Annals of surgery最新文献

{"title":"Swine Leukocyte Antigen DR Deletion is a Viable Option for Donor Pigs Used in Renal Xenotransplantation.","authors":"Andrew B Adams, Matt Tector, Christopher Burlak, Jose Estrada, Luz Reyes, Sabrina Copsel, Claudia Muniz, Victor Novara Gennuso, Melanie Martucci, Neal Iwakoshi, Michael Dryden, David Faber, Bryan Ray, Holly Haver, Jayasree Hariharan, Rodrigo Vianna, Alfred J Tector","doi":"10.1097/SLA.0000000000007095","DOIUrl":"10.1097/SLA.0000000000007095","url":null,"abstract":"<p><strong>Objective: </strong>Swine Leukocyte Antigen-DR knockout (SLA-DR KO) pigs were created and evaluated for safety/infectious profile and the ability to function in a preclinical model of xenotransplantation.</p><p><strong>Background: </strong>SLA-DR is the dominant class II MHC antigen in pigs. It is unclear whether it is feasible/safe to delete SLA-DR in donor pigs to be used in kidney xenotransplantation.</p><p><strong>Methods: </strong>SLA DR KO pigs were created on the α-gal Sd a (GGTA1/B4GALNT2) deficient genetic background using CRISPR/Cas and somatic cell nuclear transfer. Pigs were evaluated for 55 potential zoonotic pathogens using digital droplet PCR assays. Four GGTA1/B4GALNT2/SLA-DR KO pig kidneys were transplanted into immunosuppressed rhesus monkeys. Renal function was monitored to evaluate whether these prototype kidneys could provide life-supporting renal function in a preclinical model.</p><p><strong>Results: </strong>SLA-DR KO pigs were produced and are healthy more than 16 months later, devoid of 55 pathogens with zoonotic infectious potential. Recipients survived 7, 126, >365, and >365 days. Serum creatinine was maintained in long-term survivors (Cr 0.8 mg/dL in both). Early graft losses (7 and 126 d) occurred because of donor-specific pretransplant SLA antibodies detected using a SLA bead crossmatch assay.</p><p><strong>Conclusions: </strong>SLA-DR KO pigs are viable and safe to consider as potential donors in clinical trials. The SLA DR KO pig kidneys provided good long-term graft function in a preclinical model if the donor was not sensitized to other SLA antigens present in the donor pig. The SLA-DR KO prototype is promising for evaluation in pig-to-human clinical xenograft trials.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"596-606"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161549","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 Use of Prophylactic Insulin in Surgical Patients Without Diabetes: A Pilot Randomized, Controlled Trial.","authors":"Jamie Schnuck, Ian A Jones, Robert H Schmicker, Bryan A Comstock, Armando E Rodriguez Martinez, Sara DePaoli, Erin E Fannon, Isaac A Knouff, Irl B Hirsch, E Patchen Dellinger, David R Flum","doi":"10.1097/SLA.0000000000007119","DOIUrl":"10.1097/SLA.0000000000007119","url":null,"abstract":"<p><strong>Objective: </strong>Determine the feasibility and proof-of-concept of using prophylactic insulin [glucose-insulin-potassium (GIK)] to improve outcomes in nondiabetic (NoDM) surgical patients.</p><p><strong>Summary background data: </strong>Perioperative hyperglycemia increases the risk of morbidity/mortality, and insulin is used to treat it. Prevention of hyperglycemia with prophylactic insulin may be better than using treatment insulin alone, but feasibility issues need to be addressed before developing a full-scale randomized controlled trial (RCT).</p><p><strong>Methods: </strong>A pilot RCT of GIK versus placebo among nondiabetic undergoing major abdominopelvic surgery. Feasibility (willingness to randomize, treatment completion) and clinical outcomes (glycemic control, neutrophil:lymphocyte ratio, and morbidity/mortality) were measured through 30 days.</p><p><strong>Results: </strong>Of 248 eligible patients, 103 were randomized (mean age 56, 54% female) to GIK (n=50) or placebo (n=53). Treatment was completed in 97% without episodes of severe hypoglycemia. Perioperative euglycemia (<125 mg/dL) was more common in the GIK arm (42%) versus the control (27%) ( P <0.01). Hyperglycemia (BG >140 mg/dL) was less common in the GIK arm (37% vs. 48%, P <0.05), as was the use of treatment insulin (26% vs. 45%, Absolute Risk Reduction (aRR) 0.6 [95% CI: 0.4, 0.9]). The rise in neutrophil:lymphocyte ratio from preoperative to postoperative day 1 was lower in the GIK group versus placebo (Delta 0.5, 95% CI: -6.23 to 3.32). Fewer complications were noted in the GIK arm (12%) versus control (21%) (aRR 0.5 [95% CI: 0.2, 1.5]), albeit with wide CIs.</p><p><strong>Conclusions: </strong>Prophylactic insulin improves glycemic outcomes and may improve clinical outcomes, possibly in part through anti-inflammatory mechanisms. A full-scale RCT focused on morbidity/mortality endpoints is feasible and would address an important evidence gap.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"527-533"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262632","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 Path to Independence: Progression in Entrustment Reflected in Entrustable Professional Activity Ratings.","authors":"Andrada Diaconescu, Julia Kasmirski, Erin White, James R Korndorffer, M Chandler McLeod, George Sarosi, Carol Barry, Andrew Jones, Rebecca M Minter, Karen J Brasel, Brenessa Lindeman","doi":"10.1097/SLA.0000000000007114","DOIUrl":"10.1097/SLA.0000000000007114","url":null,"abstract":"<p><strong>Background: </strong>In 2016 the American Board of Surgery introduced Entrustable Professional Activities (EPAs) as an assessment framework to support competency-based education within general surgery. EPAs operationalize milestones and competencies into a practical assessment framework, enabling timely, targeted feedback and progressive entrustment.</p><p><strong>Objective: </strong>We hypothesize that variability in trainee entrustment may identify specific EPAs that function as performance targets, allowing earlier identification of trainees who may need additional support.</p><p><strong>Methods: </strong>National ABS EPA data for PGY-1 through PGY-5 residents from July 2023 to July 2025 were reviewed. Microassessments (MAs) using the ABS entrustment scale (1=Limited Participation; 4=Practice Ready) were compared by EPA, phase, and postgraduate year. Descriptive statistics summarized formative entrustment ratings and progression within postgraduate year.</p><p><strong>Results: </strong>Subjects included 9,932 residents from 345 programs, with 185,901 EPA MAs. For several intraoperative EPAs, over half of trainees achieved a median formative assessment of Indirect Supervision/Practice Ready at the PGY-3 level, including appendicitis (58.2%, n=819), abdominal wall hernia (50.4%, n=618), breast disease (52.7%, n=309), and cutaneous/subcutaneous neoplasm (66%, n=325). Colon disease (73.4%, n=756), gallbladder disease (86.6%, n=1410), inguinal hernia (76.5%, n=734), and thyroid/parathyroid disease (61.3%, n=184) showed a slower progression, not achieving 50% of residents until the PGY-4 level. Earlier progression was noted for soft tissue infection with 54.8% (n=355) attaining indirect supervision or higher at the PGY-2 level.</p><p><strong>Conclusions: </strong>The introduction of EPAs and shift towards competency-based assessment enables the identification of periods of rapid entrustment progression and supports the identification of targets that may facilitate the development of a competency-based training framework.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"573-581"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222690","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":"Expression of the High-affinity Neurotensin Receptor Defines an Immune‑cold, Poor‑prognosis Colorectal Cancer Subtype.","authors":"Haoming Wu, Yang Wang, Jun Song, Baoxiang Yan, Chi Wang, Jinpeng Liu, Daheng He, Heidi L Weiss, Piotr Rychahou, Moumita Banerjee, Jing Li, B Mark Evers","doi":"10.1097/SLA.0000000000007131","DOIUrl":"10.1097/SLA.0000000000007131","url":null,"abstract":"<p><strong>Objective: </strong>We investigated neurotensin receptor 1 (NTSR1) as a potential mediator of the mechanical immune barrier that contributes to T-cell exclusion.</p><p><strong>Summary background data: </strong>The efficacy of immunotherapy in advanced colorectal cancer (CRC) is limited by primary resistance, frequently characterized by an \"immune-excluded\" phenotype where physical and biological barriers prevent effector T-cell infiltration. Through its high-affinity receptor, NTSR1, neurotensin signaling has been implicated in tumor progression, yet its role in shaping the immune landscape of CRC remains unclear.</p><p><strong>Methods: </strong>We integrated transcriptomic and clinical data from The Cancer Genome Atlas discovery cohort with an independent surgical validation cohort from the University of Kentucky. Random Forest machine learning identified molecular features associated with NTS/NTSR1 signaling, and a 3D tumor spheroid co-culture model was used to evaluate the impact of NTS/NTSR1 signaling on spatial T-cell distribution in vitro .</p><p><strong>Results: </strong>Dual-cohort analyses revealed high NTSR1 expression as an independent risk factor for progression-free interval in the discovery cohort and overall survival in the validation cohort. Mechanistically, the NTS/NTSR1 axis upregulates a mechano-structural network centered on PLXNB3, FLNC, and AHNAK2, while simultaneously driving epithelial dedifferentiation through downregulation of core transcription factors (CDX2, SATB2). Together, these transcriptional programs are associated with the remodeling of the tumor microenvironment into an immune-cold, suppressive state. Moreover, 3D modeling indicated that ligand-activated NTS/NTSR1 signaling restricts T-cell infiltration, which was significantly reversed by the NTSR1 antagonist SR48692, providing functional support for a mechanical immune barrier proposed based on transcriptomic remodeling.</p><p><strong>Conclusions: </strong>Targeting the NTS/NTSR1 axis may attenuate biological and physical barriers underlying immune exclusion, providing a preclinical rationale for converting immune-excluded CRCs into immune-responsive tumors.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"458-471"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283000","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":"Transanastomotic Tube Use and Anastomotic Stricture: A Multicenter Prospective Randomized Trial in Neonates Undergoing Repair of Type C Esophageal Atresia With Distal Tracheoesophageal Fistula.","authors":"Justin Lee, Katie W Russell, Caitlin Smith, Claudia Mueller, Zachary Kastenberg, Anastasia Kahan, David Rothstein, Stephanie Chao, Shannon Acker, Jose Diaz-Miron, Aimee Kim, Lorraine Kelley-Quon, Benjamin Keller, David Lazar, Sarah Cairo, Natasha Corbitt, Benjamin Carr, Elizabeth Fialkowski, Paul Kang, Jason Fraser, Eric Scaife, Aaron Jensen, Steven Lee, Samir Pandya, Romeo Ignacio, Thomas Inge, Kenneth Azarow, Kasper Wang, Ben Padilla, Daniel Ostlie","doi":"10.1097/SLA.0000000000007132","DOIUrl":"10.1097/SLA.0000000000007132","url":null,"abstract":"<p><strong>Objective: </strong>Anastomotic stricture (AS) is the most common complication following repair of type C esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Retrospective studies suggest transanastomotic tube (TT) use may increase AS risk, but are limited by design. We conducted a multicenter randomized trial to evaluate the impact of TT placement on AS.</p><p><strong>Methods: </strong>Infants undergoing type C EA/TEF repair at 10 children's hospitals were randomized to TT placement or no TT. A total of 142 patients (74 no TT, 68 TT) were enrolled. The primary outcome was AS requiring dilation within 12 months. Secondary outcomes included anastomotic leak, feeding outcomes, and postoperative morbidity. Multivariable analysis adjusted for clinically relevant covariates.</p><p><strong>Results: </strong>Baseline characteristics were similar between groups. No statistically significant difference in stricture rates was observed (47.3% no TT vs. 53.7% TT; P =0.45). Rates of leak, infection, reoperation, and readmission were similar. On multivariable analysis adjusting for weight, thoracoscopic approach, anastomotic tension, leak, and acid suppression, TT use was not independently associated with stricture ( OR =1.18, 95% CI, 0.58-2.45; P =0.64). Moderate-to-severe surgeon-assessed anastomotic tension was the only independent predictor of stricture ( OR =2.45, 95% CI, 1.11-5.40; P =0.026).</p><p><strong>Conclusion: </strong>In this multicenter randomized trial, TT use was not associated with a statistically significant difference in AS risk. Anastomotic tension, as assessed intraoperatively by the surgeon, was the strongest predictor of stricture, underscoring the central role of surgical assessment in outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"658-664"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262676","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":"Ciprofloxacin Exposure Promotes Aortic Dissection and Arterial Rupture in a Mouse Model of Vascular Ehlers-Danlos Syndrome.","authors":"Scott A LeMaire, Lin Zhang, Chen Zhang, Deborah Vela, Joseph S Coselli, Ying Shen","doi":"10.1097/SLA.0000000000007133","DOIUrl":"10.1097/SLA.0000000000007133","url":null,"abstract":"<p><strong>Objective: </strong>We tested the hypothesis that ciprofloxacin exposure increases the incidence of aortic dissection and arterial rupture in vascular Ehlers-Danlos (vEDS) mice.</p><p><strong>Background: </strong>While data support that fluoroquinolones exacerbate lethal sequela in some types of aortic pathology, the potential danger of these drugs has not been studied in the context of vEDS.</p><p><strong>Methods: </strong>Eight-week-old male and female vEDS mice ( Col3a1[G209S/WT] ) and wild-type littermates ( Col3a1[WT/WT] ) were randomly assigned to receive either ciprofloxacin (n=25) or vehicle control (n=24) through daily gavage for 2 weeks and were monitored for 4 weeks. We compared groups based on survival, aortic dissection and rupture incidence, and aortic tissue levels of collagen, lysyl oxidase (LOX), matrix metalloproteinases (MMP), macrophages, and apoptosis.</p><p><strong>Results: </strong>All vEDS mice that received vehicle and all littermate controls survived the 4-week study period. In contrast, 44% of vEDS mice that received ciprofloxacin died ( P <0.001) due to aortic or arterial rupture manifesting as hemopericardium or hemothorax, most within 7 days of exposure. Findings were similar in male and female vEDS mice. Compared with aortic tissue from vehicle-treated vEDS mice, tissue from ciprofloxacin-treated vEDS mice exhibited decreased collagen content, decreased LOX, increased MMP2 and 9 levels, increased macrophage infiltration, and increased apoptosis (all P <0.001).</p><p><strong>Conclusions: </strong>In a mouse model of vEDS, ciprofloxacin exposure resulted in aortic inflammation, collagen disruption, cell death, reduced LOX, and increased risk of fatal dissection and rupture of the aorta and branch arteries. These novel translational findings strongly support recommendations to avoid fluoroquinolones in patients with vEDS.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"516-526"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262951","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":"Integrating Artificial Intelligence Into Medical Illustration: A Balance of Promise and Precaution.","authors":"Stephanie M Cohen, Maria Baimas-George, Brian Dunham, Francois I Luks","doi":"10.1097/SLA.0000000000007208","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007208","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863019","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":"GLP-1 Demand Shock: Work Reallocation, Productivity Decline, and Training Implications Across General and Bariatric Surgery.","authors":"Ramsey Michael Dallal, Aditya Das, Edmund A Pribitkin, Alec C Beekley, Talar Tatarian, Davinder K Malhotra, T Dan Harrison, Charles J Yeo","doi":"10.1097/SLA.0000000000007039","DOIUrl":"10.1097/SLA.0000000000007039","url":null,"abstract":"<p><strong>Background: </strong>In the glucagon-like peptide-1 receptor agonists (GLP-1RAs) era, demand for bariatric surgery has decreased. How surgical systems absorb such demand shocks, through reassignment of operative work and effects on productivity, remains poorly characterized.</p><p><strong>Objective: </strong>To quantify changes in bariatric surgery volume, redistribution of operative work, and bariatric surgeon productivity during rapid diffusion of GLP-1RAs within a large integrated health system.</p><p><strong>Methods: </strong>We analyzed enterprise operative records from 31 hospitals (2021 Q3-2025 Q4) for changes in volume and productivity between bariatric and non-bariatric surgeons using difference-in-differences mixed-effects count models to estimate differential changes in procedure volumes for bariatric versus non-bariatric surgeons (DID-IRR).</p><p><strong>Results: </strong>Among 209,169 operative encounters, 9,849 were bariatric procedures. Quarterly bariatric volume declined from 693 cases in 2021 Q3 to 354 in 2025 Q4 (-48.9%), and the bariatric share of total volume fell from 6.29% to 2.99%, despite stable overall system operative volume and surgeon staffing. Despite this contraction, bariatric surgeons maintained their overall operative activity by increasing volume in a composite of competitive procedures relative to non-bariatric surgeons (DID-IRR 1.31; 95% CI 1.12-1.53), and particularly for increased hernia operations (DID-IRR 1.41; 95% CI 1.14-1.74). Quarterly mean wRVU units per bariatric surgeon declined 27% from peak to trough. Conclusions: Bariatric surgery volume contracted sharply within a stable workforce, yet bariatric surgeons remained clinically active through measurable redistribution into other general surgery without incremental growth. This substitution preserved operative participation while compressing productivity, highlighting operational, financial, and training implications in the GLP-1RA era.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"556-565"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324144","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":"5x-Multiplier Versus 3-Tier Model: A Pragmatic Randomized Clinical Trial for Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery.","authors":"Brittany C Fields, Timothy E Newhook, Heather A Lillemoe, Anneliese N Hierl, Innocent Rukundo, Jose A Karam, Surena F Matin, Larissa A Meyer, Zhouxuan Li, Wei Qiao, Jean-Nicolas Vauthey, Matthew H G Katz, Ching-Wei D Tzeng","doi":"10.1097/SLA.0000000000007115","DOIUrl":"10.1097/SLA.0000000000007115","url":null,"abstract":"<p><strong>Background: </strong>Standardized prescribing models can reduce discharge opioid prescriptions and excess pill volumes, mitigating potential opioid dependence and diversion after abdominal operations. This study's objective was to determine which of 2 validated discharge prescribing models resulted in fewer opioids prescribed and consumed after major abdominal surgery.</p><p><strong>Methods: </strong>This was a pragmatic single-center, phase II randomized clinical trial comparing 2 discharge opioid prescribing models: linear 5x-multiplier algorithm [last 24 h oral morphine equivalents (OME) times 5] versus capped 3-tier model (5/15/30 pills depending on 0/1-29/≥30 mg OME in last 24 h). Adults undergoing open abdominal cancer resections by 25 surgeons (5 specialties) were included. A nonopioid analgesic bundle was used perioperatively and at discharge. Coprimary endpoints were discharge opioid volume and 14-day post-discharge consumption. Secondary endpoints included patient satisfaction and symptom inventory. The power (80%) calculation was performed using the 2-sample t -test to detect a mean difference in OME with 0.05 significance (0.025 per co-primary outcomes).</p><p><strong>Results: </strong>From April to December 2024, 150 patients (52% female; median age 63) were randomized: 73 to 5x-multiplier; 77 to 3-tier model. Operations included hepatectomy (32%), pancreatectomy (29%), nephrectomy (13%), thoracoabdominal sarcoma resection (15%), and ovarian cytoreduction (11%). Median discharge OME was 25 mg (5x-multiplier) versus 75 mg (3-tier, P <0.001), with 44% of 5x-multiplier patients discharged opioid-free (1% in 3-tier). Median post-discharge 14-day opioid consumption was 0 mg (5x-multiplier) versus 10 mg (3-tier, P =0.496). Refill rates were 24% (5x-multiplier) versus 18% (3-tier, P =0.426), consistent with historical rates, with no differences in satisfaction or symptom inventory scores.</p><p><strong>Conclusion: </strong>The 5x-multiplier algorithm resulted in fewer prescribed discharge opioids with similar 14-day consumption, refill rates, and satisfaction, compared with a 3-tier model after intra-abdominal cancer surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"647-657"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283025","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":"A New Definition of Major Trauma: Overcoming the Limitations of Anatomic Injury Scoring by Incorporating Trauma-team Actions.","authors":"Samir M Fakhry, Timothy Scott, Yan Shen, Harun Mazumder, Alessandro Orlando","doi":"10.1097/SLA.0000000000007117","DOIUrl":"10.1097/SLA.0000000000007117","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the performance of injury severity score (ISS)>15, high-intensity time-sensitive (HITS) interventions (a surrogate for trauma team actions), or the combination to identify major trauma (MT).</p><p><strong>Summary background data: </strong>MT is currently defined as ISS >15 although significant numbers of high-risk patients do not meet this definition.</p><p><strong>Methods: </strong>Patients (18-89 y) from 2021-23 NTDB files were analyzed. Three MT definitions were evaluated: (1) ISS >15, (2) receiving a HITS intervention (HITS+), and (3) ISS >15 or HITS+, termed new Major Trauma (nMT+). The ability of each to identify deaths was evaluated using likelihood ratios and area under the receiver operating curves (AUROCs).</p><p><strong>Results: </strong>Among 2,676,710 patients, 17.8% had ISS>15, 11.4% were HITS+, and 22.4% were nMT+: median age 58, 60% male, median ISS=9. Twenty-four-hour mortality was 7.6% for ISS>15, 11.5% for HITS+, and 7.4% for nMT+ ( P <0.001). HITS had the highest positive likelihood ratio (6.70) for 24-hour mortality compared with ISS and nMT (4.29 and 4.12). nMT had the lowest negative likelihood ratio for 24-hour mortality (0.16), compared with ISS and HITS (0.34 and 0.34). Compared with ISS>15 and HITS+, nMT+ exhibited significantly higher discriminatory power for predicting 24-hour mortality (AUROC: 0.83, 0.78, 0.79, P <0.001). In this cohort, nMT+ identified 19,851 (29%) more in-hospital deaths and 9138 (26%) more 24-hour deaths than either ISS>15 or HITS+ alone.</p><p><strong>Conclusions: </strong>The novel concept of nMT is a more comprehensive definition of major trauma than the existing ISS-based standard, providing the highest overall ability to discriminate survivors from nonsurvivors.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"629-637"},"PeriodicalIF":7.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216057","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}