Annals of surgery最新文献

{"title":"The Mutational Status of Driver Genes in Patients with Resected Pancreatic Ductal Adenocarcinoma is Associated with Pathological Characteristics and Overall Survival.","authors":"Brady A Campbell,Dario Solinas,Amanda L Blackford,Marco Dal Molin,Julia Purchla,Thomas McPhaul,Swathikan Chidambaram,John L Cameron,Ming-Tseh Lin,Ralph H Hruban,Christopher R Shubert,Kelly J Lafaro,Richard A Burkhart,William R Burns,Jin He","doi":"10.1097/sla.0000000000006794","DOIUrl":"https://doi.org/10.1097/sla.0000000000006794","url":null,"abstract":"OBJECTIVETo evaluate whether mutations in pancreatic ductal adenocarcinoma (PDAC) driver genes (KRAS, TP53, SMAD4, and CDKN2A) are associated with pathological characteristics and prognosis.SUMMARY BACKGROUND DATAThe prognostic significance of specific mutations in PDAC driver genes is incompletely understood.METHODSWe analyzed patients who underwent pancreatectomy between 2018 and 2022 for localized PDAC and whose cancer was profiled using targeted next-generation DNA sequencing. We investigated associations between mutational status, clinical-pathological characteristics, and overall survival (OS).RESULTSAnalysis of 508 patients defined KRAS mutations as the most common genetic mutation (456, 89.8%), followed by TP53 (292, 57.5%), SMAD4 (104, 20.3%), and CDKN2A (88, 17.3%). The presence of wild-type KRAS (KRAS-wt) was associated with lower T- (P<0.001) and N-stage (P=0.04) and lower rates of perineural invasion (P=0.03), when adjusting for receipt of neoadjuvant therapy. TP53 mutations compared with TP53-wt were associated with higher T-stage (P=0.02), perineural invasion (P=0.01), and advanced tumor grade (P=0.03). Mutations in KRAS and TP53 were associated with shorter mOS compared to wild-type (HR 2.29, P=0.002 and HR 1.62, P<0.001, respectively). On multivariable analysis, N0 stage, anatomically resectable cancer, and absent lympho-vascular invasion were associated with improved mOS (all P<0.02). The presence of two (HR 1.71) or three-plus (HR 1.63) driver mutation genes was associated with shorter mOS compared to one mutation (P<0.01).CONCLUSIONSIn patients with resected PDAC, KRAS-wt and TP53-wt were associated with improved pathological characteristics and mOS, regardless of neoadjuvant therapy. The co-occurrence of two or more driver gene mutations was associated with worse mOS.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"93 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311323","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 10-year Real World Assessment of Longitudinal Outcomes Following Bailout Procedures for Severe Cholecystitis.","authors":"Pei-Wen Lim,Po Hong Tan,Keith D Lillemoe,Megan H Nelson,Pete F Johnston,Irving A Jorge,Mehrdad Motamed,Yu-Hui Chang,Chee-Chee Stucky,Nabil Wasif,James A Madura,Zhi Ven Fong","doi":"10.1097/sla.0000000000006799","DOIUrl":"https://doi.org/10.1097/sla.0000000000006799","url":null,"abstract":"OBJECTIVEWe comparatively analyzed the longitudinal outcomes of conversion to open procedure, laparoscopic subtotal cholecystectomy (CCY), and laparoscopic cholecystostomy tube placement.SUMMARY OF BACKGROUND DATASevere cholecystitis often causes dense inflammation that distorts the hepatocystic anatomy and can make safe dissection during CCY challenging. However, controversy exists regarding the optimal bailout procedure in such situations.METHODSThe New York and Florida State all-claims databases were queried for patients who underwent laparoscopic CCY for acute cholecystitis from 2012 to 2021. Hierarchical logistic regression models were used to obtain adjusted estimates, with fixed effects assigned to patient-level variables and random effects assigned to hospital identifiers to adjust for intraclass correlation.RESULTSOf 384,948 laparoscopic CCYs performed, 5,448 (1.4%) were not completed laparoscopically; 1,370 underwent conversion to open procedure, 2,646 underwent laparoscopic subtotal CCY, and 1,432 underwent laparoscopic cholecystostomy tube placement. The conversion to open rate decreased from 0.6% in 2012 to 0.3% in 2021, while the laparoscopic subtotal CCY rate increased from 0.2% in 2012 to 1.4% in 2021. The 1-year bile duct injury (BDI) rate was highest for the conversion to open group (4.4%), followed by the laparoscopic subtotal CCY (0.8%) and laparoscopic cholecystostomy tube groups (0.3%, P<0.001). On adjusted analyses with the conversion to open group as the control, laparoscopic subtotal CCY (OR 0.17, P<0.001) and laparoscopic cholecystostomy tube were associated with lower BDI rates (OR 0.08, P<0.001, Figure). The 1-year postoperative endoscopic biliary intervention rate was lowest for the conversion to open group (4.2%) followed by the laparoscopic subtotal CCY (8.4%) and the laparoscopic cholecystostomy tube groups (8.8%, P<0.001). The completion CCY rates for the laparoscopic subtotal CCY and laparoscopic cholecystostomy tube groups were 2.1% and 23.4% respectively. Among completion CCYs, the open rates were 56.4% in the laparoscopic subtotal CCY group versus 24.5% in the laparoscopic cholecystostomy tube group (P<0.001).CONCLUSIONSIn patients with severe cholecystitis requiring a bailout procedure, the BDI rate was highest after conversion to open procedure. Laparoscopic subtotal CCY and laparoscopic cholecystostomy tube were associated with lower BDI rates at the cost of higher postoperative endoscopic biliary intervention rates. Completion CCYs were required in 2.1% and 23.4% of patients who underwent laparoscopic subtotal CCY and laparoscopic cholecystostomy tube placement respectively, of which the former group's CCY was more likely to require an open operation.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"14 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311326","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":"Assessment of the NIH Salary Cap Gap Reveals the Increasing Financial Burden of Training and Hiring Surgeon-Scientists.","authors":"Juliet Emamaullee,Sarah Bangerth,Krista L Haines,Shannon Jordan,David Linehan,Arden Morris,Anton Sidawy,Tim Donahue,Ankush Gosain,Todd Rosengart","doi":"10.1097/sla.0000000000006795","DOIUrl":"https://doi.org/10.1097/sla.0000000000006795","url":null,"abstract":"OBJECTIVEThe goal of this study was to evaluate trends in the cost-share required to support NIH funded surgeon trainees and faculty.SUMMARY OF BACKGROUND DATASurgeon-scientists are critical to advancing our understanding of surgical diseases and innovating care of surgical patients. However, demands for clinical productivity while securing extramural funding in the setting of increasingly competitive National Institutes of Health (NIH) funding paylines has limited growth of the surgeon-scientist workforce.METHODSThe NIH salary cap and postdoctoral fellow stipends were obtained from the NIH website. The median total compensation for faculty at the Associate Professor rank (Non-Clinical, Clinical Faculty, Surgeons, and Surgical Subspecialties) and PGY3 level residents were obtained from Association of American Medical College data. Data were analyzed for fiscal years 2001-2023 (faculty) and 2005-2003 (trainees). Changes in the salary cap gap over time were forecasted using an exponential smoothing algorithm.RESULTSOver the study period, no cost-share was required for non-clinical faculty, while the cost-share for a surgeon investigator increased from $18,360 to $68,660 per year. For a single postdoctoral fellow trainee, the cost-share increased from $22,932 to $31,608 annually. In 2023, the total cost-share to support the program director and four positions on a T32 training grant was estimated to be $250,631. The cost-share for surgeon investigators is projected to expand by another 47% by 2035.CONCLUSIONSThis analysis demonstrates that the NIH salary cap gap creates a financial challenge for institutions and Departments of Surgery, which is projected to increase substantially over the next decade. These data highlight the urgency to advocate for policy development to adequately compensate federally funded surgical investigators and should facilitate dialogue within institutions to develop alternative funding mechanisms for surgeon-scientists.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"22 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311595","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":"American Surgical Association Presidential Address.","authors":"Ronald J Weigel","doi":"10.1097/SLA.0000000000006803","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006803","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315796","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":"Intent Vs Execution: Failure To Achieve Balanced Resuscitation In Bleeding Trauma Patients.","authors":"Jan-Michael Van Gent, Thomas W Clements, Jeremy W Cannon, Martin A Schreiber, Ernest E Moore, Nicholas Namias, Jason L Sperry, Bryan A Cotton","doi":"10.1097/SLA.0000000000006800","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006800","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the adherence to balanced resuscitation in the first 4-hours, and how whole blood (WB) affected the achievement of these ratios.</p><p><strong>Summary background data: </strong>In 2014, TQIP Best Practices recommended balanced resuscitation in a 1:1:1 (RBC:FFP:PLT) ratio. A subsequent randomized trial demonstrated a reduction in mortality with 1:1:1 in hemorrhaging trauma patients. Adoption of these recommendations and study findings have yet to be evaluated.</p><p><strong>Methods: </strong>A prospective, multicenter, observational cohort study was performed at seven academic level-1 trauma centers. Injured patients who required both blood transfusion and hemorrhage control procedures were enrolled. Primary outcome was 4-hour ratios of RBC:FFP and RBC:PLT. Patients dying in the first 60 minutes were excluded.</p><p><strong>Results: </strong>Of 1047 eligible patients, 1034 met inclusion. Overall, at 4-hours, 1:1 ratios for RBC:FFP and RBC:PLT were only achieved in 40% and 23%, respectively. Patients who achieved 1:1 for RBC:FFP (9 vs. 22%) and RBC:PLT (13 vs. 18%) at 4-hours had lower 28-day mortality rates; both P<0.05. Multivariate regression confirmed an associated reduction in mortality with achievement of 1:1 ratios of RBC:FFP (OR 0.42, 95% C.I. 0.25-0.68; P<0.001) and RBC:PLT (0.61, 95% C.I. 0.37-0.98; P=0.044). Additionally, WB was associated with an increased likelihood of achieving both RBC:FFP (OR 2.8, 95% C.I 2.14-3.62) and RBC:PLT (OR 3.4, 95% C.I. 2.55-4.62) of 1:1; both P<0.001.</p><p><strong>Conclusions: </strong>In this prospective multi-institutional study, <50% of patients were resuscitated in a balanced fashion. The use of WB was associated with increased likelihood of achieving balanced ratios. Unbalanced resuscitation was associated with decreased survival.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309446","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":"Age-specific Increase in vasopressin-induced Coronary Microvascular Contractile Response in Patients Undergoing Cardiac Surgery.","authors":"Debolina Banerjee, Sharif A Sabe, William G Cioffi, Thomas J Miner, Neel R Sodha, M Ruhul Abid, Jun Feng, Frank W Sellke","doi":"10.1097/SLA.0000000000006797","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006797","url":null,"abstract":"<p><strong>Objectives: </strong>To assess changes in coronary microvascular vasomotor and myogenic function in older patients (65+ years) undergoing cardioplegic arrest and cardiopulmonary bypass (CP/CPB) that may portend worse outcomes.</p><p><strong>Background: </strong>Elderly patients are being increasingly referred for cardiac operations requiring CP/CPB, but consistently have worse outcomes. Levels of circulating vasopressin and vasopressin receptor activity are enhanced with age. Effects of vasopressin on coronary microcirculation are controversial: animal studies showing increased microvascular vasoconstriction and decreased coronary blood flow, but vasopressin-deficiency leading to vasoplegic shock postoperatively has been widely reported. We investigated the effects of age and CP/CPB on coronary arteriolar vasomotor and myogenic reactivity.</p><p><strong>Methods: </strong>Viable coronary microvessels (<200m) were harvested from human atrial samples collected pre- and post-CP/CPB from a subset of 101 enrolled patients. Ex vivo microvascular myogenic tone and vasomotor responses to vasopressin, adenosine diphosphate, and sodium nitroprusside were assessed using video microscopy. RNA deep-sequencing and immunoblotting were used to quantify gene and protein expression, respectively.</p><p><strong>Results: </strong>Vasopressin-induced coronary microvascular response was increased in older patients (65+ years) at baseline. CP/CPB further enhanced contractile response to vasopressin in resistance arterioles while blunting nitric oxide-mediated vasodilatory responses. Gene and protein expression relevant to vasopressin signaling varied with age and following surgery. Age and vasopressin-induced contractile response predicted cardiac index.</p><p><strong>Conclusions: </strong>Older patients exhibited more pronounced coronary microvascular contractile response to vasopressin. CP/CPB was associated with further increased coronary microvascular contractile response accompanied by decreased vasodilatory capacity from baseline, potentially predisposing these patients to myocardial malperfusion and worse outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309445","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":"Global Variations in Patterns of Care for Retroperitoneal Sarcoma.","authors":"Hayden Snow,Marco Fiore,Jing Xie,Dirk Strauss,Dimitri Tzanis,Chandrajit P Raut,Piotr Rutkowski,Samuel Ford,Carol Swallow,Winan J van Houdt,Markus Albertsmeier,Ferdinando Cananzi,Jason Sicklick,Kenneth Cardona,Valerie Grignol,Carolyn Nessim,Eran Nizri,Marko Novak,Elisabetta Pennacchioli,Sergio Valeri,Dario Callegaro,Michelle Wilkinson,Sylvie Bonvalot,Mark Fairweather,Jacek Skoczylas,Fabio Tirotta,Joel Shapiro,Martin K Angele,Alessandro Gronchi,David E Gyorki,","doi":"10.1097/sla.0000000000006791","DOIUrl":"https://doi.org/10.1097/sla.0000000000006791","url":null,"abstract":"OBJECTIVETo examine variations in patterns of care for retroperitoneal sarcoma (RPS) among sarcoma centres globally, including diagnostic work-up, surgical strategies and (neo)adjuvant therapies.METHODSRetrospective analysis for primary RPS, from 19 RPS referral centres worldwide, prospectively collected within the RESAR repository (NCT03838718) between Feb 2017 - July 2022. Centres were categorised high volume (HVC) or low volume (LVC). Comprehensive resection (CR) was defined as en-bloc resection of ipsilateral kidney and colon.RESULTS1718 primary RPS were included. Preoperative biopsy was utilised frequently (median rate 98%) for solid (non-liposarcoma) RPS. In liposarcoma, the median rate of CR was 64%, with wide variation (IQR 37% [43%-80%], range 0-100%). There was greater variation in CR in liposarcoma in LVC (IQR 39.5% [40.5%-80%]) versus HVC (IQR 9.5% [58.3%-67.8%]). Perioperative chemotherapy was seldom used for liposarcoma (median 0%), with higher rates for leiomyosarcoma (median 10%) with high variation (IQR 26% [2%-28%]). Radiotherapy was used consistently infrequently in leiomyosarcoma (IQR 13% [0%-13%]. There was higher use of radiotherapy in HVC than LVC (median HVC 18.5% vs. LVC 5%). There was a significant decrease in radiotherapy use after the STRASS trial (pre 19% vs. post 14%, P=0.045).CONCLUSIONSLow variation was found in pre-operative biopsy of non-liposarcomas, use of chemotherapy in liposarcoma and radiotherapy in leiomyosarcoma, suggesting agreement between centres. There was high variation, suggesting equipoise, in the role of chemotherapy in leiomyosarcoma and the value of CR in liposarcoma. The STRASS study results seem to have been accepted, with a reduction in radiotherapy after its publication.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"25 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295818","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 Death of Laparoscopy - Volume 2: A Revised Prognosis. A retrospective study.","authors":"Tommaso Violante,Davide Ferrari,Marco Novelli,David W Larson","doi":"10.1097/sla.0000000000006792","DOIUrl":"https://doi.org/10.1097/sla.0000000000006792","url":null,"abstract":"OBJECTIVETo assess trends in surgical approaches (robotic, laparoscopic, and open) for various procedures, including prostatectomy, nephrectomy, cystectomy, colectomy, proctectomy, pancreatectomy, hepatectomy, and esophagectomy, and predict the future of these surgical approaches.SUMMARY BACKGROUND DATAThe rapid adoption of robotic surgery has raised critical questions about the future of traditional laparoscopic techniques. Understanding the trends and potential dominance of robotic surgery is essential for surgical training, healthcare infrastructure, and resource allocation.METHODSThis retrospective observational study utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2023. Vector Autoregressive modeling analyzed trends and predicted future patterns for robotic, laparoscopic, or open surgical approaches across the specified procedures. The study included all reported cases in the database where the surgical approach was specified.RESULTSThe analysis revealed a continued shift towards robotic surgery, particularly dominant in urologic procedures and rapidly adopted for complex operations like hepatectomy and esophagectomy. Laparoscopy's use is declining across most specialties, though it remains significant in colectomy. Open surgery persists at high rates, especially in pancreatic and rectal operations. Projections suggest robotic surgery will surpass laparoscopy in colectomy (44.5%) and proctectomy (38.3%) by 2026.CONCLUSIONSThe transition toward robotic surgery continues across specialties at varying rates. These findings have significant implications for surgical training, healthcare infrastructure, and resource allocation. The high rates of open surgery in certain procedures highlight opportunities for broader adoption of minimally invasive techniques.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"42 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295911","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":"Trajectories of Survivors and Non-Survivors Post-burn Injury.","authors":"Sarah Rehou,Carly Knuth,Mile Stanojcic,Marc G Jeschke","doi":"10.1097/sla.0000000000006787","DOIUrl":"https://doi.org/10.1097/sla.0000000000006787","url":null,"abstract":"OBJECTIVETo gain insights into the systemic response after burn injury, we aimed to characterize the phases of inflammatory and metabolic trajectories in survivors and non-survivors.BACKGROUNDSurvival after burn injuries has improved over the past few decades. However, a large proportion of the patients do not survive.METHODSThis was a single-center cohort study. We included patients (aged ≥ 18 years) with burn injuries (≥ 10% total body surface area; TBSA) admitted to our provincial burn center. Clinical outcomes, laboratory measures, and inflammatory biomarkers were compared among survivors, early non-survivors (died ≤4 days post-injury), and late non-survivors (died ≥5 days post-injury).RESULTSWe studied 872 patients with a median age of 49 (Interquartile Range, IQR: 35-63) years and a median percent TBSA burn of 19% (IQR: 13-34) TBSA burn for survivors (n=705; 81%), early non-survivors (n=99; 11%), and late non-survivors (n=68; 8%). The median ages were 46 (IQR: 33-59) years for survivors, 62 (IQR: 46-73) years for early non-survivors, and 67 (IQR: 54-76) years for late non-survivors (P<0.0001). The median % TBSA burn was 17 (IQR: 13-26) for survivors, 67 (IQR: 43-88) for early non-survivors, and 27 (IQR: 18-44) for late non-survivors (P<0.0001). Non-survivors exhibited significantly elevated biomarkers compared to survivors, with distinct metabolic and inflammatory profiles, including increased IL-1β, IL-8, TNF-α, and IL-10. Late non-survivors experienced higher complication rates (P<0.01), with significant differences in inflammatory and metabolic responses over time.CONCLUSIONSSurvivors and non-survivors showed distinct post-injury inflammatory and metabolic responses. Identifying the relationship between concomitant immune activation and suppression among survivors and non-survivors may improve patient outcomes by defining and altering inflammatory trajectories. Elucidating the differences in trajectories between early and late non-survivors could allow for the prediction and identification of patients at risk of mortality.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"12 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295909","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 Open-Architecture AI Model for CPT Coding in Breast Surgery: Development, Validation, and Prospective Testing.","authors":"Mohamad El Moheb,Kristin Putman,Olivia Sears,Melina R Kibbe,K Craig Kent,David R Brenin,Allan Tsung","doi":"10.1097/sla.0000000000006793","DOIUrl":"https://doi.org/10.1097/sla.0000000000006793","url":null,"abstract":"OBJECTIVETo develop, validate, and prospectively test an open-architecture, transformer-based Artificial Intelligence (AI) model to extract procedure codes from free-text breast surgery operative notes.SUMMARY OF BACKGROUND DATAOperative note coding is time-intensive and error-prone, leading to lost revenue and compliance risks. While AI offers potential solutions, adoption has been limited due to proprietary, closed-source systems lacking transparency and standardized validation.METHODSWe included all institutional breast surgery operative notes from July 2017 to December 2023. Expert medical coders manually reviewed and validated surgeon-assigned Current Procedural Terminology (CPT) codes, establishing a reference standard. We developed and validated an AI model to predict CPT codes from operative notes using two versions of the pre-trained GatorTron clinical language model: a compact 345 million-parameter model and a larger 3.9 billion-parameter model, each fine-tuned on our labeled dataset. Performance was evaluated using the area under the precision-recall curve (AUPRC). Prospective testing was conducted on operative notes from May to October 2024.RESULTSOur dataset included 3,259 operative notes with 8,036 CPT codes. Surgeon coding discrepancies were present in 12% of cases (overcoding: 8%, undercoding: 10%). The AI model showed strong alignment with the reference standard (compact version AUPRC: 0.976 [0.970, 0.983], large version AUPRC: 0.981 [0.977, 0.986]) on cross-validation, outperforming surgeons (AUPRC: 0.937). Prospective testing on 268 notes confirmed strong real-world performance.CONCLUSIONSOur open-architecture AI model demonstrated high performance in automating CPT code extraction, offering a scalable and transparent solution to improve surgical coding efficiency. Future work will assess whether AI can surpass human coders in accuracy and reliability.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"33 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295910","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}