Surgery open science最新文献

{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2589-8450(26)00020-5","DOIUrl":"10.1016/S2589-8450(26)00020-5","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"31 ","pages":"Page i"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147713575","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":"Laparoscopic versus open minor liver resections of colorectal cancer liver metastases in a state at war: A prospective cohort study","authors":"Anton Burlaka ,&nbsp;Serhii Zemskov ,&nbsp;Veronika Rozhkova ,&nbsp;Vitaliy Zvirych ,&nbsp;Mykhailo Dupyk ,&nbsp;Andrii Beznosenko ,&nbsp;Volodymyr Bezverkhnyi ,&nbsp;Volodymyr Skyba","doi":"10.1016/j.sopen.2026.03.006","DOIUrl":"10.1016/j.sopen.2026.03.006","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2017 the laparoscopic left lateral sectionectomy and minor resections of the anterior liver segments were considered the standard of practice worldwide. However, in 2023 only 5% of liver resections were conducted laparoscopically within the Ukrainian specialized centers.</div></div><div><h3>Aim</h3><div>To investigate whether the laparoscopic minor liver resections (LLR) have better financial, surgical and long-term oncological outcomes compared to open liver resections (OLR) in the two state specialized hospitals in Ukraine<strong>.</strong></div></div><div><h3>Methods</h3><div>Between January 2022 and June 2025, 205 patients with colorectal liver metastases (CLM) received either minor OLR or LLR. Primary end-points were the 30-day morbidity, surgical outcomes. Secondary endpoints were hospital costs and the oncological outcomes.</div></div><div><h3>Results</h3><div>There was a difference in postoperative morbidity between the groups in favor of the LLR – 3.8% (<em>n</em> = 4) vs 11.7% (<em>n</em> = 12) in OLR (<em>p</em> = 0.04). 1.9% (<em>n</em> = 2) in the OLR group had major complications. No mortality was registered in either group. The final sum of costs for treatment of 103 patients in LLR vs 102 patients in OLR was 3.8 M UAH vs 3.5 M UAH, respectively (<em>p</em> = 0.82). The 2-year recurrence-free survival (RFS) was 44% vs 54%, and 19.6 months vs 24.0 months respectively for OLR and LLR groups (<em>p</em> = 0.62)<strong>.</strong></div></div><div><h3>Conclusions</h3><div>The laparoscopic minor liver resections in patients with colorectal cancer liver metastases in state specialized hospitals reduced the recovery period and the postoperative morbidity level with similar oncological outcomes and costs<strong>.</strong></div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"31 ","pages":"Pages 54-59"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612688","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":"An integrated mini-CEX and OSCE assessment model for optimizing standardized training in department of hepatobiliary surgery","authors":"Hucheng Ma MD ,&nbsp;Haozhen Ren MD ,&nbsp;Xingyu Wu MD ,&nbsp;Decai Yu MD","doi":"10.1016/j.sopen.2026.01.008","DOIUrl":"10.1016/j.sopen.2026.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Standardized residency training in China requires robust evaluation mechanisms, yet significant disparities exist due to lacking standardized criteria. Current tools like OSCE (simulation-based) and Mini-CEX (workplace-based) have limitations: Mini-CEX excludes surgical skills, while OSCE lacks authentic clinical context. Combining them offers holistic assessment potential but is understudied in hepatobiliary surgery.</div></div><div><h3>Methods</h3><div>A prospective cohort study randomized 36 hepatobiliary surgery residents into: Experimental group (<em>n</em> = 18): Monthly Mini-CEX assessments (evaluating medical interviewing, physical exam, clinical judgment, communication, treatment planning, patient-centered care, and overall competence via 9-point scale) followed by final OSCE. Control group (<em>n</em> = 18): Monthly traditional written/procedural assessments followed by final OSCE.</div><div>The OSCE (100-point max) comprised stations for history-taking, physical exam, hepatobiliary procedural skills, case analysis and doctor-patient communication. Intergroup comparisons used Student's <em>t</em>-tests and chi-square tests (SPSS 26.0, <em>p</em> &lt; 0.05 significant).</div></div><div><h3>Results</h3><div>Baseline characteristics showed no significant differences between groups. The experimental group achieved significantly higher final OSCE total scores (<em>p</em> &lt; 0.05), with notable improvements in physical examination and doctor-patient communication. No significant differences were found in history-taking, hepatobiliary procedural skills, or case analysis. Satisfaction was significantly higher in the experimental group (1/18 vs. 6/18 dissatisfied in controls). Trainees valued Mini-CEX's real-time feedback and competency mapping.</div></div><div><h3>Conclusions</h3><div>Integrating Mini-CEX and OSCE creates an effective dual-modality system for hepatobiliary surgery residents. It significantly enhances overall clinical competency (especially physical exam and communication) and trainee satisfaction compared to traditional methods. This combined approach provide both formative feedback (Mini-CEX) and summative validation (OSCE), establishing a promising specialty-specific framework. Future multi-center studies are recommended.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 41-45"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189676","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":"Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer","authors":"Axel Bengtsson MD,&nbsp;Roland Andersson MD, PhD,&nbsp;Bodil Andersson MD, PhD,&nbsp;Daniel Ansari MD, PhD","doi":"10.1016/j.sopen.2026.01.002","DOIUrl":"10.1016/j.sopen.2026.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic ductal adenocarcinoma (PDAC) is characterized by a prominent desmoplastic stroma, which plays a crucial role in tumor biology and treatment resistance. While the stromal compartment is a defining histopathological feature of PDAC, its prognostic significance remains incompletely understood. This study aimed to quantify the stromal content in PDAC using digital pathology and evaluate its association with patient outcomes.</div></div><div><h3>Methods</h3><div>Tissue microarrays (TMAs) were constructed from resected PDAC specimens (<em>n</em> = 142). Digital analysis of tumor stroma percentage (TSP) was performed on tissue sections labeled with CA19–9. Cases were stratified into low and high TSP groups based on an optimized threshold of 44.2%. Associations between TSP and clinicopathological variables were assessed, and survival outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Digital quantification revealed wide intertumoral variability in TSP. A total of 127 (89%) patients were categorized into the high TSP group (&gt;44.2% stroma). A high TSP was significantly associated with anatomic location of the tumor in the head of the pancreas. Patients with high TSP exhibited significantly prolonged overall survival (median: 27.8 months vs 12 months, <em>p</em> &lt; 0.001). In multivariable analysis, high TSP remained an independent predictor of favorable prognosis (HR = 0.26, 95% CI: 0.13–0.52, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>A high TSP is independently associated with improved survival in PDAC. These findings challenge traditional views of the stroma as purely tumor-promoting and suggest a potential protective role of the stromal compartment in certain contexts.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 8-13"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039443","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":"Surgery for colorectal liver metastases: Predictive factors of biliary fistula","authors":"Mohamed Guelbi ,&nbsp;Mohamed Hajri ,&nbsp;Zied Hadrich ,&nbsp;Aziz Atallah ,&nbsp;Sofiene Gabsi ,&nbsp;Rached Bayar ,&nbsp;Lassad Gharbi ,&nbsp;Sahir Omrani","doi":"10.1016/j.sopen.2026.01.006","DOIUrl":"10.1016/j.sopen.2026.01.006","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal liver metastases (CRLM) are the most common secondary site of colorectal cancer. Hepatic resection remains the potentially curative standard treatment, but postoperative morbidity remains substantial, with biliary fistula representing the most frequent and clinically significant specific complication. This study aimed to identify predictive factors of biliary fistula following CRLM surgery.</div></div><div><h3>Methods</h3><div>A retrospective single-center study was conducted including 129 patients who underwent surgery for CRLM at Mongi Slim Hospital, La Marsa, between January 2020 and December 2024. The primary endpoint was postoperative biliary fistula according to ISGLS criteria. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors.</div></div><div><h3>Results</h3><div>Postoperative biliary fistulas occurred in 31 patients (24%). They were detected through surgical drainage in 61%, through abdominal collections in 29%, and as biliary peritonitis in 9.7%. Most fistulas were grade A (71%), followed by grades B (16%) and C (13%). Spontaneous resolution occurred in 67.7% of cases, while 19.4% required percutaneous drainage and 12.9% required surgical re-intervention. Univariate analysis identified several factors associated with biliary fistula: low BMI, elevated preoperative PAL and GGT levels, preoperative cholestasis, and sinusoidal obstruction syndrome. In multivariate analysis, three independent predictors were retained: low BMI (OR = 0.818; <em>p</em> = 0.04), postoperative hyperleukocytosis (OR = 4.001; <em>p</em> = 0.028), and postoperative cholestasis (OR = 8.382; <em>p</em> = 0.041). Overall postoperative morbidity reached 43.4%, with no postoperative mortality.</div></div><div><h3>Conclusion</h3><div>Biliary fistula remains a major complication after CRLM resection. Identifying high-risk patients may improve postoperative surveillance and outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 33-35"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189677","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":"Surgery for adrenal gland disease. Experience of a tertiary center","authors":"Gaia Cicioni ,&nbsp;Immacolata Iannone ,&nbsp;Daniele Crocetti ,&nbsp;Mariarita Tarallo ,&nbsp;Paolo Sapienza ,&nbsp;Giuseppe Cavallaro ,&nbsp;Giorgio De Toma ,&nbsp;Luigi Petramala ,&nbsp;Claudio Letizia ,&nbsp;Maria Irene Bellini","doi":"10.1016/j.sopen.2026.01.009","DOIUrl":"10.1016/j.sopen.2026.01.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic adrenalectomy and robotic adrenalectomy are increasingly accepted methods for removing adrenal lesions, especially for benign conditions. This study investigated the evolution of surgical techniques and patient characteristics at a tertiary centre during the transition from open to minimally invasive surgery.</div></div><div><h3>Patients and methods</h3><div>The analysis included all adrenal surgery cases referred to our institution between January 2009 and June 2025. The following were recorded for each patient: demographics, diagnosis, surgical approach, intraoperative blood loss, histology, length of hospital stays, and complications.</div></div><div><h3>Results</h3><div>A total of 292 adrenalectomies were performed (56% female; mean age 54.5 ± 12.6 years). The left adrenal was more frequently affected (59%), and the mean tumor size was 46.8 ± 25.1 mm. Indications included primary hyperaldosteronism (37%), Cushing's syndrome (28%), pheochromocytoma (15%), adrenal cysts or myelolipomas (17%), adrenocortical carcinomas (4%), and adrenal metastases (2%). Laparoscopy was the most common approach (76%), followed by open (10%) and robotic adrenalectomy (9%); overall 7 (2%) patients required conversion to open surgery and postoperative morbidity was 7%. Minimally invasive procedures were associated with shorter operative times, less blood loss, and shorter in-hospital stays when compared to open surgery (<em>p</em> &lt; 0.05). Robotic adrenalectomy had the lowest intraoperative blood loss, while laparoscopy had the fastest operative time.</div></div><div><h3>Conclusions</h3><div>Minimally invasive adrenalectomy is safe and effective for adrenal tumors. In our series, robotic-assisted surgery is becoming increasingly prevalent and has excellent results; however, its implementation needs to be balanced with the associated costs.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 46-50"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313346","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/ethnicity on firearm & self-injuries during COVID-19 using TQIP data","authors":"Veronica Layrisse Landaeta M.D. ,&nbsp;Shahenda Khedr B.A. ,&nbsp;Victoria Yuan M.D. ,&nbsp;Eshani Pareek M.B.S. ,&nbsp;Debra D'Angelo M.S. ,&nbsp;Elizabeth Zhao BS ,&nbsp;Gala Cygiel M.D. ,&nbsp;Konstantin Khariton D.O., F.A.C.S. ,&nbsp;Steven Y. Chao M.D., F.A.C.S.","doi":"10.1016/j.sopen.2026.01.001","DOIUrl":"10.1016/j.sopen.2026.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic led to increased assaults, self-inflicted injuries, and firearm-related injuries across the nation, along with increased reports of depression and anxiety worldwide. Our study examines trends in these types of injuries among diverse racial and ethnic groups in the United States during this time.</div></div><div><h3>Methods</h3><div>Data was extracted from the ACS-TQIP database, including patients with assaults, self-inflicted injuries and firearm-related injuries from 2018 to 2021. Pre-COVID period was defined as 2018–2019, and COVID period as 2020–2021. We performed univariable and multivariable logistic regressions to identify associations between injury rates and COVID period, sex, race, and ethnicity.</div></div><div><h3>Results</h3><div>We identified 417,797 assaults (9.3% of traumas), 57,853 self-inflicted injuries (1.3%) and 208,882 firearm-related injuries (4.7%). Multivariable analysis revealed significant increase in assaults (OR: 1.02, 95% CI: [1.01, 1.03]; <em>p</em> &lt; 0.001) and firearm-related injuries (1.28 [1.27, 1.29]; p &lt; 0.001) and a significant decrease in self-inflicted injuries (0.98 [0.97, 0.99]; <em>p</em> = 0.039) during the COVID period.</div><div>Asian American Pacific Islanders (1.06 [1.02–1.10]; <em>p</em> &lt; 0.005), American Indians (3.47 [3.35–3.60]; <em>p</em> &lt; 0.001), Black or African American (5.32 [5.26–5.38]; <em>p</em> &lt; 0.001, other races (1.23 [1.20–1.25]; p &lt; 0.001) and Hispanics (1.71[1.65–1.74]; p &lt; 0.001) had higher odds of assaults during COVID.</div><div>Asian American Pacific Islanders (1.12 [1.04–1.20]; <em>p</em> = 0.001) and American Indians (1.23 [1.12–1.35]; <em>p</em> &lt; 0.001 had higher odds of self-inflicted injuries and Hispanic patients had lower odds (0.73 [0.70–0.76]; <em>p</em> &lt; 0.001) during COVID.</div><div>American Indians (1.45 [1.36–1.55]; <em>p</em> &lt; 0.001), Black or African Americans (6.42 [6.33–6.52]; <em>p</em> &lt; 0.001), Hispanics (1.46 [1.43–1.50]; p &lt; 0.001) and other races (1.11 [1.08–1.15]; p &lt; 0.001) had higher odds of firearm related injuries during COVID.</div></div><div><h3>Conclusion</h3><div>The COVID period saw higher odds of assaults, self-inflicted injuries, and firearm-related injuries in certain racial/ethnic minorities. These findings highlight the need for targeted interventions to address the disproportionate impact on racial/ethnic minorities.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 1-7"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963174","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":"The role of negative pressure wound therapy—From the perspective of drainage fluid composition","authors":"Muhaimaiti Abudurezhake ,&nbsp;Yifei Huang ,&nbsp;Hailong Wang ,&nbsp;Gulinuer Aili ,&nbsp;Yamei Xu ,&nbsp;Yajun Tian ,&nbsp;Zhanjun Ma","doi":"10.1016/j.sopen.2026.01.003","DOIUrl":"10.1016/j.sopen.2026.01.003","url":null,"abstract":"<div><div>Negative pressure wound therapy (NPWT) accelerates wound healing processes by promoting angiogenesis and vascularization. However, the molecular mechanisms and biological effects underpinning these processes remain unclear, while drainage fluids (and associated components) extracted by negative pressure suction are rarely investigated. This study investigated these components and explored their relationship with wound healing. To this end, a diabetic wound rat model was established, and wound exudate was collected using negative pressure wound therapy (NPWT) equipment. Platelet-derived growth factor (PDFG-BB), transforming growth factor-β (TGF-β1), epidermal growth factor (EGF), vascular endothelial growth factor-A (VEGF-A), and stromal cell-derived factor-1 (SDF-1) expression levels were investigated using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and western blotting. Circulating endothelial progenitor cells (EPCs), circulating fibrocytes, and mesenchymal stem cells (MSCs) were analyzed by flow cytometry. This study observed that during wound healing, the expression levels of platelet-derived growth factor (PDGF), transforming growth factor-β (TGF-β1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and chemokine-1 (SDF-1) were significantly higher in the experimental group than in the control group. This expression pattern was similar to that observed in endothelial progenitor cells (EPCs), fibroblasts, and mesenchymal stem cells (MSCs). The data from this study indicate that NPWT significantly increases the clearance of drainage fluid and its related components (including growth factors, chemokines, and cells). Also, drainage fluid levels were proportional to wound healing.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 23-32"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039445","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":"Development of prediction models for perioperative opioid needs in laparoscopic cholecystectomy patients: A machine-learning approach","authors":"Yongmei Huang MD, DrPH ,&nbsp;Guohua Li MD, DrPH ,&nbsp;Silvia S. Martins MD, PhD ,&nbsp;Pia M. Mauro PhD ,&nbsp;Ana I. Tergas MD, MPH ,&nbsp;June Hou MD, MBA ,&nbsp;Xiao Xu PhD ,&nbsp;Elena B. Elkin PhD ,&nbsp;Judith S. Jacobson DrPH, MBA ,&nbsp;Jason D. Wright MD","doi":"10.1016/j.sopen.2026.01.005","DOIUrl":"10.1016/j.sopen.2026.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Changes in opioid prescribing practices have evolved, including perioperative settings. However, computerized clinical decision support systems to guide opioid prescribing remain limited. This study aimed to develop and validate prediction models for perioperative opioid needs among patients undergoing laparoscopic cholecystectomy (LC) and to create a risk-scoring tool.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study. Using electronic medical records (EMR), we identified patients aged 18–64 years who underwent LC for benign conditions between October 2015 and December 2018. Demographic, clinical, and surgical data were collected. Perioperative opioid needs were classified as none/low (0–3 days), medium (4–6 days), or high (≥7 days), based on self-reported pain scores and prescription duration. The cohort was split into training (70%) and testing (30%) datasets. Prediction models were developed using random forest, Least Absolute Shrinkage and Selection Operator (LASSO), and subject-matter expertise, with performance evaluated by discrimination, calibration, accuracy, precision, recall, and F1 score.</div></div><div><h3>Results</h3><div>A total of 1136 patients were identified. In the training dataset (<em>n</em> = 803), 36.1% of patients were in the none/low group, 22.1% in the medium group, and 41.8% in the high group. In testing dataset (<em>n</em> = 333), LASSO outperformed random forest with better calibration. The revised LASSO model, incorporating subject-matter knowledge, improved interpretability, achieving an AUC of 0.64 and Brier score of 0.20. Key predictors included gender, pre-operative medication, emergency surgery, anesthesia type, and surgical indications. A nomogram was developed for visual prediction.</div></div><div><h3>Conclusions</h3><div>Prediction of perioperative opioid needs using EMR and machine-learning is feasible and may support individualized pain management, though further refinement of model performance is warranted.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Pages 14-22"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039444","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":"Response to “Comment on the systematic review of TROPIS for anal fistula”","authors":"Yang-Tao Chen Doctor of Medicine ,&nbsp;Rong Shi Bachelor of Medicine ,&nbsp;Jing Wang Doctor of Medicine","doi":"10.1016/j.sopen.2025.10.004","DOIUrl":"10.1016/j.sopen.2025.10.004","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"30 ","pages":"Page 53"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397989","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}