Annals of surgery最新文献

{"title":"Procedural Maturation and Midterm Durability of the Posterior Rectus Sheath Flap for Hiatal Augmentation in Complex Paraesophageal Hernias.","authors":"Yalini Vigneswaran, Michelle Campbell, Alex W Lois, Lawrence J Gottlieb, Mustafa Hussain","doi":"10.1097/SLA.0000000000007213","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007213","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate procedural maturation, donor-site morbidity, and midterm durability of posterior rectus sheath flap for hiatal augmentation (PoRSHA) within an IDEAL Phase 2b framework.</p><p><strong>Background: </strong>Large paraesophageal hernia repair remains limited by high recurrence rates associated with structural weakness of the diaphragmatic crura. Existing reinforcement strategies remain limited by inconsistent long-term durability. PoRSHA, a vascularized autologous tissue technique developed for complex hiatal repair, previously demonstrated early feasibility and promising early outcomes in IDEAL Phase 2a evaluation.</p><p><strong>Methods: </strong>This prospective single-center IDEAL Phase 2b study included 104 consecutive patients undergoing PoRSHA between 2021 and 2026. The analytic cohort consisted of patients with primary type III/IV (n=71) and recurrent paraesophageal hernias (n=23). Radiologic recurrence (>2 cm) was assessed using Kaplan-Meier analysis to account for variable imaging follow-up. Secondary outcomes included symptomatic recurrence requiring reoperation, postoperative dysphagia, and donor-site morbidity.</p><p><strong>Results: </strong>Estimated radiologic recurrence in the overall analytic cohort was 1.4% at 12 months and 13.8% at 24 months (95% CI, 5.7%-31.3%), remaining stable at 18.1% through 48 months. After exclusion of the procedural maturation phase (n=16), estimated radiologic recurrence improved to 9.2% at both 24 months and 36 months (95% CI, 2.9%-27.4%), with no additional recurrences during follow-up. Recurrences were small and did not result in reoperation. Donor-site morbidity was infrequent.</p><p><strong>Conclusions: </strong>Following procedural maturation, PoRSHA demonstrated favorable midterm durability with limited donor-site morbidity. These findings support continued multicenter evaluation of vascularized autologous tissue augmentation for complex paraesophageal hernia repair.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886189","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":"Morphology-Based Surgery for Chronic Pancreatitis Across Europe: Toward the Next Generation of Unified Guidelines.","authors":"Charlotte L Van Veldhuisen, Charlotte A Leseman, Fleur E M De Rijk, Joana C Marques-Antunes, Fabio Ausania, Orlin Belyaev, Frederik Berrevoet, Marja Boermeester, Ugo Boggi, Stefan A Bouwense, Marco J Bruno, Olivier R Busch, Kevin C Conlon, Safi Dokmak, Massimo Falconi, Poya Ghorbani, Filip Gryspeerdt, Roel Haen, Arturan Ibrahimli, Jakob R Izbicki, Christina Krikke, Arto Kokkola, Lancelot Marique, J S D Mieog, Gennaro Nappo, Janis Pavulans, Haralds Plaudis, Geert Roeyen, Pasquale Scognamiglio, Domenico Tamburrino, Tore Tholfsen, Marie Toschka, Faik G Uzunoglu, Susan Van Dieren, Casper H J Van Eijck, Jeanin E van Hooft, Hjalmar C Van Santvoort, Robert C Verdonk, Rogier P Voermans, Anne Waage, Marc G Besselink","doi":"10.1097/SLA.0000000000007202","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007202","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the use and impact of current surgical guidelines for chronic pancreatitis (CP) across Europe.</p><p><strong>Summary background data: </strong>Current guidelines recommend morphology-based surgery for CP, but international studies evaluating their use and impact are lacking.</p><p><strong>Methods: </strong>Post hoc analysis of the prospective multicenter ESCOPA study, including patients undergoing surgery for symptomatic CP at 22 centers in 13 countries (June 2021-November 2022), with 6-month follow-up. Patients were stratified by morphologic subtype: \"isolated dilated main pancreatic duct (MPD),\" \"isolated enlarged pancreatic head (PH),\" \"combined dilated MPD and enlarged PH,\" and \"small duct disease.\" Treatment was based on the European HaPanEU and International IAP-APA-JPS-EPC guidelines. Primary outcomes were 90-day major morbidity, mortality, and pain relief at 6 months. Practice variation was assessed, including a case-based survey.</p><p><strong>Results: </strong>Overall, 207 patients were included following surgery for CP, with 1.4% 90-day mortality and 72.6% pain relief. The surgical approach varied widely by morphologic subtype: duodenum-preserving pancreatic head resections (DPPHR) were most common for \"combined dilated MPD and enlarged PH\" (46.8%, P=0.016); whereas formal pancreatectomy predominated for \"isolated dilated MPD\" (63.3%, P=0.040) and \"small duct disease\" (66.0%, P=0.004). Guideline-concordant surgery (66%) was not associated with improved rates of major morbidity (12.9% vs. 18.8%, P=0.387), mortality (1.6% vs. 1.6%, P>0.999), or pain relief (75.3% vs. 66.7%, P=0.468). Outcomes were also comparable between drainage/parenchyma-preserving surgery and formal pancreatectomy. Survey findings confirmed practice variation, including the use of formal and V-shaped pancreatectomy for small duct disease.</p><p><strong>Conclusion: </strong>The substantial variation in surgical practice for CP across Europe highlights the need for unified guidelines with clear recommendations, particularly regarding formal and V-shaped pancreatectomy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886267","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":"Single-dose Preoperative Glucocorticoids in Major Gastrointestinal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Rathin Gosavi, Baxter Smith, Kavindu Hathurusinghe, Anjana Ravi, Sarah A Martin, Walston Reginald Martis, Vignesh Narasimhan, Geraldine Oo","doi":"10.1097/SLA.0000000000007215","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007215","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy and safety of single-dose preoperative systemic glucocorticoids in adults undergoing major gastrointestinal surgery.</p><p><strong>Summary of background data: </strong>Major gastrointestinal surgery induces a systemic inflammatory response that contributes to postoperative morbidity and delayed recovery. Single-dose glucocorticoids attenuate inflammation, but uncertainty remains regarding clinical benefit, safety, and optimal dosing.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials was performed and registered with PROSPERO. Trials comparing a single preoperative systemic glucocorticoid with placebo or no steroid in adult major gastrointestinal surgery were included. Primary outcomes were total postoperative complications and infectious complications. Secondary outcomes included length of stay, anastomotic leak, postoperative day 1 inflammatory markers, and mortality. Random-effects models were used. Dose-stratified analyses were prespecified and exploratory.</p><p><strong>Results: </strong>Eighteen randomized trials, including 3667 patients were analyzed. Preoperative glucocorticoids reduced total postoperative complications (OR 0.69, 95% CI: 0.54-0.89; I²=12%) and infectious complications (OR 0.62, 95% CI: 0.45-0.88; I²=55%). Length of stay was reduced by 1.09 days (95% CI: -1.68 to -0.50). Postoperative day 1 IL-6 was lower with glucocorticoids, while CRP showed no consistent difference. Anastomotic leak and mortality were not increased. Exploratory analyses suggested greater benefit with higher-dose regimens.</p><p><strong>Conclusions: </strong>Single-dose preoperative systemic glucocorticoids reduce postoperative morbidity, infections, and length of stay after major gastrointestinal surgery, without evidence of increased surgical harm in included trial populations.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886253","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 Multicenter Prospective, Observational Study of Observation Versus Colectomy in Recurrent Diverticulitis.","authors":"Alexander T Hawkins, Russell L Rothman, Lauren R Samuels, Timothy Geiger, Matthew Mutch, Scott Regenbogen, Marissa C Kuo, Michael Feng, Isabella Schafer, David Penson","doi":"10.1097/SLA.0000000000007217","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007217","url":null,"abstract":"<p><strong>Background: </strong>Understanding changes in quality of life that occur with colectomy is critical to decision-making in management of recurrent diverticulitis. We hypothesized that patients choosing colectomy at surgical consultation would report better disease-specific quality of life at 1 year than those choosing observation.</p><p><strong>Objective: </strong>To investigate the association between colectomy versus observation for recurrent sigmoid diverticulitis and disease-specific quality of life at 1 year.</p><p><strong>Methods: </strong>We performed a multicenter prospective observational study including patients with recurrent uncomplicated diverticulitis choosing colectomy versus observation at initial consultation. The primary outcome was disease-specific quality of life at 1 year, measured by the Diverticulitis Quality of Life questionnaire total score.</p><p><strong>Results: </strong>A total of 113 patients were enrolled (median age 57; 64% female, 92% white); 42 (37%) chose colectomy at surgical consultation. At enrollment, median lifetime episodes of diverticulitis were similar between groups (colectomy: 5, observation: 4); the colectomy group had a higher rate of hospitalization in the past 5 years (colectomy: 71%, observation: 49%). In an adjusted linear mixed effects model, choosing colectomy was associated with better quality of life by 1.73 points (95% CI: 1.02-2.46) compared with choosing observation. 7 people (17%) who chose colectomy experienced recurrence within 1 year compared with 32 who chose observation (45%). In an adjusted model, choosing colectomy was associated with lower odds of recurrence (aOR 0.16; 95% CI: 0.05-0.48).</p><p><strong>Conclusion: </strong>For patients with recurrent sigmoid diverticulitis presenting for surgical consultation, colectomy may offer meaningful improvement in disease-specific quality of life and may be associated with reduced 1-year recurrence rates.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886199","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":"Beyond the Helm: Reflections on Leadership in Academic Surgery From the Experience of Early-Career Surgeons.","authors":"Jad M Abdelsattar, Heather J Logghe","doi":"10.1097/SLA.0000000000007216","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007216","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886241","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":"The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management (ALES Study): A Multicenter Cohort Study.","authors":"Lorenzo Giorgi, Nadia Guidozzi, Riadh Salem, Wing K Chou, Stijn Vanstraelen, Helena Gielen, Johnny Moons, Philippe Nafteux, Femke E Lammes, Jelle P Ruurda, Richard van Hillegersberg, Alban Todesco, Xavier Benoit D'Journo, Alice Collizzolli, Barbara Ajazi, Simone Giacopuzzi, Maria Bencivenga, Sam Alhayo, Ella Seabourne, Ewen A Griffiths, Aram Abu Hejleh, Lars M Schiffmann, Christiane J Bruns, Giovanni Maria Garbarino, Andrea Pansa, Silvia Basato, Ophélie Bacoeur-Ouzillou, Caroline Gronnier, Sofie P G Henckens, Suzanne S Gisbertz, Rakesh Ahmed, Nithiesh Loganathan, Jessie A Elliott, Kirsty Cole, Youssef Ibrahim, Chanakya Anand, Philip H Pucher, Martin Skogar, Jakob Hedberg, Eloise Bonnin, Julie Veziant, Guillaume Piessen, Agnese Carresi, Francesco Puccetti, Silvia Battaglia, Riccardo Rosati, Fahad Murad, Fredrik Klevebro, Magnus Nilsson, Grard A P Nieuwenhuijzen, Lars van de Sanden, Misha Luyer, Rita Alfieri, Carlo Castoro, Mark I van Berge Henegouwen, Sheraz R Markar","doi":"10.1097/SLA.0000000000007190","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007190","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of severity of esophageal anastomotic leak (AL), standardized by ECCG grading, on long-term survival within a contemporary multicenter cohort.</p><p><strong>Summary background data: </strong>Historical evidence suggesting AL is associated with increased recurrence and poor survival is limited by heterogeneous definitions and outdated management. This study utilizes the standardized ECCG definition to evaluate the prognostic significance of AL severity under modern perioperative protocols and endoscopic rescue strategies.</p><p><strong>Methods: </strong>An international multicenter cohort across 17 high-volume European centers. Adult patients with esophageal or junctional cancer treated with neoadjuvant CROSS or FLOT, followed by esophagectomy were included (2018-2023).</p><p><strong>Results: </strong>Out of 2905 patients, 425 (14.6%) developed an AL. AL was associated with a nearly two-fold increase in pulmonary complications (46.8% vs. 26.7%; P<0.001). AL requiring surgical reintervention (type III) was associated with an increased 30- and 90-days mortality rate (7.3% vs. 2.7% and 12.3% vs. 4%, P<0.001) and a significant reduction in median overall survival versus the no leak group (33.9 vs. 69.3; months P<0.001). After multivariable adjustment, type III AL was associated with a greater likelihood of death (HR 1.51; 95% CI: 1.04-2.18; P=0.029). A lower rate of adjuvant therapy administration (33.9% vs. 43.3%; P=0.004) was observe for AL patients. No significant survival deficits were observed for leaks treated conservatively or with no-surgical intervention.</p><p><strong>Conclusions: </strong>AL requiring surgical reintervention was associated with impaired survival. This relationship identifies a high-risk clinical profile and represents a critical target for future research into strategies for clinical stabilization and risk mitigation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878935","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":"Expanding Indications of Nonvascularized Rectus Fascia as a Cross-Disciplinary Allograft: A Prospective Single-Center Study.","authors":"Laurens J Ceulemans, Ewout Muylle, Gert De Hertogh, Andrea Zajacova, Marina G M C Mori da Cunha, Steffi De Pelsmaeker, Ina Benoy, Antoine Dubois, Thomas Douchy, Daphne Hompes, Albert Wolthuis, Diethard Monbaliu, Philippe Nafteux, Paul De Leyn, André D Hoore, Jacques Pirenne, Nele Van De Winkel","doi":"10.1097/SLA.0000000000007194","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007194","url":null,"abstract":"<p><strong>Objective: </strong>To report the expanding application of nonvascularized rectus fascia allotransplantation (NVRF-alloTx) in solid organ transplant (SOT) and non-SOT patients and evaluate its effectiveness, integration, and immunologic response in complex abdominal and thoracic reconstruction.</p><p><strong>Summary background data: </strong>Synthetic and biological meshes are limited by infection risk, long-term failure, donor-site morbidity, and high cost. NVRF-alloTx, first applied in intestinal/multivisceral-Tx with a 5.9% herniation rate, offers a simple and promising alternative for challenging defects.</p><p><strong>Methods: </strong>This prospective single-center study included all consecutive patients undergoing NVRF-alloTx (2020-2025). Patients were divided into 2 groups: (1) reconstruction in SOT patients (simultaneous or elective closure post-SOT) and (2) reconstruction in non-SOT patients, without immunosuppression. NVRF-allografts were procured from deceased donors, preserved at 2°C, and implanted without HLA-matching. Primary endpoints were successful closure, graft failure, and functional outcome. Clinical and radiologic follow-up was performed, with HLA donor-specific antibody (HLA-DSA) testing and histology whenever available.</p><p><strong>Results: </strong>Forty-seven NVRF-Tx procedures were performed in 41 patients using grafts from 48 deceased donors: group 1 (n=17) and group 2 (n=24). In 2 patients (4.9%), the graft did not integrate due to pancreatic leakage and vasopressor therapy. Others resulted in successful functional outcomes. Histology (n=5) showed graft integration through host fibrotic remodeling with neovascularization evident from 1 month after implantation. (De novo) HLA-DSA developed more frequently in non-SOT NVRF recipients than in SOT NVRF recipients.</p><p><strong>Conclusions: </strong>NVRF-alloTx is a versatile and effective reconstructive option for complex defects in SOT and non-SOT patients, providing an alternative to conventional meshes in challenging clinical scenarios.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886206","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":"Cancer Surgery Outcomes After Implementation of a Global Budget Model in Rural Hospitals.","authors":"Jacob Whitman, Eric T Roberts, Jonathan G Yabes, Donald Bourne, Zhaojun Sun, Manisha Bhattacharya, Jeremy M Kahn, Bruce L Jacobs, Lindsay M Sabik","doi":"10.1097/SLA.0000000000007207","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007207","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between the implementation of the Pennsylvania Rural Health Model (PARHM), a global budget program for rural hospitals, and short-term outcomes for rural residents undergoing cancer surgery.</p><p><strong>Background: </strong>Rural hospitals play a critical role in delivering surgical care but face ongoing financial instability. Global budget models aim to stabilize hospitals and preserve access to care. While designed to stabilize finances and improve population health, its impact on quality of care for complex surgical services remains unknown.</p><p><strong>Methods: </strong>We conducted a repeated cross-sectional study using a stacked difference-in-differences design to compare outcomes before and after the implementation of PARHM. Linked Pennsylvania inpatient discharge and cancer registry data (2016-2023) were used to identify patients undergoing inpatient surgery for 11 cancer types. Patients residing in hospital service areas (HSAs) with PARHM-participating hospitals were compared with those in PARHM-eligible nonparticipating HSAs. Models adjusted for patient and area characteristics and included HSA and year fixed effects.</p><p><strong>Results: </strong>Among 17,048 cancer surgery admissions, 3537 occurred in PARHM HSAs and 13,511 in comparison HSAs. Baseline patient and area characteristics were broadly similar across groups. PARHM implementation was not associated with changes in 30- or 90-day mortality, readmission, or composite outcomes. Findings were generally consistent across adoption cohorts and cancer types, with no evidence of systematic improvement or deterioration in outcomes following implementation.</p><p><strong>Conclusions: </strong>Implementation of PARHM was not associated with changes in short-term cancer surgery outcomes among rural residents in Pennsylvania. Alternative strategies may be needed to improve short-term surgical oncology outcomes in rural hospitals.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878885","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":"Benchmarking Robotic Pancreatoduodenectomy: Is It Time to Benchmark Surgeons, Not Just Patients?","authors":"Sangrag Ganguli, Melissa E Hogg","doi":"10.1097/SLA.0000000000007212","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007212","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878917","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":"The Impact of Out-of-Hours Liver Transplantation on Outcomes: A Swedish National Study.","authors":"Mathias V A Vidgren, Rose Matin, Samuel A E Lundgren, Antonio Romano, Amanda L M Habermann, Malin E Aram, Sebastian P Forssten, William F D Bennet, Gabriel C Oniscu","doi":"10.1097/SLA.0000000000007185","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007185","url":null,"abstract":"<p><strong>Objectives: </strong>This national, multicenter retrospective study of 764 adult liver transplantations (LT) in Sweden (2019-2023) employed a data-driven approach to identify the out-of-hours (OOH) high-risk window and evaluate its impact on patient outcomes and health care costs.</p><p><strong>Summary background data: </strong>LT logistics often necessitate OOH surgery, but the evidence for an impact on outcomes remains conflicting, partly due to arbitrary window definitions.</p><p><strong>Methods: </strong>Using the mathematical principle of permutations and linear regression analysis of 1-hour start-time intervals across 552 temporal windows, we identified the period with the greatest impact on the primary endpoint: the 3-month Comprehensive Complication Index (CCI). Secondary outcomes included intensive care unit length of stay, Clavien-Dindo complications, reoperations, patient and graft survival, and health care costs.</p><p><strong>Results: </strong>The 17:00 to 05:59 window was identified as having the greatest negative impact on CCI. After adjusting for covariates, procedures initiated during this timeframe were associated with significantly higher CCI (β=7.41, 95% CI: 4.27-10.56, P<0.01), increased Clavien-Dindo IIIb and IV complications, 1.16 days longer intensive care unit stay and a higher risk of LT-related reoperations (odds ratio: 1.61, 95% CI: 1.11-2.36). One-year graft and patient survival were comparable between groups. Health care costs were 169.629 SEK (€15,500) higher per patient operated OOH, during the 3-month follow-up.</p><p><strong>Conclusion: </strong>This data-driven analysis identified a high-risk OOH window beginning earlier than previously reported (17:00 vs. traditional nighttime definitions). LT starting in this interval is associated with significantly increased morbidity and health care costs. Further studies are needed to evaluate mitigating strategies to enable daytime transplantation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872646","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}