Annals of surgery最新文献

{"title":"Anatomic Location Predicts Response Rates: Real World Outcomes with Over 1,100 Cycles of Talimogene Laherparepvec (TVEC) Description: A Retrospective Review of a Prospectively Maintained Database.","authors":"Kristen E Dougherty,Gray B Peery,Chris B Agala,Veronica P Pham,Morgan E Gwynn,Michael O Meyers,Karyn B Stitzenberg,Jonathan D Sorah,Patricia K Long,C Paige Jones,Frances A Collichio,David W Ollila","doi":"10.1097/sla.0000000000006931","DOIUrl":"https://doi.org/10.1097/sla.0000000000006931","url":null,"abstract":"OBJECTIVEWe hypothesized that anatomic location of metastatic melanoma is associated with the degree of therapeutic response to TVEC.SUMMARYTVEC is the first FDA-approved injectable oncolytic virus to treat unresectable stage IIIB-IV metastatic melanoma patients. Previously published real-world outcomes demonstrated a 39% complete response (CR) rate to TVEC.METHODSA prospective single-center melanoma database of patients treated with TVEC from December 2015-December 2023 was analyzed. Patients were categorized into groups based on treated anatomic sites. Patient characteristics were summarized using frequencies, means, medians, comparisons, and tests of proportions using chi-square, Fisher's exact, and Wilcoxon rank sum tests. We used unadjusted generalized estimating equation models with repeated measures to estimate relative risk ratios for local treatment response and anatomic sites.RESULTS173 patients were included: median age 75 years; majority male (n=112, 64.7%) and white (n=170, 98.3%). We analyzed 190 therapeutic plans of TVEC with a total of 1,133 cycles, median 6 cycles/patient (1-18). Median follow-up was 41 months (11-107). Of the anatomic sites treated, 73 were head/neck (38.4%), 73 lower extremity (38.4%), 25 torso (13.2%), and 19 upper extremity (10%). CR was seen in 79 (41.6%), partial response (PR) in 41 (21.6%), mixed response/stable disease in 37 (19.5%), and disease progression in 33 (17.4%). In the CR group, 40 (50.6%) responses were head/neck, 24 (30.4%) lower extremity, 11 (13.9%) torso, and 4 (5.1%) upper extremity.CONCLUSIONSThis is the largest prospective cohort evaluating real-world outcomes of metastatic melanoma patients treated with TVEC based on anatomic location. TVEC is a well-tolerated, durable treatment for advanced staged melanoma. Our findings demonstrate head/neck metastases have the greatest CR rate and should be considered as a possible first-line therapy in select patients.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"49 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025553","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":"Clinical Momentum: An Observational Study Identifying Latent Forces Driving Surgical Interventions for Older Adults Near the End of Life.","authors":"Melanie L Fritz,Michael A Jaeb,Sarah I Zaza,Alex Dudek,Kristine L Kwekkeboom,Anne Buffington,Leah M Gober,Margaret L Schwarze","doi":"10.1097/sla.0000000000006934","DOIUrl":"https://doi.org/10.1097/sla.0000000000006934","url":null,"abstract":"OBJECTIVEWe evaluated the empirical fit of our model of clinical momentum for older adults with life-limiting illness undergoing unplanned surgery.BACKGROUNDOlder adults often undergo surgery near the end of life, in contrast to generally stated preferences. Systems forces promoting intervention may produce nonbeneficial treatment despite advances in communication. We conducted an observational study to understand how a conceptual model of clinical momentum might apply to patients with life-limiting illnesses having surgery.METHODSWe interviewed 29 interdisciplinary clinicians caring for 8 patients age 65+ with life-limiting illness who underwent unplanned surgical intervention. We evaluated physical, cognitive, and social behavioral processes related to the course of care. We used content analysis to code interview transcripts and higher-level analysis to understand the empirical fit of the conceptual model.RESULTSWe found evidence of model components, including \"fix it\" and \"recognition-primed decision-making\" that related to actual clinical events and processes that occurred for patients, promoting a default of surgical intervention followed by an accumulating \"cascade\" of interventions that generated a perception of \"sunk costs.\" We identified novel momentum accelerators including binary options and care fragmentation. Clinicians expressed concerns that surgery was nonbeneficial but were unable to disrupt this momentum in the moment of decision-making around surgery. We identified momentum disruption when the patient's abnormality could not be fixed and additional surgery was not considered or offered.CONCLUSIONSClinical momentum characterizes systems forces leading to acute surgical intervention for patients with life-limiting illnesses despite surgeon concerns that the treatment does more harm than good. These forces are difficult to disrupt and may require interventions beyond improved communication to reduce nonbeneficial therapy.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"54 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026026","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":"Perioperative Collagen IV-Targeted Ac2-26 Nanoparticles Enhance Anastomotic Healing in Acute Crohn's Disease-Like Colitis: A Preclinical Study on Systemic, Oral, and Rectal Delivery Routes.","authors":"Kamacay Cira,Vincent Vieregge,Sebastian Pollak,Jong Hyun Lee,Stefan Reischl,Robert Leon Walter,Zoe Clees,Atsuko Kasajima,Thomas Metzler,Helmut Friess,Nazila Kamaly,Philipp-Alexander Neumann","doi":"10.1097/sla.0000000000006929","DOIUrl":"https://doi.org/10.1097/sla.0000000000006929","url":null,"abstract":"OBJECTIVEThis preclinical study investigates a novel targeted collagen type IV nanoparticle formulation, Ac2-26 coated with chitosan and pectin ((pc)-Col-IV-Ac2-26-NPs), to promote anastomotic healing in a model of acute Crohn's disease (CD) with distal colo-colonic anastomosis, using intraperitoneal, oral and rectal delivery to optimize therapeutic effects while minimizing systemic immunosuppression.SUMMARY BACKGROUND DATASurgery remains critical for CD-patients due to irreversible tissue damage, with anti-inflammatory therapies increasing the risk of postoperative complications like anastomotic leaks.METHODFemale BALB/c mice (n=152) with CD-like colitis (2,4,6-Trinitrobenzenesulfonic acid) were randomized to receive (pc)-Col-IV-Ac2-26-NPs or scrambled NPs intraperitoneally, orally, or rectally every 3.5 days pre- and postoperatively, followed by distal end-to-end colo-colonic anastomosis. Perioperative outcomes (weight loss, disease activity index (DAI)), anastomotic healing scores (endoscopic, histologic), and immunohistochemical (IHC) markers were assessed on postoperative days (POD) 3 and 7.RESULTSNPs accumulated selectively at the anastomosis in a route-dependent manner and associated with higher collagen expression (P<0.0001), reduced pro-inflammatory (nuclear RelA; iNOS+-M1 macrophages, all P<0.0001) and increased pro-resolving markers (ANXA1; Arg-1+-M2 Macrophages, all P<0.0001) at the anastomotic site. These effects were most pronounced with rectal delivery, corresponding with improved preoperative DAI (P=0.03) and both endoscopic (POD3:P<0.0103; POD7:P<0.0077) and histologic (POD3:P<0.0112; POD7:P<0.0170) healing scores. While intraperitoneal delivery produced similar outcomes, oral delivery showed the weakest effect.CONCLUSION(pc)-Col-IV-Ac2-26-NPs promote anastomotic healing during CD-colitis through targeted, route-dependent immunomodulation and tissue repair, with rectal delivery showing the highest local efficacy. These findings support their potential as locally acting, non-immunosuppressive therapy for high-risk CD-patients undergoing intestinal surgery.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"64 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995882","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":"In vivo Hypothermic Perfusion Intestinal Auto-transplantation for Patients With Tumors Invading the Mesenteric Root Vascular System: An Unusual Consecutive 19-case Series (with video).","authors":"Peng Li, Chong Yang, Xinyu You, Jipeng Jiang, Donghui Cheng, Bangyou Zuo, Yu Zhang","doi":"10.1097/SLA.0000000000006924","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006924","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the safety and outcomes of radical resection combined with in vivo hypothermic perfusion and intestinal auto-transplantation (IATx) for tumors invading the mesenteric root vascular system.</p><p><strong>Background: </strong>Radical resection combined with IATx is safe and effective for mesenteric root tumors invading the vascular system. However, classic IATx procedures require removing the mesenteric root tumor as well as the small intestine and ascending colon for ex vivo hypothermic perfusion. These conditions result in more gastrointestinal anastomoses and resection of the ileocolonic junction, thereby extending the operation time and increasing the risk of severe complications postoperatively. In this study, the safety, feasibility, efficacy, and outcomes of alternative in vivo hypothermic perfusion and IATx were explored.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 19 patients who underwent in vivo hypothermic perfusion and IATx for mesenteric root tumors invading the vascular system, especially the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), between June 2022 and January 2024. The operative parameters, pathological findings, and surgical outcomes were systematically analyzed.</p><p><strong>Results: </strong>All patients successfully underwent in vivo hypothermic perfusion combined with IATx. The average operation time was 10.5 hours, with all patients achieving negative surgical margins. Indocyanine green fluorescence imaging revealed a stable blood supply to the intestines from the SMA. None of the patients experienced postoperative gastrointestinal bleeding or anastomotic leakage. Additionally, no patient died perioperatively or needed intravenous fluid infusion after discharge. Among the 19 patients included in this study, 3 had locally recurrent tumors resulting in 1 death; 3 had liver metastasis, while 13 exhibited no signs of recurrence or metastasis.</p><p><strong>Conclusion: </strong>In vivo hypothermic perfusion combined with IATx represents a safe and feasible option for treating mesenteric root tumors invading the vascular system, representing a curative approach in a selected patient group. However, further investigations of long-term oncological outcomes and multidisciplinary studies are needed to validate these findings.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939853","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":"Transitional Subtype of Circulating Tumor Cells in Early Post-Operative Period of 5-Year Survivors Following Resection of Pancreatic Ductal Adenocarcinoma.","authors":"Ammar A Javed, Ingmar F Rompen, Joseph R Habib, Jin He, Christopher L Wolfgang","doi":"10.1097/SLA.0000000000006925","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006925","url":null,"abstract":"<p><strong>Objectives: </strong>The objective was to assess the ability of circulating tumor cells (CTCs) to predict long-term survival (LTS, >5 y after resection) in pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Summary of background data: </strong>Predictors of LTS remain poorly understood in PDAC.</p><p><strong>Methods: </strong>Patients enrolled in the prospective CLUSTER Trial for serial assessment of CTCs, undergoing PDAC resection were included (2016-2018). Number of epithelial (eCTCs) and transitional (trCTCs) CTCs were serially assessed. Clinicopathological factors and CTC characteristics associated with LTS were identified and their ability to predict LTS was assessed.</p><p><strong>Results: </strong>In 133 patients, 41% and 82% received neoadjuvant and/or adjuvant therapy, respectively. LTS was achieved by 17% patients. Nodal disease and perineural invasion (PNI) were present in 62%, and 80% of patients, respectively. Preoperatively eCTCs and trCTCs were observed in 97% and 68% of patients as compared to 77% and 27% postoperatively. PNI (OR:0.19,95%CI:0.06-0.60), nodal disease (OR:0.28,95%CI:0.09-0.82), and postoperative trCTCs (OR:0.04,95%CI:0.01-0.38) were independently associated with LTS. A clinical score based on PNI and nodal disease demonstrated an AUC of 0.79 (95%CI:0.69-0.89) in predicting LTS. Addition of postoperative trCTC into a translational score demonstrated an AUC of 0.84 (95%CI:0.75-0.92). Upon internal validation the clinical and translational scores had AUCs of 0.78 (95%CI:0.67-0.89) and 0.84 (95%CI:0.73-0.92), respectively (P<0.001).</p><p><strong>Conclusions: </strong>Patients with residual postoperative trCTCs are unlikely to achieve LTS and trCTCs emerge as one of the strongest predictors of LTS in resected PDAC. Inclusion of postoperative trCTC status to clinicopathological factors improves our ability to predict LTS.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939881","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":"Moving the Needle on Health System Care Delivery: From Observation to Intervention.","authors":"Calista Harbaugh, Kristy Broman","doi":"10.1097/SLA.0000000000006927","DOIUrl":"10.1097/SLA.0000000000006927","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939833","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":"Association of Neighborhood Socioeconomic Status and Ethnic Diversity with Failure to Rescue in Curative-intent Colorectal Cancer Surgery: A Population-based Cohort Study.","authors":"Adom Bondzi-Simpson, Tiago Ribeiro, Andrea Covelli, Aisha Lofters, Rinku Sutradhar, Rebecca A Snyder, Callisia N Clarke, Natalie G Coburn, Julie Hallet","doi":"10.1097/SLA.0000000000006928","DOIUrl":"10.1097/SLA.0000000000006928","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between neighborhood-level socioeconomic status (SES) and ethnic diversity and failure to rescue (FTR) after curative-intent colorectal cancer (CRC) resection.</p><p><strong>Background of data: </strong>FTR is an outcome reflecting a system's ability to detect and treat clinical deterioration after complications. However, little is known about how social characteristics influence FTR in oncologic populations.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study of adults undergoing resection for stage I-III CRC (2007-2020). Exposures were SES and ethnic diversity defined by ecologic measures from census data. The primary outcome was FTR, defined as in-hospital death following a major postoperative complication. Logistic regression examined the association between exposures and FTR while adjusting for confounders. Subgroup analysis explored associations by cancer site and procedure setting.</p><p><strong>Results: </strong>Among 60,470 patients included, FTR occurred in 1,158 (1.9%). Of those, 25.0% resided in the lowest SES neighborhood (5th quintile) versus 16.9% in the highest (1st quintile) (P<0.001), and 18.5% resided in the most ethnically diverse neighborhoods (5th quintile) versus 21.2% in the least (1st quintile, P=0.12). After adjustment, residing in the lowest SES (Odds Ratio, OR 1.26; 95% confidence interval, CI 1.05-1.52) or most ethnically diverse neighborhoods (OR 1.53, 95%CI 1.26-1.85) was associated with higher odds of FTR compared to patients residing in the highest SES or least ethnically diverse neighborhoods. These observations persisted in the colon but not rectal cancer subgroup and in the emergency but not elective setting.</p><p><strong>Conclusion: </strong>These findings outline inequalities in post-operative outcomes by social characteristics pointing towards potential gaps in structures of care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939875","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":"Prevention of Liver-related Surgical Site Infections in Combined Liver and Colorectal Surgery.","authors":"Donatien Fouché, Stylianos Tzedakis, David Fuks, Antoine Dewitte, Benjamin Fernandez, Bertrand Célérier, Lara Boissieras, Christophe Laurent, Jean-Philippe Adam, Louise Peugeot, Ugo Marchese, Arthur Marichez, Laurence Chiche","doi":"10.1097/SLA.0000000000006926","DOIUrl":"10.1097/SLA.0000000000006926","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the role of short-course (72h) postoperative antibiotic prophylaxis (PPA) in reducing liver-specific surgical site infections (liver-SSI) incidence.</p><p><strong>Summary background data: </strong>Simultaneous liver and colorectal resections (SLCR) represent a valid oncologic strategy for colorectal liver metastases, however, this approach has been reported to increase the risk of postoperative liver-SSIs.</p><p><strong>Methods: </strong>Patients undergoing SLCR (2012-2024) in two tertiary centers were included and divided into two groups: patients receiving intraoperative antibiotic prophylaxis alone (IPA) and those receiving additional PPA. Outcomes included liver-SSI incidence, severe morbidity (Clavien-Dindo grade III-IV), and length of hospital stay. Matching (PSM) and Inverse Probability Treatment Weigthing (IPTW) on a propensity score and mixed-effects models were employed to adjust for confounders and center-level clustering. We tested for interactions with the liver resection approach (laparoscopy-laparotomy) and extend (major-minor).</p><p><strong>Results: </strong>Of 250 patients (median [95%CI] age: 67.0 years [65.0-68.0], 58.0% men), 40% (n=100) received PPA. Liver-SSI was significantly less frequent in the PPA group (11% vs. 29.3%; P<0.001), with consistent results across centers and across resection approach (pinteraction=0.451) and extend (pinteraction=0.490). The PPA group experienced shorter hospital stay (8.0 days [7.0-10.0] vs. 11.0 days [9.0-12.0], P=0.045) and fewer severe complications (15% vs. 29.3%, P=0.01). PPA was independently associated with a reduced risk of liver-SSI before (OR: 0.24, 95%CI:0.09-0.57, P=0.002) and after matching (ORPSM: 0.27, 95%CI: 0.09-0.73, P=0.014) and IPTW (ORIPTW: 0.27, 95%CI: 0.15-0.47, P<0.001).</p><p><strong>Conclusions: </strong>PPA is associated with a significant liver-SSI reduction following SLCR and our findings support its use, warranting further validation in prospective randomized studies.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939821","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":"Leadership in Surgery: Insights from the Helm of Academic Medicine.","authors":"Syed Shahyan Bakhtiyar","doi":"10.1097/SLA.0000000000006930","DOIUrl":"10.1097/SLA.0000000000006930","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939862","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":"Timing Is Everything: Early Initiation of VTE Prophylaxis Following Major Trauma Is Effective and Safe.","authors":"Andrew J Kerwin, Saskya Byerly, Dina M Filiberto, Emily K Lenart, Martin A Croce, Ernest E Moore, Mary Margaret Knudson","doi":"10.1097/SLA.0000000000006784","DOIUrl":"10.1097/SLA.0000000000006784","url":null,"abstract":"<p><strong>Objective: </strong>To examine the efficacy and safety of the initiation of pharmacologic venous thromboembolism (VTE) prophylaxis within 24 hours of admission for major trauma patients at risk for VTE.</p><p><strong>Background: </strong>Pharmacologic VTE prophylaxis following major trauma is essential, but there is a fear of bleeding complications. The safety of initiating treatment within 24 hours of admission has not been established.</p><p><strong>Methods: </strong>We examined the efficacy and safety of early initiation of pharmacologic VTE prophylaxis. Patients were stratified by time to initiation [≤24 h (EARLY) or >24 h (LATE)] and compared. VTE, VTE prophylaxis agents, and bleeding complications secondary to VTE prophylaxis were analyzed. A generalized linear mixed model (GLMM) was performed to identify predictors of VTE.</p><p><strong>Results: </strong>There were 3369 EARLY group patients and 3200 LATE group patients. More patients in the LATE group developed VTE (7.8% vs. 2.8%; P <0.001). Among 345 patients with VTE, deep venous thrombosis (DVT) alone [181 (72%) vs. 61 (65%)], pulmonary embolism (PE) alone [46 (18%) vs. 22 (23%)] and both DVT and PE [24 (10%) vs. 11 (12%)] were present in the LATE compared with the EARLY group. The LATE group had a higher incidence of increased or new intracranial hemorrhage following prophylaxis initiation (0.5% vs. 0.2%; P =0.009) and higher mortality (1.8% vs. 0.6%; P <0.001). GLMM demonstrated that EARLY VTE prophylaxis was associated with a lower risk of VTE [odds ratio (OR): 0.58; 95% CI: 0.44-0.78; P <0.001], after controlling for covariates.</p><p><strong>Conclusions: </strong>Initiating VTE prophylaxis within the first 24 hours after admission resulted in a 42% reduction of the risk of VTE without increased risk of bleeding and should be regarded as the standard of care, even in traumatic brain injury patients.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"382-388"},"PeriodicalIF":6.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257149","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}