Surgery open science最新文献

{"title":"Association of hospital for-profit status with clinical and financial outcomes following emergency general surgery","authors":"Izhar Mbarani MD ,&nbsp;Sara Sakowitz MD, MBA ,&nbsp;Amulya Vadlakonda MD ,&nbsp;Troy Coaston MSCR ,&nbsp;Esteban Aguayo MD ,&nbsp;Syed Shaheer Ali ,&nbsp;Konmal Ali ,&nbsp;Saad Mallick MD ,&nbsp;Peyman Benharash MD MS","doi":"10.1016/j.sopen.2025.06.003","DOIUrl":"10.1016/j.sopen.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>The impact of for-profit (FP) hospital ownership on healthcare outcomes has garnered increasing attention in recent years with limited work linking FP status with lower quality of care and higher costs. However, outcomes emergency general surgery (EGS) at FP hospitals remains unknown.</div></div><div><h3>Methods</h3><div>All non-elective adult (≥18 years) hospitalizations entailing EGS (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of admission, were tabulated from the 2016 to 2021 National Inpatient Sample. Multivariable models were constructed to evaluate the independent associations between hospital FP status with key clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of an estimated 2,124,394 patients, 337,950 (16 %) were classified as FP. Compared to others, the FP cohort was younger, of lower comorbidity burden, and more frequently in the lowest income quartile. After risk adjustment, care at FP hospitals was associated with a greater likelihood of in-hospital mortality or any major complication (Adjusted Odds Ratio [AOR] 1.15, 95 % Confidence Interval [CI] 1.12–1.18), including infectious (AOR 1.22, 95 % CI 1.18–1.26), respiratory (AOR 1.26, 95 % CI 1.21–1.31), and renal sequelae (AOR 1.12, 95 % CI 1.08–1.16). While associated with reduced per-patient hospitalization costs (β -$2910, 95 % CI -3180,-2640), treatment at FP institutions was associated with increased odds of non-home discharge (AOR 1.09, 95 % CI 1.05–1.13).</div></div><div><h3>Conclusions</h3><div>Care at for-profit hospitals appears to be associated with greater risk of morbidity and nonhome discharge. Future work is needed to consider the factors contributing to greater morbidity, and developing interventions aimed at improving quality of care.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 1-7"},"PeriodicalIF":1.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144264111","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":"Role of cholecystectomy in hyperkinetic biliary dyskinesia: A systematic review and meta-analysis","authors":"Duyen Quach MD ,&nbsp;Kayla Nguyen MD ,&nbsp;Gabriella Tavera BS ,&nbsp;Rachel Wright MD ,&nbsp;Zuhair Ali MD ,&nbsp;Mike Liang MD","doi":"10.1016/j.sopen.2025.06.001","DOIUrl":"10.1016/j.sopen.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Biliary dyskinesia is disorder characterized by reduced gallbladder ejection fraction, which have shown a good response to cholecystectomy. In contrast, hyperkinetic biliary dyskinesia (HBD), as defined by ejection fraction ≥80 %, is an emerging phenomenon, and the role of cholecystectomy is not yet clearly defined. This review investigates the effectiveness of cholecystectomy in alleviating symptoms of HBD.</div></div><div><h3>Material and methods</h3><div>A comprehensive literature search was conducted to retrieve studies based on predefined inclusion criteria. Data were extracted by two-independent reviewers. A random-effects model was used for meta-analysis. Risk ratios (RR) were calculated to estimate the impact of cholecystectomy on symptom improvement. Heterogeneity was calculated using the I² statistic and Q-test, with subgroup analyses performed based on study design.</div></div><div><h3>Results</h3><div>Fourteen studies involving 416 patients with HBD were included. Overall, the pooled RR for symptom relief post-cholecystectomy was 3.72 (95 % CI: 2.57–5.38). A subgroup analysis of retrospective reviews showed an RR of 3.9 (95 % CI: 2.57–5.92). Moderate heterogeneity (I² = 30.01 %) was observed.</div></div><div><h3>Conclusion</h3><div>Based on existing evidence, cholecystectomy appeared to be a promising and effective treatment for HBD in select patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 128-134"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212228","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 body mass index and outcomes in surgical and transcatheter aortic valve replacement","authors":"Bennet S. Cho MD ,&nbsp;Troy N. Coaston BS ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Sara Sakowitz MPH, MS ,&nbsp;Syed Shaheer Ali ,&nbsp;Esteban Aguayo MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.05.008","DOIUrl":"10.1016/j.sopen.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>The association between body mass index (BMI) and outcomes in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) is not well understood. This study assessed the nuanced relationship between BMI and clinical outcomes in a nationally representative cohort undergoing aortic valve replacement.</div></div><div><h3>Methods</h3><div>Adult (≥18 years) admissions for elective SAVR or TAVR from the 2016–2021 National Inpatient Sample were analyzed. BMI was categorized as underweight (&lt;20), ideal weight (20–30), obesity class I (30–34.9), class II (35–39.9), and class III (≥40). The primary outcome was in-hospital mortality. Secondary outcomes included major adverse events (MAE), a composite of mortality and complications (e.g., stroke, thromboembolic, cardiac, respiratory, infection, renal).</div></div><div><h3>Results</h3><div>Among 103,000 patients, 61.2 % underwent TAVR. TAVR patients were older (76 vs. 64 years; p &lt; 0.001) and more frequently underweight (3.1 % vs. 1.5 %; p &lt; 0.001) compared to SAVR patients. In TAVR, BMI &lt; 20 was associated with higher mortality (AOR 2.99, 95 % CI 1.16–7.74) and MAE (AOR 1.74, 95 % CI 1.30–2.34) compared to ideal BMI. Obesity did not increase the overall incidence of MAE in patients undergoing TAVR. In SAVR, mortality was not associated with BMI, but underweight (AOR 2.05, 95 % CI 1.33–3.15) and class III obesity (AOR 1.34, 95 % CI 1.09–1.65) were linked to higher MAE risk.</div></div><div><h3>Conclusions</h3><div>Extremes of BMI results in poorer outcomes in SAVR and TAVR. Underweight patients had increased risks across both approaches, while severe obesity elevated MAE risk in SAVR. These findings underscore the need for tailored perioperative strategies and risk counseling.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 135-139"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220839","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":"Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula","authors":"Yang-Tao Chen ,&nbsp;Zhao-Chu Wang,&nbsp;Ya-Meng Xie,&nbsp;Xun Wang,&nbsp;Xu-Xiong Wu,&nbsp;Yang Li,&nbsp;Rong Shi,&nbsp;Jing Wang","doi":"10.1016/j.sopen.2025.05.010","DOIUrl":"10.1016/j.sopen.2025.05.010","url":null,"abstract":"<div><div>Transanal Opening of Intersphincteric Space (TROPIS) has emerged as a promising surgical approach for anal fistula management over recent years. This meta-analysis comprehensively evaluates the comparative efficacy and safety of TROPIS versus conventional treatments through systematic analysis of 24 clinical studies involving 2813 patients. Through systematic searches across 7 major biomedical databases (including PubMed, EMBASE, and Chinese repositories) from inception to March 2024, we identified comparative studies assessing TROPIS against six established interventions: incision-thread-drawing, seton placement, LIFT, EAFR, fistulotomy, and incision-suture techniques. Pooled analysis demonstrated TROPIS achieved superior clinical outcomes, with a 3.15-fold higher total efficacy rate (95 % CI 1.22–8.13, <em>p</em> = 0.02) and 64 % lower complication risk compared to conventional methods (OR 0.28, 95 % CI 0.18–0.42, <em>p</em> &lt; 0.00001). Sensitivity analyses confirmed result stability across study designs, while publication bias assessment via funnel plots and Egger's test revealed no significant distortion. Importantly, TROPIS maintained its advantage across various complication subtypes including incontinence (OR 0.31), infection (OR 0.27), and recurrence (OR 0.19). These findings establish TROPIS as a clinically superior alternative that significantly improves therapeutic outcomes while reducing procedure-related risks, suggesting its potential to become the new reference standard in anal fistula management. The consistent results across diverse patient populations and comparator procedures underscore the robustness of this evidence synthesis.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 15-30"},"PeriodicalIF":1.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314319","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":"Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis","authors":"Prakasini Satapathy ,&nbsp;Abhay M. Gaidhane ,&nbsp;Nasir Vadia ,&nbsp;Soumya V. Menon ,&nbsp;Kattela Chennakesavulu ,&nbsp;Rajashree Panigrahi ,&nbsp;Ganesh Bushi ,&nbsp;Mahendra Singh ,&nbsp;Sanjit Sah ,&nbsp;Awakash Turkar ,&nbsp;S. Govinda Rao ,&nbsp;Khang Wen Goh ,&nbsp;Muhammed Shabil","doi":"10.1016/j.sopen.2025.05.009","DOIUrl":"10.1016/j.sopen.2025.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %–28.00 %), with substantial heterogeneity (I² = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %–18.95 %) compared to 21.89 % (95 % CI, 12.92 %–34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %–40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %–100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index −1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 68-80"},"PeriodicalIF":1.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633375","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":"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":"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":"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}