Annals of surgery最新文献

{"title":"Perioperative Changes in Serum Transaminase Levels: Impact on Postoperative Morbidity After Liver Resection of Hepatocellular Carcinoma.","authors":"Fumin Wang, Jingming Lu, Tian Yang, Yaoxing Ren, Francesca Ratti, Hugo P Marques, Silvia Silva, Olivier Soubrane, Vincent Lam, George A Poultsides, Irinel Popescu, Razvan Grigorie, Sorin Alexandrescu, Guillaume Martel, Aklile Workneh, Alfredo Guglielmi, Tom Hugh, Luca Aldrighetti, Itaru Endo, Yi Lv, Xu-Feng Zhang, Timothy M Pawlik","doi":"10.1097/SLA.0000000000006235","DOIUrl":"10.1097/SLA.0000000000006235","url":null,"abstract":"<p><strong>Objectives: </strong>To define how dynamic changes in pre versus postoperative serum aspartate aminotransferase (AST) and alanine transaminase (ALT) levels may impact postoperative morbidity after curative-intent resection of hepatocellular carcinoma (HCC).</p><p><strong>Background: </strong>Hepatic ischemia/reperfusion can occur at the time of liver resection and may be associated with adverse outcomes after liver resection.</p><p><strong>Methods: </strong>Patients who underwent curative resection for HCC between 2010 and 2020 were identified from an international multi-institutional database. Changes in AST and ALT (CAA) on postoperative day 3 versus preoperative values ( ) were calculated using the formula: based on a fusion index through the Euclidean norm, which was examined relative to the Comprehensive Complication Index (CCI). The impact of CAA on CCI was assessed by the restricted cubic spline regression and Random Forest analyses.</p><p><strong>Results: </strong>A total of 759 patients were included in the analytic cohort. Median CAA was 1.7 (range: 0.9-3.25); 431 (56.8%) patients had a CAA <2 215 (28.3%) patients with CAA 2 to 5, and 113 (14.9%) patients had CAA ≥5. The incidence of postoperative complications was 65.0% (n = 493) with a median CCI of 20.9 (interquartile range: 20.9-33.5). Spline regression analysis demonstrated a nonlinear incremental association between CAA and CCI. The optimal cutoff value of CAA was 5, identified by the recursive partitioning technique. After adjusting for other competing risk factors, CAA ≥5 remained strongly associated with the risk of postoperative complications (reference CAA <5, odds ratio: 1.63, 95% CI: 1.05-2.55, P = 0.03). In fact, the use of CAA to predict postoperative complications was very good in both the derivative (area under the curve: 0.88) and external (area under curve: 0.86) cohorts (n = 1137).</p><p><strong>Conclusions: </strong>CAA was an independent predictor of CCI after liver resection for HCC. The use of routine laboratories, such as AST and ALT, can help identify patients at the highest risk of postoperative complications after HCC resection.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"624-631"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139721345","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":"BMI Is Not Associated With Chest-Specific Body Image, Complications, or Revisions in Gender-Affirming Mastectomy: A Single-Center Cross-Sectional Study.","authors":"Cole Roblee, Tannon Topple, Jennifer B Hamill, Maria Ibarra, Andrew Bolze, Alexander N Khouri, Jessica J Hsu, Megan Lane, William M Kuzon, Edwin G Wilkins, Shane D Morrison","doi":"10.1097/SLA.0000000000006143","DOIUrl":"10.1097/SLA.0000000000006143","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the impact of Body Mass Index (BMI) on clinical and patient-reported outcomes following gender-affirming mastectomy (GM).</p><p><strong>Background: </strong>BMI is a barrier for obese patients seeking GM despite increasing evidence that it is safe in this population. Currently, little is known about the impact of BMI on chest-specific body image and satisfaction after GM.</p><p><strong>Methods: </strong>This single-center, cross-sectional study included individuals 18 years and older who underwent GM between 1990 and 2020 and were at least 2 years postoperative. Patient-reported chest-specific body image was measured using the BODY-Q and Gender Congruence and Life Satisfaction chest subscales. Satisfaction was measured using the Holmes-Rovner Satisfaction with Decision scale. Clinical and demographic variables were identified from the chart review. Bivariate analysis was performed to determine whether BMI was associated with chest-specific body image, satisfaction, and complications within 30 days or revisions in GM.</p><p><strong>Results: </strong>Two hundred twenty-seven individuals meeting eligibility criteria were contacted to participate and 137 responded (60.4% response rate). The mean age was 29.1 (SD=9.0), and mean BMI was 30.9 (SD=8.0), with 26.4% (N=60) of the cohort having a BMI>35. Chest-specific body image and satisfaction with the decision did not vary by BMI or breast resection weight. Complications and revisions were not associated with BMI.</p><p><strong>Conclusions: </strong>Individuals undergoing GM reported high rates of satisfaction after GM regardless of BMI. Complication and revision rates did not vary significantly by BMI or breast resection weight. Surgeons should re-evaluate the role BMI plays in patient selection and counseling for GM.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"703-709"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49688498","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 Outcome of a Centralization Program in Biliary Atresia: Twenty Years and Beyond.","authors":"Mark Davenport, Erica Makin, Evelyn Gp Ong, Khalid Sharif, Michael Dawrant, Naved Alizai","doi":"10.1097/SLA.0000000000006273","DOIUrl":"10.1097/SLA.0000000000006273","url":null,"abstract":"<p><strong>Objective: </strong>Biliary atresia is a rare disease and reported outcomes of surgical management, typically a Kasai portoenterostomy (KPE), vary considerably across the world. Centralization has been proposed to improve this.</p><p><strong>Background: </strong>A national centralization program was started in January 1999, involving 3 English units with colocated liver transplant facilities. As the program has now reached the 20-year point, the main aim was to update outcome statistics and identify trends.</p><p><strong>Methods: </strong>Prospective registry and database. The main measures of outcome were (1) time to KPE, (2) clearance of jaundice (CoJ), defined as reaching a bilirubin value of <20 µmol/L (≈1.5 mg/dL), and (3) actuarial native liver survival and overall survival (OS). Data are quoted as median (interquartile range) and nonparametric statistical comparison used with P <0.05 regarded as statistically significant.</p><p><strong>Results: </strong>A total of 867 infants were born with biliary atresia and managed between January 1999 and December 2019. Death occurred without intervention (n = 10, 1.1%) or were subject to primary transplant (n = 26, 3.0%); leaving 831 (95.9%) infants who underwent KPE at a median age of 51 (interquartile range: 39-64) days. Age at KPE reduced over the period ( P = 0.0001) becoming 48 (35-57) days in the last 5-year era. CoJ was achieved in 505/831 (60.6%), also increasing over the period ( P = 0.002). Forty-two (5.0%) died post-KPE and 384 were transplanted, leaving 405 alive with their native livers at the last follow-up. Of the 412 children transplanted, there were 23 (5.6%) deaths, leaving 387 alive. Five-year and 10-year native liver survivals were 51.3% (95% CI: 54.8-47.8) and 46.5% (95% CI: 50.1-42.9) and OSs were 91.5% (95% CI 93.2-89.4) and 90.5% (95% CI 92.3-88.2%), respectively.</p><p><strong>Conclusions: </strong>There have been continued improvements in efficiency over the period of centralization with a significant reduction in time to KPE and improved CoJ after KPE. OS in this disease remains >90%.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"608-614"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140179199","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 Hispanic Paradox and the Rising Incidence and Mortality From Hepatobiliary and Gastric Cancers Among Hispanic Individuals in the United States: A Call for Surgeon Advocates.","authors":"Benjamin Grobman, Gezzer Ortega, George Molina","doi":"10.1097/SLA.0000000000006510","DOIUrl":"10.1097/SLA.0000000000006510","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"556-558"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035040","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":"Equity in Pay: Rethinking the GME Funding Model: Erratum.","authors":"","doi":"10.1097/SLA.0000000000006657","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006657","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"281 4","pages":"e4"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613176","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":"Promoting Female Surgeons Through Structured Award Nominations.","authors":"Karen Trang, Caroline Q Stephens, Colleen Flanagan, Ava Yap, Audrey Brown, Yvonne Kelly, Heather L Yeo, Julie Ann Sosa, Lucy Z Kornblith, Madhulika G Varma","doi":"10.1097/SLA.0000000000006430","DOIUrl":"10.1097/SLA.0000000000006430","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"551-553"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475764","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":"Trends in End-of-Life Care and Satisfaction Among Veterans Undergoing Surgery.","authors":"Shukri H A Dualeh, Maia S Anderson, Paul Abrahamse, Neil Kamdar, Emily Evans, Pasithorn A Suwanabol","doi":"10.1097/SLA.0000000000006253","DOIUrl":"10.1097/SLA.0000000000006253","url":null,"abstract":"<p><strong>Objective: </strong>To examine trends in end-of-life care services and satisfaction among veterans undergoing any inpatient surgery.</p><p><strong>Background: </strong>The Veterans Health Administration has undergone system-wide transformations to improve end-of-life care yet the impacts on end-of-life care services use and family satisfaction are unknown.</p><p><strong>Methods: </strong>We performed a retrospective, cross-sectional analysis of veterans who died within 90 days of undergoing inpatient surgery between January 2010 and December 2019. Using the Veterans Affairs (VA) Bereaved Family Survey (BFS), we calculated the rates of palliative care and hospice use and examined satisfaction with end-of-life care. After risk and reliability adjustment for each VA hospital, we then performed a multivariable linear regression model to identify factors associated with the greatest change.</p><p><strong>Results: </strong>Our cohort consisted of 155,250 patients with a mean age of 73.6 years (SD: 11.6). Over the study period, rates of palliative care consultation and hospice use increased more than two-fold (28.1%-61.1% and 18.9%-46.9%, respectively) while the rate of BFS excellent overall care score increased from 56.1% to 64.7%. There was wide variation between hospitals in the absolute change in rates of palliative care consultation, hospice use, and BFS excellent overall care scores. Rural location and Accreditation Council for Graduate Medical Education accreditation were hospital-level factors associated with the greatest changes.</p><p><strong>Conclusions: </strong>Among veterans undergoing inpatient surgery, improvements in satisfaction with end-of-life care paralleled increases in end-of-life care service use. Future work is needed to identify actionable hospital-level characteristics that may reduce heterogeneity between VA hospitals and facilitate targeted interventions to improve end-of-life care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"682-688"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139929700","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":"Rural Nontrauma Centers: The Unrecognized Cornerstone of Rural Trauma Care.","authors":"Marta L McCrum","doi":"10.1097/SLA.0000000000006597","DOIUrl":"10.1097/SLA.0000000000006597","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"540-541"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794329","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 Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes.","authors":"Seth Z Aschen, Ashley Zhang, Gillian M O'Connell, Sophia Salingaros, Caroline Andy, Christine H Rohde, Jason A Spector","doi":"10.1097/SLA.0000000000006614","DOIUrl":"10.1097/SLA.0000000000006614","url":null,"abstract":"<p><strong>Objective: </strong>To assess rates of surgical complications and postoperative readmission in diabetic patients with and without active perioperative prescriptions for glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications.</p><p><strong>Background: </strong>With the rapid growth of GLP-1 RA use in the United States, it is important to understand the potential effect of these drugs on surgical outcomes broadly.</p><p><strong>Methods: </strong>In this retrospective, observational cohort analysis, patients with a diagnosis of type 1 or type 2 diabetes undergoing a surgical procedure at a multicenter quaternary-care health care system between February 2020 and July 2023 were included. Propensity score matching was performed between procedures in patients with and without an active GLP-1 RA prescription. The primary outcome was 30-day readmission, and secondary outcomes were documented dehiscence, infection, hematoma, and bleeding within 180 days after surgery.</p><p><strong>Results: </strong>Among 74,425 surgical procedures in 21,772 patients included in the analysis, 27.2% were performed in the setting of an active GLP-1 RA prescription. In 13,129 patients [48.0% men, 52.0% women; median (interquartile range) age, 67 (57, 75)], 35,020 procedures were propensity score matched. After matching, the active GLP-1 RA prescription group had a significantly reduced risk of 30-day readmission [relative risk (RR): 0.883; 95% CI: 0.789-0.987; P = 0.028; number needed to treat (NNT): 219; 95% CI: 191-257], postoperative wound dehiscence (RR: 0.711; 95% CI: 0.577-0.877; P = 0.001; NNT: 266; 95% CI: 202-391), and postoperative hematoma (RR: 0.440; 95% CI: 0.216-0.894; P = 0.023; NNT: 1786; 95% CI: 652-2416). No significant differences were seen in rates of infection and bleeding.</p><p><strong>Conclusions: </strong>An active perioperative GLP-1 RA prescription in patients with diabetes was associated with significant reductions in risk-adjusted readmission, wound dehiscence, and hematoma, and no difference in infection and bleeding rates. Further study is warranted to elucidate any causal association.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"600-607"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863174","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":"Noninvasive Artificial Intelligence System for Early Predicting Residual Cancer Burden During Neoadjuvant Chemotherapy in Breast Cancer.","authors":"Wei Li, Yu-Hong Huang, Teng Zhu, Yi-Min Zhang, Xing-Xing Zheng, Ting-Feng Zhang, Ying-Yi Lin, Zhi-Yong Wu, Zai-Yi Liu, Ying Lin, Guo-Lin Ye, Kun Wang","doi":"10.1097/SLA.0000000000006279","DOIUrl":"10.1097/SLA.0000000000006279","url":null,"abstract":"<p><strong>Objective: </strong>To develop an artificial intelligence (AI) system for the early prediction of residual cancer burden (RCB) scores during neoadjuvant chemotherapy (NAC) in breast cancer.</p><p><strong>Background: </strong>RCB III indicates drug resistance in breast cancer, and early detection methods are lacking.</p><p><strong>Methods: </strong>This study enrolled 1048 patients with breast cancer from 4 institutions, who were all receiving NAC. Magnetic resonance images were collected at the pre-NAC and mid-NAC stages, and radiomics and deep learning features were extracted. A multitask AI system was developed to classify patients into 3 groups (RCB 0 to I, II, and III ) in the primary cohort (PC, n=335). Feature selection was conducted using the Mann-Whitney U test, Spearman analysis, least absolute shrinkage and selection operator regression, and the Boruta algorithm. Single-modality models were developed, followed by model integration. The AI system was validated in 3 external validation cohorts (EVCs, n=713).</p><p><strong>Results: </strong>Among the patients, 442 (42.18%) were RCB 0 to I, 462 (44.08%) were RCB II, and 144 (13.74%) were RCB III. Model I achieved an area under the curve of 0.975 in the PC and 0.923 in the EVCs for differentiating RCB III from RCB 0 to II. Model II distinguished RCB 0 to I from RCB II-III, with an area under the curve of 0.976 in the PC and 0.910 in the EVCs. Subgroup analysis confirmed that the AI system was consistent across different clinical T stages and molecular subtypes.</p><p><strong>Conclusions: </strong>The multitask AI system offers a noninvasive tool for the early prediction of RCB scores in breast cancer, supporting clinical decision-making during NAC.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"645-654"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334477","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}