utility for perioperative risk assessment appears limited. Despite criticisms regarding subjectivity and moderate inter-rater reliability, ASA classification determined by experienced professionals may capture patient factors beyond documented comorbidities, potentially reflecting underlying disease severity or patient resilience.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261463220"},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399841","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":"Cost efficiency of topical tranexamic acid in reduction mammaplasty surgeries.","authors":"Krisztina Sipos, Mervi Rautalin, Kaisu Ojala, Susanna Kauhanen","doi":"10.1177/14574969261461398","DOIUrl":"https://doi.org/10.1177/14574969261461398","url":null,"abstract":"<p><strong>Background and aims: </strong>Perioperatively used, topically administered tranexamic acid (TXA) has attracted increasing interest in plastic surgery, and several studies have compared the effectiveness and safety of topical and intravenous (IV) administration. Topical TXA has been reported to have an equal or superior effect in reducing postoperative bleeding and transfusion requirements, with no increase in reported adverse events. Although prophylactic topical TXA is believed to result in cost savings, cost-effectiveness analyses concerning the use of TXA in breast surgery have not yet been reported.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study calculated the costs for all patients who underwent reduction mammaplasty between 2019 and 2021 at Jorvi Hospital, Finland. We compared postoperative complications and total healthcare costs associated with surgery between two groups: patients who received topical TXA perioperatively (TXA group) and patients who did not receive TXA (non-TXA group). Total costs were analyzed, including both the intraoperative and postoperative periods. All costs were calculated in euros, based on the 2020 Helsinki University Hospital (HUS) rates.</p><p><strong>Results: </strong>In 328 breast reduction surgeries, the leading postoperative costs were caused by reoperations, and additional ward stays due to complications. The cost of TXA irrigation itself was negligible compared with the other expenses. The median postoperative costs were €414 in the non-TXA group and €335 in the TXA group, and the mean postoperative costs were €874 in the non-TXA group and €453 in the TXA group (p = 0.002). In the non-TXA group, 11 patients (6.1%) underwent reoperation for hematoma and four (2.2%) for other wound-healing complications. In contrast, in the TXA group only one (0.7%) patient required reoperation for hematoma and one (0.7%) for wound-healing complications.</p><p><strong>Conclusion: </strong>This study demonstrates that the application of this low-cost drug may reduce the overall costs associated with reduction mammaplasty.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261461398"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354174","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":"Implementation of robot-assisted transabdominal preperitoneal inguinal hernia repair: A prospective cohort study.","authors":"John C F Glent, Joachim B Haugen, Ida Helgestad, Branislav Azanjac, Sheraz Yaqub, Davit L Aghayan, Mushegh A Sahakyan","doi":"10.1177/14574969261459827","DOIUrl":"https://doi.org/10.1177/14574969261459827","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted transabdominal preperitoneal repair (rTAPP) is increasingly used for inguinal hernia. However, evidence on its implementation in district hospitals and its integration into resident training programs remains limited. The aim of this study was to assess a real-world implementation of rTAPP in a public district hospital.</p><p><strong>Methods: </strong>Patients with inguinal hernia who underwent rTAPP between May 2024 and May 2025 were included. Perioperative outcomes, quality of life (QoL), and recurrence within the first 6 months were assessed. Implementation was analyzed across three consecutive phases to evaluate changes in operative performance and trainee involvement. QoL was measured using the 5-level EQ-5D version (EQ-5D-5L) in a subset of patients with available pre- and postoperative data.</p><p><strong>Results: </strong>A total of 120 patients underwent rTAPP. There were no conversions to laparoscopic or open surgery. Postoperative complications were observed in 8 (6.7%) patients and were limited to Accordion grade I-II events. The median length of postoperative stay was 20 h. One patient (0.8%) experienced hernia recurrence within 6 months. In contrast with phase 1, resident surgeons performed rTAPP in phases 2 (15%) and 3 (12.5%). Mean operative time decreased from 86 min in phase 1 to 74 and 77 min in phases 2 and 3, respectively (p = 0.041) without a significant difference in postoperative complications. Paired EQ-5D-5L data demonstrated significant postoperative improvement in pain/discomfort, daily activities, and overall health score.</p><p><strong>Conclusion: </strong>Robotic-assisted inguinal hernia repair can be safely implemented in a district hospital setting with favorable short-term outcomes. Structured introduction of rTAPP allowed rapid involvement of surgeons without compromising perioperative safety or efficiency.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261459827"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354253","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":"Understanding personality in surgical career development: A cross-sectional study of Swedish medical students and surgeons.","authors":"Johan Wänman, Leif Berglund, My Blohm, Per Jolbäck, Aleksandra McGrath","doi":"10.1177/14574969261459277","DOIUrl":"https://doi.org/10.1177/14574969261459277","url":null,"abstract":"<p><strong>Background: </strong>The selection of a medical specialty is influenced by multiple factors, with personality traits potentially shaping career preferences. This study examines the personality traits and their impact on interest in surgical specialty among Swedish medical students, considering gender and comparing students and practicing surgeons.</p><p><strong>Methods: </strong>The Big Five Inventory was used to assess personality traits of medical students and surgeons in a cross-sectional study. The students were recruited from Umeå University and the University of Gothenburg, whereas the included surgeons were recruited from hospitals across Sweden. The data were collected between the 29th of August 2022 and the 2nd of December 2024. Differences in personality traits were analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA), adjusting for age and gender.</p><p><strong>Results: </strong>The participants were 276 fourth-year medical students and 471 Swedish surgeons. Statistically significant differences were found between medical students who preferred surgical specialization compared to students preferring non-surgical specialization, with lower neuroticism (p = 0.007), higher extraversion (p = 0.01), and, after adjustment for gender and age, higher conscientiousness (p = 0.045) in the group who preferred surgical specialization. Female students scored higher than male students in conscientiousness (p < 0.001), agreeableness (p = 0.047), and neuroticism (p = 0.002). Female students scored higher in neuroticism than female surgeons (p = 0.005) and lower in conscientiousness (p = 0.043), while male students had lower conscientiousness scores than male surgeons (p < 0.001).</p><p><strong>Conclusions: </strong>This study suggests that a combination of personality traits distinguishes Swedish medical students with interests in surgery from medical students with interest in non-surgical specialization. This difference is likely shaped by an interplay of student selection and professional socialization.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969261459277"},"PeriodicalIF":2.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310029","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":"Defining optimal muscle surface area thresholds for sarcopenia-related mortality after cardiovascular interventions.","authors":"Otto Järvinen, Juho Tynkkynen, Iisa Lindström, Marko Virtanen, Pasi Maaranen, Minea Söderlund, Henni Huhtamo, Damir Vakhitov, Jari Laurikka, Niku Oksala, Jussi Hernesniemi","doi":"10.1177/14574969251397740","DOIUrl":"10.1177/14574969251397740","url":null,"abstract":"<p><strong>Background and aims: </strong>Psoas muscle surface area (PMA) can estimate sarcopenia related long-term mortality risk. This study explored whether this association is linear or non-linear and if a meaningful threshold defines patients at high risk.</p><p><strong>Methods: </strong>This retrospective individual participant-level meta-analysis included four different cohorts of 3893 patients undergoing cardiovascular interventions: 1302 abdominal aortic aneurysm repairs (AAA), 1099 transcatheter aortic valve insertions (TAVI), 593 surgeries for thoracic aortic and aortic valve pathology (TA) and 899 procedures for peripheral artery disease (PAD). The association between PMA and mortality was visualized using pooled spline curves. Cox models were fitted separately within each cohort with three levels of adjustment, and hazard ratios were combined using inverse-variance meta-analysis. Results were replicated in a retrospective dataset of 561 patients undergoing carotid endarterectomy or thrombectomy for ischemic stroke, where sarcopenia status was estimated using masseter muscle surface area.</p><p><strong>Results: </strong>Age and sex were the most important features associating with PMA (p < 0.001), but significant variation between the cohorts was also observed (p < 0.001). The association between PMA and long-term mortality was inverse and linear (p < 0.001). Patients with poor muscle status (Z-values -1.5 or less for PMA) had significantly higher adjusted risk of death (hazard ratio (HR) of 1.6 with 95% confidence interval (CI) 1.3-2.0, p < 0.001) when compared to all other patients. Similar results were observed in the replication cohort (HR 1.7, 95% CI 1.0-2.82, p = 0.04).</p><p><strong>Conclusions: </strong>Long-term mortality after a cardiovascular intervention increases linearly as the PMA value decreases. Patients with poor muscle status (Z-values below -1.5) seem to have consistently elevated mortality risk independent of other risk factors.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"185-193"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702724","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":"Enhanced recovery after surgery in diverticular disease: A multicenter comparison with colorectal cancer.","authors":"Mahmood Wael Mahmood, Mirna Abraham-Nordling, Anna Löf-Granström, Ali Kiasat, Fredrik Hjern, Ulf O Gustafsson","doi":"10.1177/14574969261431953","DOIUrl":"10.1177/14574969261431953","url":null,"abstract":"<p><strong>Background and aims: </strong>ERAS protocols are widely used in colorectal surgery, yet their impact on outcomes in diverticular disease (DD) is unclear. The primary aim of this study was to compare postoperative complication rates after left-sided colon resections for either DD or left-sided colonic cancer within an ERAS pathway, the secondary aim was to assess ERAS protocol compliance.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study used data from the Swedish ERAS® Interactive Audit System (EIAS) from 2010 to 2020. All participating centers consecutively register elective colorectal procedures in patients aged ⩾ 18 years. We included all adult patients undergoing elective left-sided colonic or sigmoid resection at participating centers, where all procedures are mandatorily registered within a standardized ERAS pathway, with no additional exclusions. ERAS protocol compliance (pre- and intraoperative items), postoperative symptoms, and postoperative complications were assessed according to ERAS® guidelines and compared between diagnostic groups. Associations between variables and outcomes were evaluated using logistic regression.</p><p><strong>Results: </strong>A total of 3774 patients were included (879 with DD and 2895 with cancer). Patients in the DD group were younger and had fewer comorbidities. ERAS compliance was similar between groups (86.3% for DD vs 86.7% for cancer). In multivariable analysis, there was no statistically significant difference in severe complications (Clavien-Dindo grade III-IV) between the DD and cancer groups (11.8% vs 13.1%; OR = 0.97, 95% CI = 0.87-1.09). However, DD was associated with a higher rate of overall complications (39.2% vs 36.5%; OR = 1.27, 95% CI = 1.07-1.52), particularly infectious complications (17.0% vs 12.1%; OR = 1.55, 95% CI = 1.23-1.97), including intra-abdominal abscesses (3.5% vs 2.3%; OR = 1.62, 95% CI = 1.01-2.60). In addition, DD patients were more likely to experience postoperative pain that delayed hospital discharge (5.2% vs 2.4%, OR = 1.78, 95% CI = 1.17-2.70).</p><p><strong>Conclusions: </strong>Despite similar adherence to the ERAS protocol, surgery for DD was associated with a higher overall rate of postoperative complications and similar rates of severe complications as surgery for colonic cancer. The considerable risk of complications should be carefully considered when counseling patients with DD for elective surgery.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"147-154"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482274","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}