Annals of surgery open : perspectives of surgical history, education, and clinical approaches最新文献

{"title":"Visualization of Intraoperative Pancreatic Leakage (ViP): The IDEAL Stage I First-in-human, Single-arm Clinical Pilot Trial of SmartPAN.","authors":"Thomas M Pausch, Magdalena Holze, Josefin El-Mahdy, Bodil Gesslein, Helena Ossmer Thedius, Anja Sander, Solveig Tenckhoff, Tom Sundermann, Jan Larmann, Pascal Probst, Frank Pianka, Rosa Klotz, Thilo Hackert","doi":"10.1097/AS9.0000000000000529","DOIUrl":"10.1097/AS9.0000000000000529","url":null,"abstract":"<p><strong>Background: </strong>The invisible fluid leaking from a partially resected pancreas is associated with complications including postoperative pancreatic fistula (POPF), calling for strategies to visualize intraoperative leakage. This single-arm, monocentric trial aims to evaluate the usefulness and safety of SmartPAN, a hydrogel that reacts to alkali pancreatic fluids by changing color and thus enables the surgeon to take immediate action to close leakage.</p><p><strong>Methods: </strong>Patients awaiting partial pancreatic resection for any indication were recruited to receive intraoperative SmartPAN application. Trial endpoints covered SmartPAN usability and safety according to reports completed by surgeons after each operation, laboratory measurements of nonbiodegradable compounds in body fluids, and clinical evaluations over 30 days of follow-up.</p><p><strong>Results: </strong>In total 42 patients were recruited to the trial and 29 received partial pancreatic resection with SmartPAN application according to protocol. All 16 attending surgeons rated SmartPAN as easy to learn and use, mostly agreeing that it was useful and that they intended to use it frequently. No adverse effects or complications were associated with SmartPAN, nor were its compounds detected in blood or abdominal fluids. Positive leakage response was detected in 10/29 surgeries. POPF developed in 7 patients, including 2 intraoperatively detected leakages, thereof 1 with targeted closure as well as 5 with no leakage detected.</p><p><strong>Conclusion: </strong>This study represents the first-in-human clinical trial of SmartPAN and the precursor to randomized controlled trials. The outcomes support SmartPAN's clinical usability and safety and showcase the device's potential to intraoperatively visualize precursors of POPF.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e529"},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing Surgical Success by Aligning Interventions to Outcomes: A Systematic Review.","authors":"Bonnie A Armstrong, Arthur Tung, Lisha Lo, Spencer S Abssy, Maham Zulfiqar, Juliette van Oost, Julie Wong, Josh Janevski, Julia Martyniuk, Patricia Trbovich","doi":"10.1097/AS9.0000000000000558","DOIUrl":"10.1097/AS9.0000000000000558","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify common intraoperative interventions in surgery and evaluate their effectiveness in improving surgical outcomes.</p><p><strong>Background: </strong>Despite decades of efforts, surgical adverse events remain stubbornly high. There are concerns that too much responsibility is placed on individuals to create change (ie, person-based interventions) rather than adapting systems to support human performance (ie, system-based interventions). This focus may be due to our limited understanding of which interventions most effectively improve outcomes.</p><p><strong>Methods: </strong>A 2-step search was conducted. Systematic and meta-analytic reviews of Medline, CINAHL, Embase, PsycINFO, Scopus, Cochrane Reviews, Cochrane Protocols and Cochrane Trials were identified, and individual studies within these reviews were selected. Qualitative content analysis categorized intervention and outcome types using inductive and deductive methods. Intervention details and directional findings for all outcomes were extracted.</p><p><strong>Results: </strong>A total of 575 studies were included in the final analysis comprising 5,288,513 cases, 25,435 providers and patients, 2608 hospitals, across 50 countries, with 1221 outcomes extracted. Overall, the most common interventions were person-based, including education (38%) and policy (19%). Person-based interventions were more likely to improve interpersonal outcomes such as culture, professional development, and resilience. In contrast, system-based interventions, such as technology (15%), cognitive aids (11%), equipment (11%), standardization (4%), and environment redesign (2%), though less frequently implemented, were effective across all outcome types.</p><p><strong>Conclusions: </strong>Although person-based interventions are widely implemented, system-based interventions generally have a greater impact on surgical outcomes. These results offer valuable insights for optimizing the alignment of interventions to outcomes.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e558"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major Adverse Cardiovascular Events After Colorectal Cancer Surgery, Oncological Outcomes, and Long-term Mortality: A Nationwide Retrospective Propensity Score-Matched Cohort Study.","authors":"Jawad Ahmad Zahid, Mikail Gögenur, Sarah Ekeloef, Ismail Gögenur","doi":"10.1097/AS9.0000000000000560","DOIUrl":"10.1097/AS9.0000000000000560","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the occurrence of major adverse cardiovascular events (MACE) following colorectal cancer (CRC) surgery and its association with long-term mortality and oncological outcomes.</p><p><strong>Background: </strong>Cardiovascular complications after noncardiac surgery are a leading cause of perioperative mortality. However, limited knowledge exists on how these complications impact on long-term mortality.</p><p><strong>Methods: </strong>This retrospective cohort study used data from 4 nationwide Danish health registries and included all patients undergoing elective surgery with curative intent for CRC between 2001 and 2019. Patients experiencing MACE, defined as acute myocardial infarction, stroke, new-onset heart failure, or nonfatal cardiac arrest, within 30 days of surgery were matched with those who did not using 1:1 propensity score matching (PSM). The outcomes were all-cause mortality within 1, 3, or 5 years of surgery, as well as 5-year cancer recurrence and disease-free survival.</p><p><strong>Results: </strong>Out of 39,747 patients, 900 (2.3%) had MACE. PSM resulted in 809 pairs of matched patients. Within 1 year of surgery, 110 (13.6%) patients with MACE and 2063 (5.4%) without MACE died (PSM-adjusted hazard ratio [HR] = 1.36; 95% confidence interval [CI] = 1.02-1.83). Within 3 years, 248 (30.6%) patients with MACE and 6268 (16.5%) without MACE died (PSM-adjusted HR = 1.32; 95% CI = 1.07-1.62). Within 5 years, 333 (41.1%) patients with MACE and 9232 (24.3%) without MACE died (PSM-adjusted HR = 1.25; 95% CI = 1.04-1.50). For recurrence and disease-free survival, no statistically significant differences were observed.</p><p><strong>Conclusions: </strong>MACE within 30 days of CRC surgery is associated with higher overall long-term mortality. Investigating causality and preventive measures is urgent in this group.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e560"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture Techniques and Materials for Fascial Closure of Abdominal Wall Incisions: A Comprehensive Meta-Analysis.","authors":"Rudolf van den Berg, Lucas Visscher, Anand G Menon, Eva B Deerenberg, Pieter J Tanis","doi":"10.1097/AS9.0000000000000548","DOIUrl":"10.1097/AS9.0000000000000548","url":null,"abstract":"<p><strong>Background: </strong>The aim of this systematic review and meta-analysis was to evaluate the effectiveness of different suture materials and techniques for laparotomy closure.</p><p><strong>Methods: </strong>A literature search was conducted in 3 databases in April 2024. All randomized controlled trials (RCTs) and prospective cohort studies on laparotomy closure were included. The quality of the studies was evaluated using critical appraisal checklists (ROB2 and ROBINS-I). The primary outcome was incisional hernia (IH) formation, and secondary outcomes were fascial dehiscence (FD), combined FD+IH, and surgical site infection (SSI). Meta-analyses were performed using random effects models.</p><p><strong>Results: </strong>A total of 41 RCTs and 9 prospective cohort studies were included. Meta-analysis revealed no superiority of slowly absorbable sutures over fast-absorbable sutures (5 studies, 1177 patients). Furthermore, no differences between interrupted and continuous suturing were found (14 studies, 5939 patients). Small-bites technique with a slowly absorbable suture was associated with significantly less risk of IH (odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.30-0.65), combined FD+IH (OR: 0.40; 95% CI: 0.21-0.75), and SSI (OR: 0.70; 95% CI: 0.53-0.91) compared with a large-bites technique (8 studies, 2360 patients). Significant improvements were found for the continuous modified Smead-Jones suturing in the emergency setting (2 studies, 90 patients) and retention-line suturing (1 RCT, 124 patients). Layered closure (6 studies, 2660 patients) or Hughes closure (2 studies, 772 patients) revealed no superiority over mass closure.</p><p><strong>Conclusions: </strong>Closure of laparotomies in the elective setting using a small-bites technique with slowly absorbable sutures is superior over a large-bites technique. More evidence is needed in the emergency setting, with promising alternatives such as the modified Smead-Jones technique and retention-line suturing.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e548"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mixed-Methods Evaluation of a Collaborative-Wide Quality Improvement Project to Improve Postdischarge Venous Thromboembolism Chemoprophylaxis After Abdominopelvic Cancer Surgery.","authors":"Kimberly B Golisch, Casey M Silver, Ying Shan, Andres Guerra, Lauren M Janczewski, Jeanette Chung, Brianna D'Orazio, Julie K Johnson, Vivek N Prachand, Michael F McGee, David D Odell, Anthony D Yang, Karl Y Bilimoria, Ryan P Merkow","doi":"10.1097/AS9.0000000000000555","DOIUrl":"10.1097/AS9.0000000000000555","url":null,"abstract":"<p><strong>Objective: </strong>We studied a collaborative-wide quality improvement project (CQIP) focused on improving postdischarge venous thromboembolism (VTE) chemoprophylaxis adherence. We aimed to identify patient-level characteristics associated with adherence, evaluate differences in adherence rates among participating hospitals, and assess facilitators and barriers to adherence at high- and low-performing hospitals.</p><p><strong>Background: </strong>VTE is the most common preventable cause of death after abdominopelvic cancer surgery, yet adherence to guideline-recommended postdischarge VTE chemoprophylaxis remains suboptimal. A CQIP including audit and feedback of performance data, a toolkit, coaching calls, and best practice alerts was implemented.</p><p><strong>Methods: </strong>Patients undergoing inpatient abdominopelvic cancer surgery at a CQIP-enrolled hospital during a 3-year study period were included. Unadjusted and adjusted rates were calculated for postdischarge VTE chemoprophylaxis adherence. High performance was defined as >10% improvement and/or ≥80% adherence. We conducted semistructured interviews and focus groups with collaborative members to identify barriers and facilitators to implementation.</p><p><strong>Results: </strong>Postdischarge VTE chemoprophylaxis adherence increased from 51.8% (preimplementation) to 64.5% (postimplementation; <i>P</i> < 0.05). Patients who underwent urologic (odds ratio [OR], 1.76 [95% CI, 1.27-2.43]) and gynecologic procedures (OR, 3.90 [95% CI, 2.73-5.58]) were more likely prescribed appropriate VTE chemoprophylaxis compared with colorectal procedures. Eight hospitals (50%) had improvement in adherence rates, and 8 (50%) were high performers. Barriers to implementation included a lack of surgeon buy-in, technical challenges, and a lack of awareness.</p><p><strong>Conclusions: </strong>A CQIP was associated with increased postdischarge VTE adherence rates. Different barriers exist between high- and low-performing hospitals. Future collaborative work should focus on hospital-level interventions to improve low-performer results.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e555"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Landscape of Consensus-Based Entity-Endorsed Perioperative Quality Measures.","authors":"Alex H S Harris, Kristen Davis-Lopez, Eric Schmidt, Kenneth Nieser, Nader N Massarweh","doi":"10.1097/AS9.0000000000000559","DOIUrl":"10.1097/AS9.0000000000000559","url":null,"abstract":"<p><strong>Objective: </strong>Healthcare quality measures have a central role in monitoring and incentivizing the quality of surgical care. Payors and other stakeholders rely on consensus-based entities (CBEs) for the rigorous, independent evaluation and endorsement of quality measures. The aim of this study is to catalog current CBE-endorsed, surgery-related quality measures and to assess measure characteristics, gaps, and redundancies to inform prioritization of measure development efforts.</p><p><strong>Methods: </strong>The National Quality Forum Quality Positioning System and Battelle Partnership for Quality Measurement were reviewed to identify CBE-endorsed quality measures related to perioperative care. Identified measures were characterized in terms of their type (eg, structure, process and outcome), quality domain (eg, effectiveness and efficiency), focus (eg, complications, cost and improvement in functioning), and perioperative specialty (eg, general surgery and anesthesia).</p><p><strong>Results: </strong>A total of 172 perioperative measures were identified, of which 79 were currently CBE-endorsed and 93 were previously endorsed. Among currently endorsed measures, 43 (54%) were clinical outcomes measures (eg, mortality and/or complications, readmissions), 8 (10%) were patient-reported outcomes measures, 20 (26%) were process measures, 4 (5%) were cost measures, and 4 (5%) were measures of structure. Measures specific to cardiothoracic (n = 40) and orthopedic (n = 11) surgery were the most common while 12 measures were relevant to multiple specialties.</p><p><strong>Conclusions: </strong>Despite the large number of surgery-related quality measures, most are concentrated on a small sample of quality domains for a few surgical specialties. Fewer measures are focused on patient-reported outcomes or experiences, low-value care (eg, unnecessary testing or imaging), healthcare structures, or processes that may lead to better outcomes.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e559"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy and Liver Resection Is a Treatment Option for Patients With Peritoneal and Liver Metastases From Colorectal Cancer.","authors":"Arezo Kanani, Torhild Veen, Kenneth Thorsen, Kjetil Søreide","doi":"10.1097/AS9.0000000000000556","DOIUrl":"10.1097/AS9.0000000000000556","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e556"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Validation and Refinement of Oncological Borderline Resectability Criteria for Hepatocellular Carcinoma Using Tumor Burden Score to Predict Survival.","authors":"Miho Akabane, Jun Kawashima, Abdullah Altaf, Selamawit Woldesenbet, François Cauchy, Federico Aucejo, Irinel Popescu, Minoru Kitago, Guillaume Martel, Francesca Ratti, Luca Aldrighetti, George A Poultsides, Yuki Imaoka, Andrea Ruzzenente, Itaru Endo, Ana Gleisner, Hugo P Marques, Sara Oliveira, Jorge Balaia, Vincent Lam, Tom Hugh, Nazim Bhimani, Feng Shen, Timothy M Pawlik","doi":"10.1097/AS9.0000000000000557","DOIUrl":"10.1097/AS9.0000000000000557","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to externally validate the original borderline resectability (BR) category for predicting overall survival (OS) in hepatocellular carcinoma (HCC) following resection and to assess whether incorporating the tumor burden score (TBS) and other clinical factors could enhance predictive accuracy.</p><p><strong>Background: </strong>A recent Japanese expert panel introduced a new HCC classification scheme: resectable (R), borderline resectable 1 (BR1), and borderline resectable 2 (BR2).</p><p><strong>Methods: </strong>Patients undergoing curative-intent hepatectomy for HCC (2000-2023) were classified as R, BR1, and BR2 using the original BR and a novel TBS-BR category. The TBS-BR category replaces BR's categorical tumor morphology factors with the continuous TBS (TBS² = [maximum tumor diameter]² + [number of tumors]²). Multivariable analysis identified oncologic, morphometric, and patient-level factors associated with OS, which were incorporated into an online predictive tool.</p><p><strong>Results: </strong>Among 1766 patients, the original BR category grouped 1504 (85.2%) as R, 249 (14.1%) as BR1, and 13 (0.7%) as BR2. Utilizing the TBS-BR category, patients were reclassified as TBS-BR R (n = 684, 38.7%), BR1 (n = 1009, 57.1%), and BR2 (n = 73, 4.1%). Both the original and TBS-BR categories correlated with 5-year OS (original: 65.1%, 48.2%, 46.4%; TBS-BR: 70.8%, 58.3%, 40.0%; <i>P</i> < 0.001 for both; area under the curve: 0.54 vs 0.58). On multivariable analysis, TBS-BR1 (hazard ratio [HR]: 1.59 [1.20-2.09]; <i>P</i> = 0.001), TBS-BR2 (HR: 2.45 [1.47-4.07]; <i>P</i> < 0.001, reference: TBS-BR R), American Society of Anesthesiologists (ASA) class >2 (HR: 1.40 [1.09-1.80]; <i>P</i> = 0.007), albumin-bilirubin (ALBI) score (HR: 1.51 [1.21-1.88]; <i>P</i> < 0.001), and log <i>α</i>-fetoprotein (AFP) (HR: 1.07 [1.03-1.11]; <i>P</i> < 0.001) were independently associated with OS. A TBS-BR composite model based on these factors (TBS-BR category, ASA class, ALBI score, and log AFP) was developed and made available online (https://makbn.shinyapps.io/BRHCC/). The model's area under the receiver operating characteristic at 5 years (0.70) outperformed both the original BR (0.57) and Barcelona Clinic Liver Cancer classification (0.64).</p><p><strong>Conclusions: </strong>The TBS-BR composite model, integrating tumor morphology (TBS), tumor biology (log AFP), overall physical status (ASA class), and liver function (ALBI score) demonstrated superior predictive accuracy for OS compared with the original BR and Barcelona Clinic Liver Cancer classifications.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e557"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of Diabetes Mellitus and Extended Hepatectomy on Perihilar Cholangiocarcinoma.","authors":"Jun Shibamoto, Shimpei Otsuka, Yuta Okawa, Ryo Ashida, Katsuhisa Ohgi, Yoshiyasu Kato, Hideyuki Dei, Katsuhiko Uesaka, Teiichi Sugiura","doi":"10.1097/AS9.0000000000000552","DOIUrl":"10.1097/AS9.0000000000000552","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prognostic impact of diabetes mellitus (DM) in patients who underwent resection for perihilar cholangiocarcinoma (PHCC) and the influence of remnant liver volumes on postoperative glycemic profiles and survival outcomes.</p><p><strong>Background: </strong>The impact of DM and extended hepatectomy on survival outcomes of patients with PHCC remains unclear.</p><p><strong>Methods: </strong>A total of 184 patients who underwent hepatectomy with extrahepatic bile duct resection for PHCC between 2002 and 2020 were retrospectively analyzed and divided into groups based on DM and future liver remnant (FLR) ≥40% or <40%. Survival outcomes and glycemic profiles were analyzed.</p><p><strong>Results: </strong>Patients with DM (n = 34) had significantly worse overall survival compared with those without DM (n = 150; median survival time: 23.3 vs 46.7 months; <i>P</i> = 0.003) although cancer-specific survival was comparable (<i>P</i> = 0.894). Patients with DM had a higher incidence of death from infections (<i>P</i> < 0.001). Multivariate analysis identified DM as an independent prognostic factor (hazard ratio, 1.742; <i>P</i> = 0.021). DM with FLR <40% (n = 11) exhibited worse survival (median survival time: 13.7 vs 35.0 months; <i>P</i> = 0.026) and a higher incidence of death from infections (<i>P</i> = 0.016) compared with those with FLR ≥40% (n = 23). The median glucose fluctuation was larger in patients with DM and FLR <40% (80 vs 39 mg/dL; <i>P</i> = 0.023).</p><p><strong>Conclusions: </strong>DM was an independent prognostic factor in patients with PHCC undergoing hepatectomy. DM and FLR <40% were associated with worse survival and larger glucose fluctuation postoperatively.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e552"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglect, Recklessness, and Deliberate Indifference in the Face of a Serious Neurosurgical Pathology: Lessons From the Tragic Fate of Prisoner Elliot Earl Williams.","authors":"Lawson E Spence, Kathleen S Botterbush, Justin K Zhang, Todd A Berger, Philippe A Mercier, Tobias A Mattei","doi":"10.1097/AS9.0000000000000554","DOIUrl":"10.1097/AS9.0000000000000554","url":null,"abstract":"<p><p>The US prison system, which houses nearly 2 million people, depends on its healthcare agents to provide the first line of diagnosis and treatment for any medical needs that arise during incarceration. Given the high rates of illness and injuries in this population, there is a pressing need for high-quality medical care. However, surgeons often observe that the system frequently fails to provide adequate healthcare services to incarcerated individuals. This study examines an instance of neglect, recklessness, and deliberate indifference in the facet of a serious acute traumatic spinal pathology, which made it to the lay press headlines several years ago. This case involves a prisoner who suffered a cervical spine trauma and, because of delayed diagnosis and treatment, ultimately progressed to quadriplegia and death. Through an analysis of the case's background, legal context, and outcomes, alongside a review of the formal legal complaint filed with the US District Court for the Northern District of Oklahoma, this article provides a detailed root-cause analysis of the systemic failures which led to this unfortunate outcome. Ultimately, the tragic case of US Veteran Elliott Earl Williams serves as a unique learning opportunity for surgeons, physicians, healthcare workers, correctional staff, and facility administrators so that the healthcare system for inmates can be improved to prevent future similar cases.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e554"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}