Surgery open science最新文献

{"title":"Searching for bacteria within acute cholecystitis using next-generation sequencers","authors":"Tomohiro Otsuka ,&nbsp;Yoichi Ishizaki ,&nbsp;Jiro Yoshimoto ,&nbsp;Kenji Takamori ,&nbsp;Shin Watanabe","doi":"10.1016/j.sopen.2025.05.006","DOIUrl":"10.1016/j.sopen.2025.05.006","url":null,"abstract":"<div><h3>Introduction</h3><div>A biliary microbiome comprising flora within normal gallbladders was recently uncovered through analyses targeting the bacterial 16S ribosomal RNA (16S rRNA) gene, despite the gallbladder previously being regarded as a sterile environment. In the present study, we subjected bile samples from patients with acute cholecystitis to gene analysis targeting bacterial flora.</div></div><div><h3>Methods</h3><div>We targeted patients diagnosed as having Grade I or Grade II acute cholecystitis (in accordance with the Tokyo Guidelines 2018 established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery) who underwent laparoscopic cholecystectomy within 24 h of diagnosis at Juntendo University Urayasu Hospital between July 2021 and January 2024 for evaluation. We drew bile sample from the gallbladder of each patient to confirm the presence of biliary bacterial flora, using both standard bacteriology (culture test) and 16S rRNA gene sequence.</div></div><div><h3>Results</h3><div>Of the 29 samples, 15 yielded cultures positive for bacterial flora, and gene analysis revealed the presence of bacterial biliary flora in all 14 samples that had tested negative in standard bacteriology. Considering the bacterial flora of a normal gallbladder without lesions as “normal flora,” bacteria other than normal flora—<em>Propionibacterium</em> spp., <em>Coprococcus</em> spp., <em>Prevotella</em> spp., <em>Sediminibacterium</em> spp., and <em>Collinesella</em> spp.—were detected in 25 of the 29 cases (86 %).</div></div><div><h3>Conclusions</h3><div>Bacteria not detected in non-inflammatory gallbladders such as <em>Propiobacterium</em> spp., <em>Coprococcus</em> spp., <em>Prevotella</em> spp., <em>Sediminibacterium</em> spp., and <em>Collinesella</em> spp. may play a role in the mechanism underlying development of acute cholecystitis.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 113-118"},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreaticoduodenectomy on soft-embalmed human cadavers according to Dodge – a pilot feasibility report","authors":"Dariya Jaeger ,&nbsp;Eric Hinrichs ,&nbsp;Ralf Schoppe ,&nbsp;Gebhard Reiss ,&nbsp;Georg Feigl ,&nbsp;Benno Mann","doi":"10.1016/j.sopen.2025.05.005","DOIUrl":"10.1016/j.sopen.2025.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>Pancreaticoduodenectomy (PD) is one of the most complex procedures in abdominal surgery. Nowadays, it is very difficult for novice surgeons to learn the procedure of PD on living patients. New concepts are needed to improve the surgical training of PD, comparable to education in the operating room.</div></div><div><h3>Method</h3><div>We investigated the feasibility of performing PD on a soft embalmed human cadaver using the Dodge preservation technique, considering all operative steps. Surgery was performed by a certified expert. The settings corresponded to the conditions of the operating room with the original surgical instruments and sutures. Upon completion of the PD, feedback in the form of a comprehensive questionnaire was obtained from the expert by evaluating all relevant operational steps in terms of realism using a 5 point Likert scale.</div></div><div><h3>Results</h3><div>PD was performed successfully by the expert. The results showed very good feasibility for PD on the used Dodge embalmed cadaver (DeC). The expert confirmed a realistic surgical performance similar to real-life conditions, with good color contrast, clearly visible tissue layers for a layered preparation, and a great result for the reconstruction part of the anastomoses.</div></div><div><h3>Conclusions</h3><div>New educational methods are needed to improve surgical training of PD. Hands-on training of PD performed on DeC enables a realistic surgical experience and offers a promising educational method for training in pancreatic surgery.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 107-112"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video-based learning for basic surgical skills - A randomized trial","authors":"I. Dantas ,&nbsp;I. Jorge ,&nbsp;A. Nicolau ,&nbsp;M. Vales ,&nbsp;C. Coutinho ,&nbsp;S. Rodrigues ,&nbsp;P. Febra ,&nbsp;V.N. Lopes","doi":"10.1016/j.sopen.2025.05.003","DOIUrl":"10.1016/j.sopen.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>The authors sought to evaluate how video-based learning compares to traditional learning method in basic surgical skills.</div></div><div><h3>Design</h3><div>Prospective, randomized and blinded case-control study.</div></div><div><h3>Setting</h3><div>Faculty of Medicine, University of Porto.</div></div><div><h3>Participants and methods</h3><div>Fifty medical students were randomized into two groups: traditional learning (in-person course) and video-based learning. Four sutures were taught to both groups: simple interrupted, cruciate mattress, horizontal mattress and vertical mattress sutures.</div><div>A first evaluation occurred following the learning sessions, and a retention evaluation was performed two weeks later.</div><div>Both groups were compared on performance quality (using a modified Objective Structured Assessment of Technical Skills scale (mOSATS)), time to complete the procedure, and participant satisfaction and self-evaluation (using a Likert-like questionnaire). The frequency and duration of autonomous training by the video-based learning group was documented.</div></div><div><h3>Results</h3><div>Performance quality was similar in the first evaluation, except for the horizontal [25.88 (SD (Standard Deviation) 3.58) vs 28.28 (SD 3.79), <em>p</em> = 0.04] and vertical mattress sutures [24.14 (SD 3.59) vs 28.44 (SD 3.69), <em>p</em> &lt; 0.01], where the video-based learning group got higher mOSATS scores. In the retention evaluation, the video-based learning group demonstrated higher mOSATS ratings.</div><div>The time spent learning with videos was 45 min longer [median in hours: 2:15:30 (IQR (Interquartile Range) 2:17:44)] than the in-person course duration. Overall, the traditional learning group completed sutures faster (<em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Video-based learning may be an effective alternative to traditional teaching of basic surgical skills, in performance quality and retention, offering better resource allocation and cost savings.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 94-106"},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of social ties in dissemination of Commission on Cancer's synoptic operative report","authors":"Ko Un Park ,&nbsp;Mary Brindle ,&nbsp;Heather Neuman ,&nbsp;Tasleem J. Padamsee ,&nbsp;Sarah Birken","doi":"10.1016/j.sopen.2025.05.004","DOIUrl":"10.1016/j.sopen.2025.05.004","url":null,"abstract":"<div><div>In 2020, the Commission on Cancer (CoC) launched templated synoptic element documentation in operative reports (SORs) as an accreditation standard to standardize and document surgical techniques for key portions of cancer operations. The study team identified multi-level factors influencing implementation of CoC's breast cancer SORs, including variations in surgeons' knowledge about the new SOR standard. One identified facilitator of SOR dissemination was social ties. To better understand mechanisms underlying social ties in disseminating breast SORs, we performed secondary analysis of key informant interviews in this study.</div><div>Social ties were identified by characterizing the surgeon's relationship to that program's Cancer Liaison Physician (CLP) or surgeon belonging to a CoC affiliate organization (e.g., Cancer Research Program). The CLP serving as each program's designated physician quality leader was also the central actor receiving information directly from the CoC. We found that both the CLP's direct ties to the CoC, and indirect ties (e.g., personal ties to someone with direct ties to the CoC), facilitated early dissemination of information about SORs. Leveraging interorganizational ties and providing guidance to CLPs about how and when to communicate with providers about new standards may facilitate dissemination.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 61-63"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease","authors":"Oh Jin Kwon ,&nbsp;Esteban Aguayo ,&nbsp;Kevin Tabibian ,&nbsp;Jeffrey Balian ,&nbsp;Arjun Chaturvedi ,&nbsp;Dariush Yalzadeh ,&nbsp;Joseph Hadaya ,&nbsp;Yas Sanaiha ,&nbsp;Peyman Benharash","doi":"10.1016/j.sopen.2025.04.011","DOIUrl":"10.1016/j.sopen.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into <em>non-CKD</em>, <em>CKD 1–2</em>, and <em>CKD 3–5</em> based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.</div></div><div><h3>Results</h3><div>Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as <em>CKD 3–5</em>. Following risk adjustment, <em>CKD 3–5</em> was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to <em>non-CKD</em>. Additionally, both <em>CKD 1–2</em> and <em>CKD 3–5</em> were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, <em>CKD 3–5</em> was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.</div></div><div><h3>Conclusions</h3><div>Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 87-93"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dall-E in hand surgery: Exploring the utility of ChatGPT image generation","authors":"Daniel Soroudi ,&nbsp;Daniel S. Rouhani ,&nbsp;Alap Patel ,&nbsp;Ryan Sadjadi ,&nbsp;Reta Behnam-Hanona ,&nbsp;Nicholas C. Oleck ,&nbsp;Israel Falade ,&nbsp;Merisa Piper ,&nbsp;Scott L. Hansen","doi":"10.1016/j.sopen.2025.04.012","DOIUrl":"10.1016/j.sopen.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education.</div></div><div><h3>Methods</h3><div>Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: “Hand Anatomy”, “Hand Fracture”, “Hand Joint Injury”, “Hand Tumor”, and “Hand Dislocation”. Responses were graded on a 1–5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated.</div></div><div><h3>Results</h3><div>ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2.</div></div><div><h3>Conclusions</h3><div>This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 64-78"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis","authors":"Ayesha P. Ng ,&nbsp;Troy N. Coaston ,&nbsp;Konmal Ali ,&nbsp;Christian de Virgilio ,&nbsp;Peyman Benharash","doi":"10.1016/j.sopen.2025.05.002","DOIUrl":"10.1016/j.sopen.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.</div></div><div><h3>Methods</h3><div>All adults undergoing nonelective cholecystectomy for mild GSP in the 2017–2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.</div></div><div><h3>Results</h3><div>Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (<em>p</em> &lt; 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74–0.86]).</div></div><div><h3>Conclusions</h3><div>IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 79-86"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of frailty with clinical and financial outcomes of hospitalization for non-operative trauma","authors":"Zeyu Liu BS ,&nbsp;Saad Mallick MD ,&nbsp;Nam Yong Cho BS ,&nbsp;Esteban Aguayo MD ,&nbsp;Mahima Chillakanti BS ,&nbsp;Giselle Porter BS ,&nbsp;Konmal Ali ,&nbsp;Joseph Song BS ,&nbsp;Areti Tillou MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.008","DOIUrl":"10.1016/j.sopen.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations.</div></div><div><h3>Methods</h3><div>We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019–2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0–3.0) and HF (AOR 3.3; 95 % CI, 2.7–4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2–1.4 days) and costs of $3200 (95 % CI, $3100–$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8–5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600).</div></div><div><h3>Conclusion</h3><div>Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 47-53"},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race based disparities in clinical and financial outcomes associated with major elective and emergent surgery","authors":"Saad Mallick MD ,&nbsp;Sara Sakowitz MS MPH ,&nbsp;Syed Shahyan Bakhtiyar MD MBE ,&nbsp;Nam Yong Cho BS ,&nbsp;Troy Coaston BS ,&nbsp;Esteban Aguayo MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.010","DOIUrl":"10.1016/j.sopen.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.</div></div><div><h3>Methods</h3><div>All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.</div></div><div><h3>Results</h3><div>Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (<em>p</em> &lt; 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all <em>p</em> &lt; 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.</div></div><div><h3>Conclusions</h3><div>Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 39-46"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the environmental impact associated with disruptive surgical bleeding","authors":"Mesut Kocaman ,&nbsp;Stephen Johnston ,&nbsp;Mosadoluwa Afolabi ,&nbsp;Walter Danker ,&nbsp;Fiona Adshead","doi":"10.1016/j.sopen.2025.04.009","DOIUrl":"10.1016/j.sopen.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Minimizing avoidable healthcare resource use can support a move towards more sustainable healthcare systems. Few studies have sought to evaluate the environmental impact of complications associated with specific surgical procedures. The aim of this study was to assess the environmental impact associated with disruptive surgical bleeding across a broad range of procedures.</div></div><div><h3>Methods</h3><div>The environmental impact assessment was performed using clinical and healthcare resource use data from a retrospective database analysis of patients with disruptive bleeding across nine procedures. Emissions data from the Sustainable Healthcare Coalition were sourced for the relevant resource use activities and used to calculate the climate, water and waste impact associated with disruptive surgical bleeding.</div></div><div><h3>Results</h3><div>Across the procedures of interest, surgical bleeding was shown to incur a mean environmental impact of 167 kg CO₂e, 267 m³ water use and 20 kg waste. Considering the incidence of disruptive bleeding per 1000 procedures, treatment of bleeding during valve procedures was associated with the highest environmental impact due to the high proportion of patients in which this complication occurs (44 %). Achieving effective and timely control of surgical bleeding events and reducing their incidence by 50 % could save up to 49 tons of CO₂e, 77,082 m³ of water use, and 6.3 tons of waste per 1000 surgical procedures.</div></div><div><h3>Conclusions</h3><div>Surgical bleeding is associated with a substantial environmental impact. This study demonstrates the potential to use existing resource use data associated with specific healthcare activities to assess their environmental impact, helping to identify key areas for improvement in the sustainability of surgical departments.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 54-60"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}