Annals of surgery最新文献

{"title":"Prophylactic Regenerative Peripheral Nerve Interface Surgery in Pediatric Lower Limb Amputation Patients.","authors":"Ahneesh J Mohanty, Paul S Cederna, Stephen W P Kemp, Theodore A Kung","doi":"10.1097/SLA.0000000000006327","DOIUrl":"10.1097/SLA.0000000000006327","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prophylactic effect of regenerative peripheral nerve interface (RPNI) surgery on pediatric postamputation pain.</p><p><strong>Background: </strong>Chronic postamputation pain is a debilitating and refractory sequela of limb amputation affecting up to 83% of pediatric patients with limb loss, resulting in disability and decreased quality of life. We postulate that prophylactic RPNI surgery performed during amputation may decrease the incidence of symptomatic neuroma and development of phantom limb pain, as well as limit analgesic use among pediatric patients with limb loss.</p><p><strong>Methods: </strong>Retrospective chart review was performed on pediatric patients between the ages of 8 and 21 years who underwent major lower limb amputation with and without RPNI surgery. Documented neuroma and phantom limb pain scores, as well as analgesic use, were recorded. Narcotic use was converted to milligrams morphine equivalents per day, whereas overall analgesic use was converted to Medication Quantification Scale version III scores. Analysis was performed using Stata.</p><p><strong>Results: </strong>Forty-four pediatric patients were identified; 25 RPNI patients and 19 controls. Of control patients, 79% developed chronic postamputation pain versus 21% of RPNI patients ( P < 0.001). Among the patients who developed postamputation pain, 20% of controls developed clinical neuroma pain, compared with 0% of RPNI patients ( P < 0.001). In addition, RPNI patients demonstrated a significant decrease in pain score ( P = 0.007) and narcotic usage ( P < 0.01) compared with controls. Overall analgesic use did not vary significantly between groups.</p><p><strong>Conclusions: </strong>Prophylactic RPNI surgery shows promise for pediatric patients undergoing major lower limb amputation by preventing both symptomatic neuromas and possibly the development of phantom limb pain.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"346-351"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes from 871,441 Consecutive Surgical Procedures Without Overlap or with Maximally Permissible Nonconcurrent Overlap.","authors":"Austin J Borja, Ritesh Karsalia, Ryan S Gallagher, Krista Strouz, Jianbo Na, Scott D McClintock, Ronald P DeMatteo, Neil R Malhotra","doi":"10.1097/SLA.0000000000006340","DOIUrl":"10.1097/SLA.0000000000006340","url":null,"abstract":"<p><strong>Objective: </strong>To isolate the impact of subsumed surgery (a shorter procedure completed entirely during overlapping noncritical portions of a longer antecedent procedure) on patient outcomes.</p><p><strong>Summary background data: </strong>The American College of Surgeons recently recommended the elimination of \"concurrent surgery\" with overlap during a procedure's critical portions. Guidelines for nonconcurrent overlap have been established, but the safety of subsumed surgery remains to be examined.</p><p><strong>Methods: </strong>All consecutive procedures from 2013 to 2021 within a multihospital academic medical center were included (n=871,441). Simple logistic regression was performed to compare postoperative events between patients undergoing non-overlaping surgery (n=533,032) and completely subsumed surgery (n=11,319). Thereafter, coarsened exact matching was used to match patients with non-overlaping and subsumed surgery 1:1 on CPT code, 18 demographic features, baseline health characteristics, and procedural variables (n=7,146). Exact-matched cases were subsequently limited to pairs performed by the same surgeon (n=5,028). Primary outcomes included 30-day readmission, ED visits, and reoperations.</p><p><strong>Results: </strong>Univariate analysis suggested that subsumed surgery had a higher 30-day risk of readmission (OR 1.55, P <0.0001), ED evaluation (OR 1.19, P <0.0001), and reoperation (OR 1.98, P <0.0001). When comparison was limited to the exact same procedure and patients were matched on demographics and health characteristics, there were no outcome differences between patients with subsumed surgery and non-overlapping surgery, even when limiting analyses to the same surgeon.</p><p><strong>Conclusions: </strong>Similar surgeries for similar patients result in similar outcomes whether they are performed completely subsumed or without overlap. Individual surgeons performing a specific procedure have no outcome differences with subsumed and non-overlapping cases.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"258-266"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlapping Surgery Verbiage in Informed Consent Documents.","authors":"Margaret B Mitchell, George Lin, Kavita Prasad, Daniel R S Habib, Alexander Langerman","doi":"10.1097/SLA.0000000000006324","DOIUrl":"10.1097/SLA.0000000000006324","url":null,"abstract":"<p><strong>Objective: </strong>To assess informed consent documents from U.S. institutions for verbiage regarding overlapping surgery.</p><p><strong>Background: </strong>Overlapping surgery remains a controversial practice. Recent guidance from the Senate Finance Committee and American College of Surgeons emphasizes transparency with patients regarding this practice through the informed consent process, but it remains unclear how many institutions adopted their recommendations.</p><p><strong>Methods: </strong>Informed consent documents were collected from a national sample of 104 institutions and assessed for verbiage regarding overlapping surgery and/or attending absence during a surgical case. The verbiage of these forms was further analyzed for inclusion of key terms (e.g., \"overlapping surgery,\" \"critical portions\"), as well as transparency regarding surgeon absence.</p><p><strong>Results: </strong>Thirty (29%) forms included verbiage regarding overlapping surgery and/or surgeon absence during a case. Most of these 30 utilized the terms \"overlapping surgery\" or \"critical portions\" (18 [60%] and 25 [83%], respectively), although only 3 (10%) explicitly stated that portions of the procedure that may be performed in the absence of the attending surgeon. Six forms (20%) specifically stated who may perform the procedure without the attending present, and 3 forms (10%) had patients acknowledge this section of the consent form with an additional signature or initial. Only 2 of the forms (7%) fulfilled all of the criteria set forth by the Senate Finance Committee.</p><p><strong>Conclusions: </strong>Detailed information regarding overlapping surgery is infrequently included in hospitals' procedure informed consent documents. Forms that include this information rarely provide explicit statements of attending presence and trainee participation, raising concerns regarding surgeon-patient transparency.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"254-257"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Alternative to \"Checkmark Credentialing\" for Effective Physician Benchmarking and Professional Improvement.","authors":"Thoralf M Sundt, John B Herman, Michael Jellinek","doi":"10.1097/SLA.0000000000006725","DOIUrl":"10.1097/SLA.0000000000006725","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"199-201"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendectomy and Long-term Colorectal Cancer Incidence, Overall and by Tumor Fusobacterium nucleatum Status.","authors":"Hidetaka Kawamura, Tomotaka Ugai, Yasutoshi Takashima, Kazuo Okadome, Takashi Shimizu, Kosuke Mima, Naohiko Akimoto, Koichiro Haruki, Kota Arima, Melissa Zhao, Juha P Väyrynen, Kana Wu, Xuehong Zhang, Kimmie Ng, Jonathan A Nowak, Jeffrey A Meyerhardt, Edward L Giovannucci, Marios Giannakis, Andrew T Chan, Curtis Huttenhower, Wendy S Garrett, Mingyang Song, Shuji Ogino","doi":"10.1097/SLA.0000000000006315","DOIUrl":"10.1097/SLA.0000000000006315","url":null,"abstract":"<p><strong>Objective: </strong>To test hypotheses that appendectomy history might lower long-term colorectal cancer risk and that the risk reduction might be strong for tumors enriched with Fusobacterium nucleatum , bacterial species implicated in colorectal carcinogenesis.</p><p><strong>Background: </strong>The absence of the appendix, an immune system organ and a possible reservoir of certain pathogenic microbes, may affect the intestinal microbiome, thereby altering long-term colorectal cancer risk.</p><p><strong>Methods: </strong>Utilizing databases of prospective cohort studies, namely the Nurses' Health Study and the Health Professionals Follow-up Study, we examined the association of appendectomy history with colorectal cancer incidence overall and subclassified by the amount of tumor tissue Fusobacterium nucleatum​​ ( Fusobacterium animalis ). We used an inverse probability weighted multivariable-adjusted duplication-method Cox proportional hazards regression model.</p><p><strong>Results: </strong>During the follow-up of 139,406 participants (2,894,060 person-years), we documented 2811 incident colorectal cancer cases, of which 1065 cases provided tissue Fusobacterium nucleatum analysis data. The multivariable-adjusted hazard ratio of appendectomy for overall colorectal cancer incidence was 0.92 (95% CI, 0.84-1.01). Appendectomy was associated with lower Fusobacterium nucleatum -positive cancer incidence (multivariable-adjusted hazard ratio, 0.53; 95% CI, 0.33-0.85; P =0.0079), but not Fusobacterium nucleatum -negative cancer incidence (multivariable-adjusted hazard ratio, 0.98; 95% CI, 0.83-1.14), suggesting a differential association by Fusobacterium nucleatum status ( Pheterogeneity =0.015). This differential association appeared to persist in various participant/patient strata including tumor location and microsatellite instability status.</p><p><strong>Conclusions: </strong>Appendectomy likely lowers the future long-term incidence of Fusobacterium nucleatum -positive (but not Fusobacterium nucleatum -negative) colorectal cancer. Our findings do not support the existing hypothesis that appendectomy may increase colorectal cancer risk.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"319-327"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140846905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Women Surgeons Have It All? If Not Now, When?","authors":"Heather A Lillemoe, Rebecca A Snyder","doi":"10.1097/SLA.0000000000006768","DOIUrl":"10.1097/SLA.0000000000006768","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"184-185"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Method for Continuous Surgeon Improvement in Rectal Cancer: Risk-adjusted Cumulative Sum.","authors":"Davide Ferrari, Tommaso Violante, Amit Merchea, Eric Dozois, Robert A Vierkant, David W Larson","doi":"10.1097/SLA.0000000000006330","DOIUrl":"10.1097/SLA.0000000000006330","url":null,"abstract":"<p><strong>Objective: </strong>To develop and analyze a risk-adjusted cumulative sum (RA-CUSUM) chart as a potential method to monitor individual surgeon performance in robotic total mesorectal excision (TME) for rectal cancer.</p><p><strong>Background: </strong>Currently, surgeons lack real-time tools to monitor and enhance their performance beyond residency completion. While national quality programs exist, granular, individual-level data are crucial for continuous improvement. Previous studies suggest cumulative sum charts hold promise in identifying performance trends and outliers.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 640 robotic TME cases performed by 12 surgeons at 2 institutions. RA-CUSUM charts were generated for 3 outcomes: (1) complications, (2) operative time, and (3) length of stay.</p><p><strong>Results: </strong>The overall RA-CUSUM curves for operative time and complications showed an initial learning phase, followed by a plateau or downward slope, indicating proficiency or improvement. However, individual surgeon curves revealed significant heterogeneity. Three surgeons consistently excelled in operative time, while 5 minimized complications most effectively. Potential quality improvement could be implemented to drive performance toward positive outliers. No differences were found in unadjusted outcomes, including conversion, number of lymph nodes harvested, and positive circumferential margins.</p><p><strong>Conclusions: </strong>The RA-CUSUM chart is a promising method for identifying individual surgeon performance in robotic TME. It could help surgeons, teams, and leaders identify improvement areas and benchmark themselves against positive outliers. Further studies are needed to explore the potential of RA-CUSUM for implementing interventions to improve surgical quality.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"304-310"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Surgery Needs a Strategy, Not Just Another Training Track or Rotation.","authors":"Cody Lendon Mullens, Tyler G Hughes","doi":"10.1097/SLA.0000000000006701","DOIUrl":"10.1097/SLA.0000000000006701","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"193-195"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Rural Exposure During General Surgery Residency on Practice in a Rural Community.","authors":"Nina M Clark, Paul McClure, Aaron Erickson, Holly A Andrilla, Gordon Riha, Ashley Dennis, Barclay T Stewart, Dana C Lynge, Davis G Patterson","doi":"10.1097/SLA.0000000000006696","DOIUrl":"10.1097/SLA.0000000000006696","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate associations between rural training exposure during surgical residency and eventual practice in a rural community, and whether specific types of exposure were more likely to yield rural surgeons.</p><p><strong>Background: </strong>Growing deficits in the rural surgery workforce have prompted increased attention toward rural training. However, the association between exposure to rural surgery during residency and practice in rural communities remains limited.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of U.S. general surgery residency graduates from 2011 to 2020. Program information was abstracted from residency websites, the American College of Surgeons, and the American Medical Association. A survey distributed to programs and direct review of residency websites were used to characterize the type of rural surgery exposure offered to trainees. We evaluated associations between exposure to rural surgery in training and ultimate practice in a rural location.</p><p><strong>Results: </strong>Of 11,407 surgeons, 6.2% reported working in rural communities. Graduates of programs with rural training, according to residency websites or the American College of Surgeons, were more likely to work in rural areas [odds ratio: 1.81 (95% CI: 1.32-2.49) and 2.09 (1.28-3.40)]. Rurally located programs, rural rotations, and programs with a rural mission were associated with greater odds of graduates working in rural areas ( P < 0.05 for all). Rural tracks were not associated with more rural graduates.</p><p><strong>Conclusions: </strong>Among graduates of general surgery residency programs, rural exposures during training were associated with eventual practice in rural communities. Programs with rural missions, in rural locations, or offering rural rotations produced graduates who were more likely to work in rural areas, while rural track programs did not, highlighting the need for further study of individual rural exposure to establish effective training paradigms. Specific policies facilitating rural exposure and surgical programs in rural communities may be effective methods for addressing workforce deficits.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"186-192"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Mortality Before Interhospital Hospital for \"Unseen\" General Surgery Patients: Development, Validation, and Feasibility Trial of a Mortality Risk Calculator.","authors":"Sayf Al-Deen Said, Corey K Gentle, Abby Gross, Kelly Nimylowycz, Mir Shanaz Hossain, Allison Weathers, R Matthew Walsh, Scott R Steele, Miguel Regueiro, Toms Augustin","doi":"10.1097/SLA.0000000000006334","DOIUrl":"10.1097/SLA.0000000000006334","url":null,"abstract":"<p><strong>Objective: </strong>Develop and validate a mortality risk calculator that could be utilized at the time of transfer, leveraging routinely collected variables that could be obtained by trained nonclinical transfer personnel.</p><p><strong>Background: </strong>There are no objective tools to predict mortality at the time of interhospital transfer for Emergency General Surgery patients that are \"unseen\" by the accepting system.</p><p><strong>Methods: </strong>Patients transferred to general or colorectal surgery services from January 2016 to August 2022 were retrospectively identified and randomly divided into training and validation cohorts (3:1 ratio). The primary outcome was admission-related mortality, defined as death during the index admission or within 30 days postdischarge. Multiple predictive models were developed and validated.</p><p><strong>Results: </strong>Among 4664 transferred patients, 280 (6.0%) experienced mortality. Predictive models were generated utilizing 19 routinely collected variables; the penalized regression model was selected over other models due to excellent performance using only 12 variables. The model performance on the validating set resulted in an area under the receiver operating characteristic curve, sensitivity, specificity, and balanced accuracy of 0.851, 0.90, 0.67, and 0.79, respectively. After bias correction, the Brier score was 0.04, indicating a strong association between the assigned risk and the observed frequency of mortality.</p><p><strong>Conclusions: </strong>A risk calculator using 12 variables has excellent predictive ability for mortality at the time of interhospital transfer among \"unseen\" Emergency General Surgery patients. Quantifying a patient's mortality risk at the time of transfer could improve patient triage, bed and resource allocation, and standardize care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"267-274"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}